Note:This information form is not meant to be comprehensive. A consultation with the attorney is the best way to make sure that your estate planning needs are effectively met.

RAMSEY & PRATT, P.A.
One North Gaston Street
Brevard, NC 28712
Phone: 828-884-4113
Fax: 828-885-2494
Email: mkpratt@ramsey-pratt.com

Estate Planning Information

Part 1: INDIVIDUAL AND FAMILY INFORMATION
Full Name:
Please check one: Married Single (if single, skip all references to spouse throughout)
Spouse's Full Name:
Address:
Telephone: Email: Fax:
Social Security Number: Date of Birth:
Spouse's Social Security Number: Spouse's Date of Birth:
Children's names and dates of birth
Do you have a prenuptial or postnuptial agreement? Yes No If yes, please send a copy.
Do you have an accountant? Yes No If yes, please fill in name, address and telephone number.

Part 2: Disposition of Bodily Remains
Are you an organ donor? Yes No No, but would like information.
Do you prefer: Burial Cremation Other
Does your spouse prefer: Burial Cremation Other

Part 3: Guardianship of Minor Children ^{(If you do not have minor children, go to Part 4)}
If you and your spouse should both die, leaving minor children, who would you want to be the guardian and custodian of your minor children? (Specify names, relationship to you, and addresses.)

Part 4: Trusts
Check all that apply: I am interested in a living trust to avoid probate I am interested in a personal trust for a disabled or handicapped individual I am interested in a trust that will save federal estate taxes I am interested in a trust to meet the education and living needs of minor children I am interested in a trust to benefit charity I want to know more about trusts in general I do not want any information about trusts (If you check this option, go to Part 5)
If your estate plan includes a trust, you or your spouse may be the initial trustee. Do you want to discuss the idea of someone serving with you or your spouse as co-trustee or serving in lieu of you or your spouse? Yes No I want more information about this.
Who do you want to serve as your alternate trustee (after you and your spouse)? Attorney Family Member Corporate Trustee Other Name, Address and telephone (You may also designate an additional alternate):

Part 5: Estate Administration
If married, your spouse may be the original Executor or Personal Representative of your estate. Do you want to discuss the idea of someone serving with your spouse as co-executor or in lieu of your spouse? Yes No I want more information about this.
Who do you want to serve as your alternate? Attorney Family Member Corporate Trustee Other Name, Address and telephone (You may also designate an additional alternate):

Part 6: Assets and Liabilities

Section A. Long Term Liabilities Please list all long term liabilities,
such as mortgages and loans with an amortization of more than 10 years:

(Attach additional page if more space is needed)
Creditor	Balance Owed	Collateral	Will this debt be paid off by a specified insurance policy?

Section B. Location of Real Estate Please list all real estate owned

(Send Real Estate list if more space is needed)
Address or Deed Book and Page	County and State	Name(s) on Deed	Date Acquired

Section C. Itemization of Assets Please complete the following listing of your assets. Include real estate, motor vehicles, bank and investment accounts, stocks, bonds, IRA's and retirement accounts, life insurance, annuities, collectibles, personal property of all kinds. Note: Please group all items of personal property together unless your collectibles or antiques are of special value or unique character. Value your assets based on a recent statement or use your best estimate of value.

Send list of itemization of assets if more space is needed.
Asset name or description	Current Value	Cost Basis (If known)
House/Real Estate
Real Estate
Motor Vehicle
Motor Vehicle
Bank Account/Investment
Bank Account/Investment
IRA/Retirement Plan
IRA/Retirement Plan
Personal Property
Life Insurance	Cash Value	Policy Amount

Part 7. Your Questions, Comments, and Directions

You can either submit this form via email, or print it and send by regular mail.