Leger Law Group, LLC

10537 Kentshire Court

Baton Rouge, LA 70810

Siobhan S. Leger Telephone: (225) 615-0532

Fax: (225) 769-2300

CONFIDENTIALESTATEPLANNING

WORKSHEET

Thisinformationpacket shouldbereturnedtous prior to your meeting. Thiswillensurethat wehaveenoughtimetounderstandthe specificsof your situationbeforeour meeting.

DON’TWORRY ABOUT TOTALACCURACY –JUST DOTHEBEST YOU CAN!WE LOOK FORWARD TO SEEINGYOU.

ALL INFORMATION PROVIDEDIS STRICTLYCONFIDENTIAL

CLIENTINFORMATION

Date:

First ClientFullName(ifdifferentfromabove): (first,middle/maidenandlast)

DaytimePhone:

Fax

MailingAddress:

AlternatePhone:

CellPhone

E-mailAddress:

MilitaryService[ ]Yes [ ]NoDatesofService:

DateofBirth:

SSN:

Marital Status:0Married0Widowed0Divorced0Single

Marital History: ______

(If Applicable)

Second Client’sFullName

(first,middle/maidenand last)

DaytimePhone:

AlternatePhone:

CellPhone

E-mailAddress:

MilitaryService[ ]Yes [ ]NoDatesofService:

DateofBirth:

SSN:

MarriageDate______

Marital History______

Howdidyouhearaboutourfirm?

0 Internet – please provide website

0AttendedSeminar

0ReferredbySomeone–pleaseprovidename

0Other-pleasespecify

ADVISORS

PersonalAttorney

Phone:

Fax

MailingAddress:

Accountant

Phone:

Fax

MailingAddress:

FinancialAdvisor

Phone:

Fax

MailingAddress:

LifeInsuranceAgent

Phone:

Fax

MailingAddress:

CHILDREN AND/OROTHER FAMILYMEMBERS

Listallchildren. Copyandattachadditionalpages,ifneeded.Totalnumberofchildren:

1.

(nameof child)(first,middle/maidenandlast)(date ofbirth)(socialsecuritynumber)

(currentaddress)(phone) 0Home0Work0Cell

Parent:[ ]First Client []Second Client [ ]Both

Ischild:0Married0Widowed0Divorced0Single

NameofSpouse(ifmarried):

[ ]Adopted

(date of adoption)(courtgrantingadoption)

[ ]Deceased [ ]Yes [ ]No

(date ofdeath)(childhassurviving children?)

(Describethischild--does he or shehave“specialneeds”? Consider healthandgeneral financialstatus,including needsand abilities)

(Useadditionalpages, ifneeded)

2.

(nameof child)(first,middle/maidenandlast)(date ofbirth)(socialsecuritynumber)

(currentaddress)(phone) 0Home0Work0Cell

Parent:[ ] First Client []Second Client [ ]Both

Ischild:0Married0Widowed0Divorced0Single

NameofSpouse(ifmarried):

[ ]Adopted

(date of adoption)(courtgrantingadoption)

[ ]Deceased [ ]Yes [ ]No

(date ofdeath)(childhassurviving children?)

(Describethischild--does he or shehave“specialneeds”? Consider healthandgeneral financialstatus,including needsand abilities)

(Useadditionalpages, ifneeded)

3.

(nameof child)(first,middle/maidenandlast)(date ofbirth)(socialsecuritynumber)

(currentaddress)(phone) 0Home0Work0Cell

Parent:[ ] First Client []Second Client [ ]Both

Ischild:0Married0Widowed0Divorced0Single

NameofSpouse(ifmarried):

[ ]Adopted

(date of adoption)(courtgrantingadoption)

[ ]Deceased [ ]Yes [ ]No

(date ofdeath)(childhassurviving children?)

(Describethischild--does he or shehave“specialneeds”? Consider healthandgeneral financialstatus,including needsand abilities)

(Useadditionalpages, ifneeded)

4.

(nameof child)(first,middle/maidenandlast)(date ofbirth)(socialsecuritynumber)

(currentaddress)(phone) 0Home0Work0Cell

Parent:[ ] First Client []Second Client [ ]Both

Ischild:0Married0Widowed0Divorced0Single

NameofSpouse(ifmarried):

[ ]Adopted

(date of adoption)(courtgrantingadoption)

[ ]Deceased [ ]Yes [ ]No

(date ofdeath)(childhassurviving children?)

(Describethischild--does he or shehave“specialneeds”? Consider healthandgeneral financialstatus,including needsand abilities)

(Useadditionalpages, ifneeded)

IMPORTANTFAMILYQUESTIONS

(Pleasecheck“Yes”or“No”foryouranswer) / Yes / No
Are you(oryourspouse)receivingsocialsecurity,disability,orothergovernmental benefits?Describe
Are you(oryourspouse)makingpaymentspursuanttoadivorceorpropertysettlement order?Pleasefurnishacopy
If marriedhaveyou and yourspousesignedapre-orpost-marriagecontract?Please furnishacopy
Haveyou(oryourspouse)beenwidowed?Ifafederalestatetaxreturnorastatedeath taxreturnwasfiled,pleasefurnishacopy
Haveyou(oryourspouse)everfiledfederalorstate gifttax returns?
Pleasefurnishcopiesofthesereturns
Have(youoryourspouse)completedpreviouswill,trust,orestateplanning?Please furnishcopiesofthesedocuments
Do yousupportanycharitableorganizationsnowthatyouwishtomakeprovisionsfor atthetimeof yourdeath?Ifso,pleaseexplainbelow.
Arethereanyothercharitableorganizationsyouwishtomakeprovisionsforatthetime of yourdeath?Ifso,pleaseexplainbelow.
Are you(oryourspouse)currentlythebeneficiaryofanyoneelse’strust?Ifso,please explainbelow.
Doanyofyourchildrenhavespecialeducational,medical,orphysicalneeds?
Doanyofyourchildrenreceivegovernmentalsupportorbenefits?
Do youprovideprimaryorothermajorfinancialsupporttoadultchildrenorothers?

PROPERTYINFORMATION

INSTRUCTIONS FORCOMPLETING

THEPROPERTYINFORMATIONCHECKLIST

GeneralHeadings ThisProperty Informationchecklistisdesignedtohelpyoulistallthe propertyyouownand what itisworth. Ifyoudonotownpropertyundera particularheading,justleavethatsectionblank. Undercertainheadings youmayownmorepropertythancanbelistedonthischecklist. Ifso,use extrasheetsofpapertolist youradditionalproperty.

Type Immediately after the heading for each kind of property is a brief explanationofwhatpropertyyoushouldlistunderthatheading.

“Owner”of Property How you own your propertyis extremely importantfor purposesof properlydesigningandimplementingyourestateplan. Foreachproperty pleaseindicatehowthepropertyistitled. Whendoingso,pleaseusethe followingabbreviations:

Ownerof PropertyUse
If married,Husband’snamealone,withnootherperson / H
If married,Wife’snamealone,withnootherperson / W
If married,CommunityPropertywithspouse / C
If married,jointtenancyifpropertyoutsideLouisiana / JT
Ifyoucannotdeterminehowthepropertyisowned / ?

REALPROPERTY

TYPE: Anyinterestinrealestateincludingyourfamilyresidence,vacationhome,timeshare,vacantland,etc.

GeneralDescriptionand/or Address Owner Value Loan Balance

Total

FURNITUREANDPERSONALEFFECTS

TYPE: Listseparatelyonlysignificant or titledpersonaleffectssuchas,jewelry,collections,antiques,furs,andallother valuablenon-businesspersonalproperty(indicatetypebelowandgivealumpsumvalueformiscellaneous,less valuableitems.).

TypeorDescriptionOwnerMarketValue

MiscellaneousFurnitureand Household Effects (Total)

Total

AUTOMOBILES,BOATSANDRVS

TYPE: Foreachmotorvehicle,boat,RV,etc.pleaselistthefollowing:description,howtitled,marketvalue andencumbrance:

Year, Make, Model, Vehicle Type Owner Value Loan Balance

Total

BANKSAVINGSACCOUNTS

TYPE: CheckingAccount“CA”,SavingsAccount“SA”,Certificatesof Deposit“CD”,MoneyMarket“MM” (indicatetypebelow).Please donotincludequalified (Retirement) accounts in this section; there will be a section specifically addressing these types of accounts.

Nameof InstitutionandaccountnumberTypeOwnerAmount

Total

Note:IfAccountisinyourname(oryourspouse’sname)forthebenefitof aminor,pleasespecifyandgive minor’sname.

STOCKSANDBONDS

TYPE: Listanyand allstocksandbondsyouown.Ifheldinabrokerageaccount,lumpthemtogetherundereachaccount. (indicatetypebelow)

Stocks,BondsorInvestment AccountsTypeAcct.NumberOwnerAmount

Total

LIFEINSURANCEPOLICESAND ANNUITIES

Insurance Company, Insurance Type (Whole, Term, etc.) Insured Owner Face/Death Benefit & Cash Value

Total

RETIREMENTPLANS

TYPE: Pension(P),ProfitSharing(PS),H.R.10,IRA,SEP,401(K).ADDITIONALINFORMATION:

Describethetypeofplan,theplanname,the currentvalueoftheplan,and anyotherpertinentinformation.

Plan Name TypeOwner/ParticipantAmount

Total

BUSINESSINTERESTS

TYPE: Generaland LimitedPartnerships,SoleProprietorships,privatelyownedcorporations,professional corporations,oilinterests,farmandranchinterests.ADDITIONALINFORMATION:Giveadescriptionof theinterests,whohastheinterest, yourownershipintheinterests,andtheestimatedvalueoftheinterests.

Total

ANTICIPATEDINHERITANCE,GIFT,ORLAWSUITJUDGMENT

TYPE: Giftsorinheritancesthatyouexpecttoreceiveatsometimeinthe future;ormoneysthatyouanticipate receivingthroughajudgmentinalawsuit.Describeinappropriatedetail.

Description

OTHER ASSETS

Totalestimatedvalue

TYPE: Otherpropertyisanypropertythatyouhavethatdoesnotfitintoanylistedcategory, including money owed to you.

TypeOwnerValue

Total

BurialPlot–Client []Yes[ ]NoBurialPlot–Spouse []Yes[]No

FuneralPaid–Client[ ]Yes[]NoFuneralPaid–Spouse[]Yes[]No

DEBTS

TypeBalance

OwnerOwed

Total

SUMMARYOFVALUES

Amount*

ASSETSHusbandWifeTotalValue

RealProperty

Furniture andPersonalEffects Automobiles,BoatsandRV’s BankandSavingsAccounts

StocksandBondsLife Insurance andAnnuities

RetirementPlans

BusinessInterests

Moneyowedtoyou AnticipatedInheritance, Etc. Other Assets

TotalAssets:

TotalDebts:

*Joint Propertyvaluesenter1/2inhusband’scolumnand1/2inwife’scolumn.

DESIGNINFORMATION

Wewilldiscussthiswithyouattheinitialconsultationbutyoushouldconsiderthepersons youwouldwanttoactforyouifyouareunabletodoso

PERSONSTOACTFORYOU:

GUARDIANFORMINORCHILDREN:Ifyouhaveanychildrenundertheageof 18,listinorderof preferencewhoyouwishtobeguardian. A guardian is the person who would care for your child(ren).

NameandAddressRelationship

POWER OFATTORNEY: Ifyouwereunabletomakefinancialdecisionsforyourself,whowouldyou wanttomakethosedecisionsforyou?

HUSBAND’SAGENT

NameRelationship Phone Number

WIFE’SAGENT

NameRelationship Phone Number

HEALTHCARE POWER OF ATTORNEY:Ifyouwereunabletomakedecisionsforyourself,whowouldyouwanttomake decisionsforyouwithregardtoyourmedicaltreatment?

HUSBAND’SAGENT

NameRelationship Phone Number

WIFE’SAGENT

NameRelationship Phone Number

Husband’s Physician’sName

Wife’sPhysician’sName

SPECIFICGIFTS: Listanyspecificgiftsofrealestateorcashgiftsyouwishtomaketoeitherindividualsor charities.Indicatewhetherthesegiftsaretobemadeeveniftheotherspouseisalive.

FOR HUSBAND:

Individual or CharityAmountorPropertyContingent onWife predeceasing?

FORWIFE:

Individual or CharityAmountorPropertyContingent onHusband predeceasing?

OTHER ITEMSTOINCLUDEORDISCUSS