Date:__________

Mignanelli & Associates, Ltd.

Attorneys at Law

10 Weybosset Street, Suite 205

Providence, RI 02903

(401) 455-3500

(401) 455-0648 FAX

Website: www.mignanelli.com

ESTATE PLANNING INFORMATION FORM

Family Information Please include middle initials, any aliases, etc.

1. Full Name: ________________________________________________________________________

Date of Birth:_______________________________________________

Social Security No.:__________________________________________

E-Mail Address:_____________________________________________

2. Spouse/Domestic Partner
Full Name: _______________________________________________________________________________

Date of Birth:________________________________________________

Social Security No.:___________________________________________

E-Mail Address:______________________________________________

3. Address: _______________________________________________________________________________

_______________________________________________________________________________

Telephone: Home:__________________________ Office:________________________________

4. U.S. Citizen: Husband/Domestic Partner: Yes or No Wife/Domestic Partner: Yes or No

5. Children’s

Full Name: Address: Date of Birth: Marital Status:

_____________________________________________________________________________________________

6. Children’s

Spouses:

_____________________________________________________________________________________________

7. Grandchildren:

_____________________________________________________________________________________________

8. Husband/Domestic Partner’s:

Parents, Brothers, Sisters, Others (please identify relationship):

_____________________________________________________________________________________________

9. Wife/Domestic Partner’s:

Parents, Brothers, Sisters, Others (please identify relationship):

_____________________________________________________________________________________________

10. Do you have an existing Will and Trust Agreement? If so, please describe:

_____________________________________________________________________________________________

Fiduciary Information Please include middle initials, any aliases, etc.

1. Choice of Executor/Co-Executor (please include full name, relationship and address):

_____________________________________________________________________________________________

2. Choice of Successor Executor/Co-Executor (please include full name, relationship and address):

_____________________________________________________________________________________________

3. Choice of Trustee/Co-Trustee (please include full name, relationship and address):

_____________________________________________________________________________________________

4. Choice of Successor Trustee/Co-Trustee (please include full name, relationship and address):

_____________________________________________________________________________________________

5. Choice of Guardian/Co-Guardian for minor children, if any (please include full name, relationship and address):

_____________________________________________________________________________________________

6. Choice of Successor Guardian/Co-Guardian for minor children, if any (please include full name, relationship

and address):

_____________________________________________________________________________________________

7. Powers of Appointment over trusts:

_____________________________________________________________________________________________

Real Estate Please use these descriptions in the TYPE column for your Real Estate assets.

Primary Residence Land Rental Home Commercial Property

Second Residence Vacation Home Rental Property

Type	Description	Owner (Husband, Wife, Joint)	Asset Value

Bank Account Please use these descriptions in the TYPE column for your Bank Account assets.

Checking CD

Savings Money Market

Type	Description	Owner (Husband, Wife, Joint)	Beneficiary	Asset Value

Investment Please use these descriptions in the TYPE column for your Investment assets.

Bonds Ltd. Partnership Preferred Stock Annuity

Common Stock Mutual Fund Stock Brokerage

Type	Name of Investment	Owner (Husband, Wife, Joint)	Asset Value

Retirement Please use these descriptions in the TYPE column for your Retirement assets.

401k IRA SEP/IRA

403b Qualified Plan Other

Type	Name of Investment	Owner (Husband, Wife, Joint)	Beneficiary	Asset Value