Barouti Law Estate Analysis Form

I. CLIENT INFORMATION

Client's Name

SSN

DOB

Spouse's Name

SSN

DOB

Address Street

City, County

State

Zip

Home Phone

Other Phone

Client's Work Phone

Client's Cell Phone

Client's Email

Spouse's Work Phone

Spouse's Cell Phone

Spouse's Email

Date of Marriage

(Husband) Prior Marriage? (Yes/No)

(Wife) Prior Marriage? (Yes/No)

(if Yes,give details)

Are You a United States citizen ? (Yes/No)

Client

Yes

Spouse

Yes

II. BENEFICIARIES

A. Children of this Marriage if married; or all children if single (including adopted and deceased children)

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

B. Husband's children from prior marriage, if any.

Divorce

Yes

Death

Yes

Date of Divorce or Death

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

C. Wife's children from prior marriage, if any.

Divorce

Yes

Death

Yes

Date of Divorce or Death

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

Name

Date of Birth

If not, then to

D. Is there a possibility of more children?

Yes

E. Are your children your primary beneficiaries?
(If not, then list beneficiaries below, Section J)

Yes

F. Are your children to receive your estate in EQUAL shares?
(If not, indicate appropriate shares on page 1)

Yes

G. Are your children or beneficiaries to receive the estate OUTRIGHT ?
(If not, define distribution in H below)

Yes

H. My children or beneficiaries shall not receive the estate outright, but instead shall receive distributions as follows:

1/4 at age

1/3 at age

1/2 at age

Check here if Trustee is to have discretion to make advanced distributions for health, education and welfare

I. If a child or beneficiary predeceases you, unless indicated otherwise, that beneficiary's share shall go instead to:

equally to the living issue of the deceased child or beneficiary

equally to the surviving children or beneficiaries

Other (Specify)

J. If your children are NOT going to be your primary beneficiaries, or if you have no children, then list your primary beneficiaries below and what portion of the estate each beneficiary is to receive.

Client's Beneficiaries

Name

Age

If not, then to

Name

Age

If not, then to

Name

Age

If not, then to

Name

Age

If not, then to

Name

Age

If not, then to

Spouse's Beneficiaries

Name

Age

If not, then to

Name

Age

If not, then to

Name

Age

If not, then to

Name

Age

If not, then to

Name

Age

If not, then to

K. Beneficiaries if the above beneficiaries predecease you:

Name

Age

If not, then to

Name

Age

If not, then to

Name

Age

If not, then to

Name

Age

If not, then to

Name

Age

If not, then to

Spouse's Beneficiaries

Name

Age

If not, then to

Name

Age

If not, then to

Name

Age

If not, then to

Name

Age

If not, then to

Name

Age

If not, then to

L. Ulimate contingent beneficiaries if all of the above beneficiaries predecease you:

Client's Ultimate Beneficiaries

1. Heirs at Law

2. Charity

3. Other

Spouse's Ultimate Beneficiaries

1. Heirs at Law

2. Charity

3. Other

III. TRUSTEES AND FIDUCIARIES

A. INITIAL TRUSTEE(S) AND EXECUTORS:

CLIENT

Yes

SPOUSE

Yes

B. SUCCESSOR TRUSTEES (and Executors):

1st Choice Trustee

2nd Choice Trustee

3rd Choice Trustee

Other

Check here if the above are to serve as Co-Trustees

Notes:

C. Guardians of your minor children (Guardian of the Person & Guardian of the Estate):

Client's Will

Spouse's Will

D. Attorneys in Fact for Asset Administration in the event of incapacitation

Attorneys in Fact for Client

Attorneys in Fact for Spouse

Spouse first?

E. Attorneys in Fact for Health Care in the event of incapacitation

Attorneys in Fact for Client

Attorneys in Fact for Spouse

Spouse first?

IV. TRUST TYPES

A. TYPE OF TRUST (check applicable)

B. Married Couple Considerations for Decedent's Trust, (for AB, ABC, and QDOT Trust Only)

Check all that apply

Income to surviving spouse (optional)

5% or 5,000 to surviving spouse (optional)

Discretionary principal invasion up to 100% (optional)

Do any of the above terminate at survivor's remarriage ?

Yes

If Yes, specify :

V. FINANCIAL STATEMENT

A. BANK ACCOUNTS

1. Name of Bank

Type of Account

Interest Rate

Balance (in $)

2. Name of Bank

Type of Account

Interest Rate

Balance (in $)

3. Name of Bank

Type of Account

Interest Rate

Balance (in $)

4. Name of Bank

Type of Account

Interest Rate

Balance (in $)

5. Name of Bank

Type of Account

Interest Rate

Balance (in $)

6. Name of Bank

Type of Account

Interest Rate

Balance (in $)

7. Name of Bank

Type of Account

Interest Rate

Balance (in $)

8. Name of Bank

Type of Account

Interest Rate

Balance (in $)

Enter Total on Financial Summary Page

TOTAL (in $)

B. STOCKS, BONDS, MUTUAL FUNDS & SECURITIES

1. Name of Security

Number of Shares

Price / Share

Market Value (in $)

2. Name of Security

Number of Shares

Price / Share

Market Value (in $)

3. Name of Security

Number of Shares

Price / Share

Market Value (in $)

4. Name of Security

Number of Shares

Price / Share

Market Value (in $)

5. Name of Security

Number of Shares

Price / Share

Market Value (in $)

6. Name of Security

Number of Shares

Price / Share

Market Value (in $)

7. Name of Security

Number of Shares

Price / Share

Market Value (in $)

8. Name of Security

Number of Shares

Price / Share

Market Value (in $)

Enter Total on Financial Summary Page

TOTAL (in $)

C. IRA's, TSA's, 401(k)'s AND OTHER QUALIFIED RETIREMENT PLANS

1. Location of Account

Type of Account

Interest Rate

Balance (in $)

2. Location of Account

Type of Account

Interest Rate

Balance (in $)

3. Location of Account

Type of Account

Interest Rate

Balance (in $)

4. Location of Account

Type of Account

Interest Rate

Balance (in $)

5. Location of Account

Type of Account

Interest Rate

Balance (in $)

6. Location of Account

Type of Account

Interest Rate

Balance (in $)

7. Location of Account

Type of Account

Interest Rate

Balance (in $)

8. Location of Account

Type of Account

Interest Rate

Balance (in $)

Enter Total on Financial Summary Page

TOTAL (in $)

D. PARTNERSHIPS, CORPORATIONS, SOLE PROPRIETORSHIPS AND OTHER INVESTMENTS

1. Name of Investment

Type of Investment

Units or Shares

Market Value (in $)

2. Name of Investment

Type of Investment

Units or Shares

Market Value (in $)

3. Name of Investment

Type of Investment

Units or Shares

Market Value (in $)

4. Name of Investment

Type of Investment

Units or Shares

Market Value (in $)

5. Name of Investment

Type of Investment

Units or Shares

Market Value (in $)

6. Name of Investment

Type of Investment

Units or Shares

Market Value (in $)

7. Name of Investment

Type of Investment

Units or Shares

Market Value (in $)

8. Name of Investment

Type of Investment

Units or Shares

Market Value (in $)

Enter Total on Financial Summary Page

TOTAL (in $)

E. REAL ESTATE (Copies of the most recent GRANT DEED and PROPERTY TAX BILL for each property are required for proper processsing.)

1. Property Address

Market Value (in $)

Debt (in $)

Net Value (in $)

2. Property Address

Market Value (in $)

Debt (in $)

Net Value (in $)

3. Property Address

Market Value (in $)

Debt (in $)

Net Value (in $)

4. Property Address

Market Value (in $)

Debt (in $)

Net Value (in $)

5. Property Address

Market Value (in $)

Debt (in $)

Net Value (in $)

6. Property Address

Market Value (in $)

Debt (in $)

Net Value (in $)

7. Property Address

Market Value (in $)

Debt (in $)

Net Value (in $)

8. Property Address

Market Value (in $)

Debt (in $)

Net Value (in $)

Enter Total on Financial Summary Page

TOTAL (in $)

F. PERSONAL PROPERTY

1. Autos

Cost Basis (in $)

Market Value (in $)

2. Boats

Cost Basis (in $)

Market Value (in $)

3. Trailers & RVs

Cost Basis (in $)

Market Value (in $)

4. Mortgages Owned

Cost Basis (in $)

Market Value (in $)

5. Promissory Note

Cost Basis (in $)

Market Value (in $)

6. Promissory Note

Cost Basis (in $)

Market Value (in $)

7. Jewelry

Cost Basis (in $)

Market Value (in $)

8. Collections & Heirlooms

Cost Basis (in $)

Market Value (in $)

9. Other

Cost Basis (in $)

Market Value (in $)

Enter Total on Financial Summary Page

TOTAL (in $)

1. Company

1. Policy Owner

1. Insured

1. Primary Beneficiary

1. Secondary Beneficiary

1. Cash Value( $ )

1. Loans( $ )

1. Death Benefit( $ )

2. Company

2. Policy Owner

2. Insured

2. Primary Beneficiary

2. Secondary Beneficiary

2. Cash Value( $ )

2. Loans( $ )

2. Death Benefit( $ )

3. Company

3. Policy Owner

3. Insured

3. Primary Beneficiary

3. Secondary Beneficiary

3. Cash Value( $ )

3. Loans( $ )

3. Death Benefit( $ )

4. Company

4. Policy Owner

4. Insured

4. Primary Beneficiary

4. Secondary Beneficiary

4. Cash Value( $ )

4. Loans( $ )

4. Death Benefit( $ )

5. Company

5. Policy Owner

5. Insured

5. Primary Beneficiary

5. Secondary Beneficiary

5. Cash Value( $ )

5. Loans( $ )

5. Death Benefit( $ )

TOTAL Cash Value

TOTAL Loans

TOTAL Death Benefit

Enter Total on Financial Summary Page

H. Have you planned for Pre-memorial Needs ?

Yes

I. Do you wish to be cremated ?

Yes

J. Other burial wishes

K. Please describe and estimate any future expected inheritances

VI. FINANCIAL SUMMARY

ASSETS

Cash on Hand and in Banks (Schedule A) ($)

Stocks, Bonds, Mutual Funds and Securities (Schedule B) ($)

IRA's, SEP's, 401(K)'s and other Qualified Retirement Plans (Schedule C) ($)

Partnerships, Corporations, Sole Proprietorships & Other Investments (Schedule D) ($)

Real Estate (Schedule E) ($)

Personal Property (Schedule F) ($)

Cash Value of Life Insurance (Schedule G) ($)

Total Debt on Real Estate (Schedule E) ($)

Other Debt (specify) ($)

TOTAL LIABILITIES ($)

= TOTAL NET WORTH ($)

+ TOTAL DEATH BENEFITS OF ALL LIFE INSURANCE ($)

= TOTAL GROSS TAXABLE ESTATE ($)

TOTAL ESTIMATED FEDERAL ESTATE TAX ($)

VII. MARITAL PROPERTY CONSIDERATIONS

A. Is all Property considered to be Community Property (marital property owned equally by Husband and Wife?)

Yes

B. If not, then please describe any Separate Property (property owned individually by one spouse)

Husband's Separate Property

Wife's Separate Property

C. Describe any desired changes to Separate or Community Property

VIII. INCOME ANALYSIS

A. GROSS INCOME (enter in $)

1. Monthly Salary

1. Annual Salary

2. Monthly Pension

2. Annual Pension

3. Monthly Interest, Dividends and Royalties, etc..

3. Annual Interest, Dividends and Royalties, etc..

4. Monthly Rental Income

4. Annual Rental Income

5. Monthly Business or Corporation Profits

5. Annual Business or Corporation Profits

6. Monthly Social Security

6. Annual Social Security

7. Monthly Other (specify)

7. Annual Other (specify)

B. EXPENSES (enter in $)

1. Monthly Loans and Mortgages

1. Annual Loans and Mortgages

2. Monthly Rent

2. Annual Rent

3. Monthly Auto Loans

3. Annual Auto Loans

4. Monthly Credit Card Payments

4. Annual Credit Card Payments

5. Monthly Food and Entertainment

5. Annual Food and Entertainment

6. Monthly Travel Expenses

6. Annual Travel Expenses

7. Monthly Medical Expenses

7. Annual Medical Expenses

8. Monthly Other

8. Annual Other

C. ADJUSTED GROSS INCOME TOTAL - Monthly

D. LESS ESTIMATED STATE INCOME TAX

E. LESS ESTIMATED FEDERAL INCOME TAX

F. TOTAL ESTIMATED ANNUAL AFTER-TAX NET INCOME

IX. IRREVOCABLE TRUST ANALYSIS

A. Total Taxable Estate ($)

B. Total Current Estate Tax ($)

C. Total Projected Taxable Estate ($)

Assumed Average Rate of Growth %

D. Total Projected Estate Tax ($)

E. Annual Gift Required ($)

F. Annual Gift Per Beneficiary ($)

G. TOTAL DESIRED DEATH BENEFIT ($)

X. CRT ANALYSIS (Charitable Remainder Trust)

A. Property Address or Asset Description

B. Cost Basis of Asset or Property ($)

C. Debt on Property ($)

D. Fair Market Value of Property ($)

E. Net Value of Property ($)

F. Current IRS Interest Rate ($)

G. Current Income From Asset or Property ($)

H. Trust Rate of Return ($)

I. Desired Payout Rate ($)

J. Annual Income to Client from CRT ($)

K. Total Tax Deduction to Client ($)

XI. QPRT ANALYSIS (Qualified Personal Residence Trust)

A. Residence Address - Street

City, County

State

B. Cost Basis of Asset or Property ($)

C. Debt on Property ($)

D. Fair Market Value of Property ($)

E. Net Value of Property ($)

F. Term of Years (Choose one)

Other (Term of Years)

G. Discounted Present Value Gift ($)

XII. AMENDMENT OR CODICIL

Name of existing Trust (Copy of Trust must be submitted)

Date of existing Trust or Will

C. Type of existing Trust

Single Male

Single Female

Married Simple

AB Trust

ABC(QTIP) Trust

QDOT Trust

Other

If Other specify

D. If a Married Trust, are both spouses living?

Yes

E. If one spouse is deceased, please list the name of the deceased spouse and date of death

Name of deceased spouse

Date of death (month/day/year)

Please describe the portion(s) of the Trust or Will that the client would like to change

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Barouti Law : Estate Analysis Form

I. CLIENT INFORMATION

II. BENEFICIARIES

Client's Ultimate Beneficiaries

Spouse's Ultimate Beneficiaries

III. TRUSTEES AND FIDUCIARIES

IV. TRUST TYPES

V. FINANCIAL STATEMENT

F. PERSONAL PROPERTY

G. LIFE INSURANCE

VI. FINANCIAL SUMMARY

ASSETS

LIABILITIES

VII. MARITAL PROPERTY CONSIDERATIONS

VIII. INCOME ANALYSIS

A. GROSS INCOME (enter in $)

B. EXPENSES (enter in $)

IX. IRREVOCABLE TRUST ANALYSIS

X. CRT ANALYSIS (Charitable Remainder Trust)

XI. QPRT ANALYSIS (Qualified Personal Residence Trust)

XII. AMENDMENT OR CODICIL

XIII. NOTES