header v.2
callbuttonorange

214-236-2712



Testimonials:

"David Cook recently prepared my will, and I could not be more pleased with the service that he provided. Mr. Cook took the time to answer my questions, walk through different options with me, and explain everything necessary so that my estate will be in good order and so that my family will not have any complications during the probate process. On a more personal note, I have known David since he was born, and I can testify that he is of the highest character and a man of Christian integrity."
- Mitchell B.



View Some Of Our Reviews Online:


google-plus-icon linkedin_button

Estate Planning Questionnaire


ESTATE PLANNING QUESTIONNAIRE

 

Please Note: By filling out this questionnaire, you do not create an Attorney-Client relationship with Cook & Gore.  To begin an Attorney-Client representation by Cook & Gore, you must sign a formal Engagement Letter.

 

CLIENT:        _____________________________________________________

 

SPOUSE:        _____________________________________________________

 

ADDRESS:    _____________________________________________________

 

_____________________________________________________

 

TELEPHONE           

(H):_______________________________________________

(C):_______________________________________________

(W):_______________________________________________

 

(Fax):________________________________________________

EMAIL: _______________________________________________

 

INTRODUCTION

 

In the development of any estate plan, it is essential that the attorney designing the plan be given full and complete information about the client in order to assure that both personal and financial factors are given the careful attention they deserve.  This Estate Planning Source Document is being furnished to you in order to assure that I am given as much of such information as is feasible with a minimum of cost and inconvenience to you.  By completing and returning the Estate Planning Source Document to me prior to our scheduled conference, you allow me to consider your personal situation before I see you, thus, allowing me to make the initial conference an exchange in which I impart information and concepts to you rather than one in which a considerable amount of time must be invested in the basic information gathering process.

 

In completing this Document, please note any uncertainty you might have about the questions I am asking.  At our conference, I can clarify these questions.  Further, if you would like to discuss one or more of the questions before our conference, please give me a call at your convenience.  I will be more than happy to answer any questions you may have.

 

PERSONAL INFORMATION

 

A.        Full legal name (preferred name in parenthesis):

 

Client: _____________________________________________________

 

Spouse: _____________________________________________________

 

B.        Residence address and phone number:

 

_______________________________________________________________

 

_______________________________________________________________

 

Phone Number:           (_______)_______________________________________

 

C.        Client's business address and phone number:

 

______________________________________________________________

 

______________________________________________________________

 

Phone Number(s):       (_______)______________________________________

 

D.        Birth date:

 

Client B.D.:     _____________________

 

Spouse B.D.:_____________________

 

E.         Date of marriage:        _______________________________________________

 

F.         Approximate date you established residency in Texas:          _________________

 

G.        Do you own any real property (i.e. land) outside of Texas?  Please describe: ___

________________________________________________________________

________________________________________________________________

 

H.        Have you or your spouse previously been married?  ____________________

 

If yes, was the prior marriage terminated by (circle):   death  or  divorce?

 

If by death, please state place and date of death: _______________________

 

If you have been divorced:

 

1.         Date of divorce:  _____________________________________

 

2.         Jurisdiction granting divorce: State______County _________

 

3.         Was there a property settlement:  ________________________

 

If so, please bring a copy of the settlement decree and agreement, if any.

 

I.          Name and birth date of each child (if children are of only one parent, indicate by placing circling the appropriate parent)

 

1) Child 1: _______________________________; DOB: _________________; Child of (Cirlcle one): Husband     Wife       Both
1) Child 2: _______________________________; DOB: _________________; Child of (Cirlcle one): Husband     Wife       Both
1) Child 3: _______________________________; DOB: _________________; Child of (Cirlcle one): Husband     Wife       Both
1) Child 4: _______________________________; DOB: _________________; Child of (Cirlcle one): Husband     Wife       Both
1) Child 5: _______________________________; DOB: _________________; Child of (Cirlcle one): Husband     Wife       Both

J.          If any of the foregoing children are children by adoption, please give their first name(s).

______________________________________________________________

 

K.        Names of grandchildren:

1) Name: _________________________; Parents: _____________________________________; DOB: _____________
2) Name: _________________________; Parents: _____________________________________; DOB: _____________
3) Name: _________________________; Parents: _____________________________________; DOB: _____________ 
4) Name: _________________________; Parents: _____________________________________; DOB: _____________
5) Name: _________________________; Parents: _____________________________________; DOB: _____________ 
6) Name: _________________________; Parents: _____________________________________; DOB: _____________

 

L.         Names and addresses (city and state) of living parents and other relatives who might be involved in your plan:

 

First Column = Client Second Colum = Spouse

 

Father_________________________ Father______________________

 

Address________________________           Address_____________________

 

_______________________________          ____________________________

 

Telephone:______________________Telephone:___________________

 

 

Mother________________________ Mother_____________________

 

Address________________________           Address_____________________

 

_______________________________          ____________________________

 

Telephone:_____________________ Telephone:___________________

 

Others (give relationship, such as Brother, Sister, Aunt, Uncle, Cousin, etc.)

 

______________________________________________________________

 

______________________________________________________________

 

 

  1. Do any parties to whom you intend to involve in your plan have health problems that might require financial consideration?  ___________________

 

If yes, please explain:_________________________________________________

 

__________________________________________________________________

 

__________________________________________________________________

 

N.        Do you have a Will?   _________________

If you do, please bring a copy.

O.        Have you created any trusts?  ________________

If you have, please bring a copy.

P.         Are you a beneficiary of a trust created by someone else?  ______________

If yes, and if you have a copy of the trust, please bring a copy with you.  If yes, but you have no copy, please explain your interest to the best of your ability.

______________________________________________________________

______________________________________________________________

Q.        Have you or your spouse ever filed federal gift tax returns?  _____________

If yes, please bring copies of these returns.

R.        Do you or your spouse anticipate receiving a substantial inheritance from your parents or others?  __________________________________________

S.         Do you own any property located outside the United States?           ____________

T.         Are you a United States Citizen?  ____________________

U.        Is your spouse a United States Citizen?   ___________________

V.        What is the approximate value of your combined estate (including your homestead, other real estate, life insurance, bank accounts, retirement accounts, motor vehicles, art or collectibles, etc.): ________________________________________

 

 

MISCELLANEOUS ESTATE DOCUMENTS

 

Directives to Physicians

1.         Would you like to sign a Texas state law form declaring that you would not want to be given every available medical procedure to artificially prolong your life if you are terminally ill with no hope of recovery?

Client: Yes       No Spouse: Yes       No

Do you want to name your spouse to be consulted in such decisions?

Client: Yes       No Spouse: Yes       No

 

 

Medical Power of Attorney

2.         Would you want to sign a Texas-style law form declaring that someone can give consent to medical treatment on your behalf anytime that you are not competent?

Client: Yes       No Spouse: Yes       No

If yes:

a.         Will spouse have power to consent?               Yes       No

b.         If the person who is your first choice for this duty is not available, would you want to name a successor medical power of attorney?  If so, who?

___________________________________________________________

___________________________________________________________

___________________________________________________________

 

HIPAA Release

3.         Because of the federal HIPAA laws and regulations, it is many times impossible for family members to be able to access your medical records or even talk to your doctors if you do not give them prior consent.  By creating a HIPAA Release document, you can give your family members or friends the right to talk to your doctors about your condition and have access to your medical records.  This document does not give your family or friends the right to make medical decisions on your behalf—that is what the Medical Power of Attorney is meant to do.  However, this HIPAA Release will allow your family and/or friends to at least discuss your condition with your doctors and access your medical information.

A.        Would you want to grant anyone such power?

Client: Yes       No Spouse: Yes       No

B.        If yes, to whom would you grant it? (Note: You can name more than one person)

Client:____________________________

____________________________

____________________________

Spouse:____________________________

____________________________

____________________________

Durable General Power of Attorney

4.         In planning for incapacity, some people elect to grant General Power of Attorney to their spouse or parents which would allow them to do anything in your name that you could not do.  Such a grant of authority could survive your mental disability should you have an impairing accident or illness and the designated agent could act in your behalf.  However, any such power is a presently exercisable power the exercise of which is not conditioned upon the existence of a disabling illness or injury.

A.        Would you want to grant anyone such power?

Client: Yes       No Spouse: Yes       No

B.        If yes, to whom would you grant it?

 

Client:_______________________ Spouse:____________________________

 

C.        If the person you chose is not available, would you want to name another person as a successor power of attorney?  [Note: You do not have to have a successor, and many people do not choose to name a successor, but if there is another person who you trust implicitly, it may be a good idea to have a successor named in the document]:

 

Client:______; If yes, who: _____________________ Spouse:_______; If yes, who: _____________________

 

Declaration of Guardian for Yourself

 

5.         In planning for your own later incapacity, you can name a person or persons who you would like to take care of you and your finances in the event of your incapacity.  These should be people you trust to make wise choices about your personal care as well as your financial investments and expenses.  You can name one person to serve as both the Guardian of your Person (i.e. to be responsible for your personal care, living arrangements, and medical care) and as the Guardian of your Estate (i.e. to be responsible for managing your finances).  However, you can also name different persons to serve in each role.  This is sometimes advisable where one family member is a wonderful caretaker, but does not have the financial acumen to manage your finances.

A.        Who would you want to serve as the Guardian of your Person (i.e. to be responsible for your personal care, living arrangements, and medical care)?

Client: 1st Choice___________________________; Successor: _________________

Spouse: 1st Choice___________________________; Successor: _________________

 

B.        Who would you want to serve as the Guardian of your Estate (i.e. to be responsible for managing your finances)?

Client: 1st Choice___________________________; Successor: _________________

Spouse: 1st Choice___________________________; Successor: _________________

 

PROVISIONS FOR WILLS

 

We can discuss together the details of items that you want to include in your Will(s).  To the extent that you already have ideas regarding the items for your Wills listed below, please describe them.  (Note: If both spouses' Wills should contain similar provisions, simply note that fact in the space provided below for the wife's Will.)

 

Husband's Will

1.         Executor:

(a)        Initial executor or co-executors _______________________________

___________________________________________________________

(b)        Successor executor(s) if initial executor(s) cannot or will not serve:

___________________________________________________________

___________________________________________________________

2.         Trustee (if a trust is created for minor children or other minor beneficiaries if both spouses are deceased, we will need to list trustees):

(a)        Initial trustee or co-trustees: __________________________________

______________________________________________________________

(b)        Successor trustee or co-trustees: ______________________________

______________________________________________________________

3.         Guardian (You may designate guardians who will raise your children.  The designated guardians will serve only if the person writing the Will is the last surviving parent of that child.):

(a)        Initial guardian (an individual or a married couple)

___________________________________________________________

___________________________________________________________

(b)        Successor guardian(s)

___________________________________________________________

___________________________________________________________

4.         Do you want to make particular specific bequests of cash or specific property to specified individuals or entities?

______________________________________________________________

______________________________________________________________

______________________________________________________________

5.         Residuary estate (All of the estate remaining after paying debts, administration expenses, taxes, and specific bequests.):  [If you are unmarried and have no children, go to Paragraph (d) below.]

 

a.         If wife survives:  ____________________________________________

___________________________________________________________

___________________________________________________________

b.         If wife fails to survive but there are children surviving:  (Are the children old enough to receive the assets outright or should the assets be held in trust until they are older?  If so, at what age should they receive the assets outright?)

___________________________________________________________

___________________________________________________________

c.         What if a child is deceased but survived by his or her own children?  Should those grandchildren be entitled to the share the deceased child would have received?

___________________________________________________________

___________________________________________________________

___________________________________________________________

d.         If there is no spouse and no descendants surviving?

___________________________________________________________

___________________________________________________________

 

Wife's Will

1.         Executor:

(a)        Initial executor or co-executors ______________________________

______________________________________________________________

(b)        Successor executor(s) if initial executor(s) cannot or will not serve:

___________________________________________________________

___________________________________________________________

2.         Trustee (if a trust is created for minor children or other minor beneficiaries if both spouses are deceased, we will need to list trustees):

(a)        Initial trustee or co-trustees: _________________________________

________________________________________________________

(b)        Successor trustee or co-trustees: _____________________________

_____________________________________________________________

3.         Guardian (You may designate guardians who will raise your children.  The designated guardians will serve only if the person writing the Will is the last surviving part of that child.):

(a)        Initial guardian (an individual or a married couple)

___________________________________________________________

___________________________________________________________

(b)        Successor guardian(s)

___________________________________________________________

___________________________________________________________

4.         Do you want to make particular specific bequests of cash or specific property to specified individuals or entities?

______________________________________________________________

______________________________________________________________

______________________________________________________________

5.         Residuary estate (all of the estate remaining after paying debts, administration expenses, taxes, and specific bequests):  [If you are unmarried and have no children, go to Paragraph (d) below.]

a.         If husband survives: __________________________________________

___________________________________________________________

___________________________________________________________

b.         If husband fails to survive but there are children surviving:  (Are the children old enough to receive the assets outright or should the assets be held in trust until they are older?  If so, at what age should they receive the assets outright?)

___________________________________________________________

___________________________________________________________

c.         What if a child is deceased but survived by his or her own children?  Should those grandchildren be entitled to the share the deceased child would have received?

___________________________________________________________

___________________________________________________________

___________________________________________________________

d.         If there is no spouse and no descendants surviving?

___________________________________________________________

___________________________________________________________