Quest Couple Form

Quest Couple

Who referred you to Peter L. Klenk, Esquire?(Required)

Spouse A

Spouse A Name

AKA

Citizenship

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Marital History

Parents’ Name/Ages

Name

Age

Spouse B

Spouse B Name

AKA

Citizenship

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Marital History

Parents' Names/Ages

Name

Age

Children

Name

Address

Date of Birth

Spouse’s Name

Beneficiaries: If you didn’t have to worry about taxes or any rules, how would you want your estate divided at your death? (ex: all to spouse, then equally to children, etc.).

Selecting the People Who Will Carry Out Your Estate Plan

In general, spouses select each other as the first person to serve and then they agree on a backup.

Executor: Person who “executes” your plan.

Spouse A’s First Choice

Spouse A’s Second Choice

Spouse B’s First Choice

Spouse B’s Second Choice

Guardian: Person responsible for minor children’s physical custody.

Spouse A’s First Choice

Spouse A’s Second Choice

Spouse B’s First Choice

Spouse B’s Second Choice

Trustee: Person responsible for any part of your estate left in trust.

Spouse A’s First Choice

Spouse A’s Second Choice

Spouse B’s First Choice

Spouse B’s Second Choice

Durable Power of Attorney: Your attorney-in-fact may act for you in your absence or inability.

Spouse A’s First Choice

Spouse A’s Second Choice

Spouse B’s First Choice

Spouse B’s Second Choice

Living Will (Health Care Directive): Authorizes removal of life support.

Spouse A’s First Choice

Spouse A’s Second Choice

Spouse B’s First Choice

Spouse B’s Second Choice

Financial Background

The requested information will allow us to calculate potential estate tax liability. Please be as accurate as possible, but figures do not need to be accurate to the penny. If calculations are necessary, show them on the back of this page. Please round to the nearest thousand.

IRAs, 401K, 403bs, etc.

Spouse A

Where (asset location)

Approximate Current Value

Spouse B

Where (asset location)

Approximate Current Value

Jointly

Where (asset location)

Approximate Current Value

Checking + Savings Accounts

Spouse A

Where (asset location)

Approximate Current Value

Spouse B

Where (asset location)

Approximate Current Value

Jointly

Where (asset location)

Approximate Current Value

Investments

Spouse A

Where (asset location)

Approximate Current Value

Spouse B

Where (asset location)

Approximate Current Value

Jointly

Where (asset location)

Approximate Current Value

Business you own (Please list)

Spouse A

Spouse B

Jointly Owned

Home (Please list)

Spouse A

Spouse B

Jointly Owned

Other real estate (Please list)

Spouse A

Spouse B

Jointly Owned

Life insurance (Please list)

Spouse A

Spouse B

Jointly Owned

Furniture & furnishings (approx. value)

Spouse A

Spouse B

Jointly Owned

Vehicles (approx. value)

Spouse A

Spouse B

Jointly Owned

Collections

Spouse A

Spouse B

Jointly Owned

Anything else of value

Spouse A

Spouse B

Jointly Owned

Total Assets

Total Assets (Spouse A)

Total Assets (Spouse B)

Total Assets (Jointly Owned)

Liabilities

Anything else of value

Spouse A

Spouse B

Jointly Owned

Other mortgages

Spouse A

Spouse B

Jointly Owned

Loans

Spouse A

Spouse B

Jointly Owned

Other debts (credit cards, loans, etc.)

Spouse A

Spouse B

Jointly Owned

Total Liabilities

Total Liabilities (Spouse A)

Total Liabilities (Spouse B)

Total Liabilities (Jointly Owned)

*TOTAL NET WORTH: Assets - Liabilities =

*(If you sold everything for cash, paid off your bills, this is the amount you would have left over)

Death Benefits

List all life insurance policies that you own, that you are a beneficiary of, or other plans that pay out at your death.

Death Benefits

Name of Policy or Plan

Death Benefit

Present Value

Beneficiary

Please provide the following information.

Accountant Email Address

Accountant Phone

Life Insurance Agent Email Address

Life Insurance Agent Phone

Investment Advisor Email Address

Investment Advisor Phone

Trust Officer Email Address

Trust Officer Phone

Commercial Banker Email Address

Commercial Banker Phone

Stockbroker Email Address

Stockbroker Phone

Casualty Insurance Agent Email Address

Casualty Insurance Agent Phone

Peter Klenk is the founding member of Klenk Law, a seven-attorney boutique estate planning law firm. We serve clients in Pennsylvania and New Jersey. Peter Klenk received his Master’s in Taxation, LL.M., from NYU Law School and his J.D. from the University of Minnesota Law School. He served his country in the Navy JAGC during Desert Storm. Easy to talk to, feel free to call Peter for an appointment. We will make the process as easy as possible!

Free Consultation

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Client Review

"I worked for Peter Klenk for 4 wonderful years. I can’t speak highly enough of everyone at the firm. Everyone truly cares about their clients and has a strong sense of responsibility to get things done right. I would highly recommend Klenk Law!"
Flora Novick

Areas Served:

Philadelphia PA, Allentown PA, King of Prussia PA, Montgomery County PA, Bucks County PA, Doylestown PA, Jenkintown PA, Marlton NJ, Moorestown NJ

Quest Couple Form

Quest Couple

Spouse A

Spouse B

Children

Selecting the People Who Will Carry Out Your Estate Plan

Financial Background

IRAs, 401K, 403bs, etc.

Checking + Savings Accounts

Investments

Business you own (Please list)

Home (Please list)

Other real estate (Please list)

Life insurance (Please list)

Furniture & furnishings (approx. value)

Vehicles (approx. value)

Collections

Anything else of value

Liabilities

Anything else of value

Other mortgages

Loans

Other debts (credit cards, loans, etc.)

Death Benefits

Please provide the following information.

Pages

Free Consultation

PRIVACY STATEMENT

Client Review

Areas Served:

What Our clients are saying

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Jim Yannessa

Alex Mangas

Kate Parghi

Bill Cass

PRIVACY STATEMENT