FRED SCHOEN

FRED SCHOEN FIDUCIARY SERVICES

INCORPORATED

1218 THIRD AVENUE, SUITE 2000

SEATTLE, WASHINGTON 98101

(206) 625-9290

FACSIMILE (206) 625-0946

E-MAIL: FREDSCHOEN@AOL.COM

MARTHA DANIELS

COLIN SLOTE

ESTATE PLANNING QUESTIONNAIRE

________________________________

CLIENT

________________________________

DATE

DOCUMENTS TO BE ATTACHED

attached or n/a

1. EXISTING WILLS OF BOTH SPOUSES ______

2. LATEST INCOME AND GIFT TAX RETURNS FILED BY EITHER SPOUSE ______

3. LIFE INSURANCE POLICIES ______

4. PENSION, PROFIT-SHARING, DEFERRED COMPENSATION OR OTHER ______

5. RETIREMENT BENEFIT PLANS ______

6. BUY/SELL OR STOCK REDEMPTION AGREEMENTS ______

7. TRUST INSTRUMENTS ______

8. PRE-NUPTIAL AGREEMENT ______

FAMILY STATISTICS

1. ADDRESS:_______________________________________ PHONE___________________

____________________________________________________BIRTH DATE___________________

2. NAME OF SPOUSE____________________________________BIRTHDATE_______________

3. DATE AND PLACE OF MARRIAGE______________________________________________________

4. YOUR CHILDREN:

NAME AND ADDRESS BIRTH DATE

A. __________________________________ ________________________

B. __________________________________ ________________________

C. __________________________________ ________________________

5. PARTICULARS REGARDING YOUR GRAND CHILDREN:

THEIR PARENTS NAMES OF GRANDCHILDREN BIRTH DATE

________________ ____________________________ ____________

6. PARENTS:

HUSBAND

FATHER:___________________________ BIRTH DATE__________________

ADDRESS:________________________________________________________

MOTHER:___________________________ BIRTH DATE____________

ADDRESS:________________________________________________________

ADVISERS

1. ATTORNEY___________________________________________________

2. ACCOUNTANT:_______________________________________________

3. LIFE INSURANCE ADVISOR:___________________________________

4. BANK AND TRUST OFFICER:___________________________________

5. STOCKBROKERS:_____________________________________________

6. PERSONAL REPRESENTATIVE _________________________________

7. TRUSTEE: __________________________________________________

8. DESIGNATED GUARDIAN FOR CHILDREN: ______________________________________________________________

9. INVESTMENT ADVISOR:_______________________________________

10. PHYSICIAN:__________________________________________________

11. CLERGYMAN:________________________________________________

ASSETS

COMMUNITY PROPERTY

1. HAVE YOU LIVED IN A STATE OTHER THAN WASHINGTON? IF SO, WHERE AND FOR HOW LONG? ______________________________________________________________________________

2. DID YOU OR YOUR SPOUSE OWN ANY SUBSTANTIAL SEPARATE PROPERTY BEFORE MARRIAGE? _________________________________________________________________________

3. HAVE ANY GIFTS OR INHERITANCES BEEN RECEIVED BY EITHER YOU OR YOUR SPOUSE SEPARATELY? _______________________________________________________________________

4. WHAT ASSETS DO YOU THINK ARE SEPARATE PROPERTY? WHOSE SEPARATE PROPERTY? _____________________________________________________________________________________

5. HAVE YOU OR YOUR SPOUSE EVER RESIDED IN A FOREIGN COUNTRY? IF SO, WHAT COUNTRIES AND FOR HOW LONG? ____________________________________________________

6. ARE YOU OR YOUR SPOUSE A FOREIGN NATIONAL? __________________ IF YES FROM WHICH COUNTRY? ______________________

DISTRIBUTION OBJECTIVES

1. UPON YOUR DEATH HOW AND TO WHOM DO YOU WISH YOUR ASSETS DISTRIBUTED?_

_____________________________________________________________________________________

_____________________________________________________________________________________

2. IF YOU AND YOUR SPOUSE SHOULD BOTH DIE PREMATURELY, SHOULD YOUR CHILDREN RECEIVE PROPERTY AT 21 OR SHOULD IT BE HELD TO A MORE MATURE AGE? ___________ _____________________________________________________________________________________

3. DO ANY OF YOUR CHILDREN HAVE SPECIAL EDUCATIONAL, MEDICAL OR, FINANCIAL NEEDS? _____________________________________________________________________________

_____________________________________________________________________________________

4. DO YOU WANT A SURVIVOR TO MANAGE YOUR ESTATE FROM AN INVESTMENT STANDPOINT? _______________________________________________________________________

5. TO WHOM WOULD SURVIVOR LOOK FOR MANAGEMENT HELP? _________________________

_____________________________________________________________________________________

6. IS AVOIDING UNNECESSARY ESTATE TAXATION OF GREAT IMPORTANCE TO YOU? _______

_____________________________________________________________________________________

7. DO YOU CONTEMPLATE MAKING FUTURE GIFTS? ______________________________________

_____________________________________________________________________________________

8. DO YOU WISH TO MAKE BEQUESTS TO YOUR CHURCH OR SYNAGOGUE OR TO ANY OTHER CHARITABLE ORGANIZATION? _________________________________________________

_____________________________________________________________________________________

9. IF NONE OF YOUR CHILDREN ARE LIVING AT THE TIME OF YOUR SPOUSE'S DEATH, DO YOU WANT YOUR ESTATE TO GO TO: YOUR FAMILY? _______ SPOUSES FAMILY? ______

ELSEWHERE? ________________________________

10. Do YOU ANTICAPATEANY GIFTS OR INHERITENCE FROM FRIENDS OR FAMILY? _________

ASSETS:

Real Estate:

_____________________________________ _________________ ___________ ____________

Primary Residence Ownership Value Liability

_____________________________________ _________________ ___________ ____________

Vacation Residence Ownership Value Liability

_____________________________________ _________________ ___________ ____________

Rental Property Ownership Value Liability

_____________________________________ _________________ ___________ ____________

Rental Property Ownership Value Liability

_____________________________________ _________________ ___________ ____________

Rental Property Ownership Value Liability

Bank Accounts:

Type

Description

Owned

Asset Value

Co-Owned Husband Wife

Investments:

Bonds, Common Stock, Mutual Funds, Ltd. Partnerships, Preferred Stock

Type

Description

Ownership:

Asset Value

Co-Owned Husband Wife

Retirement:

401K, 403B, IRA's, Qualified Plans, SEP/IRA

Type:

Description

Owner:

Asset Value

Co-Owner Husband Wife

Insurance:

Term Policy, Whole Life Policy, Universal Life, Variable Life

Type

Description

Owner:

Asset Value

Co-Owner Husband Wife

Annual Expenditures:

Standard of Living:

Food $______________________

Mortgage payment or rent $______________________

Real Estate Taxes $______________________

Entertainment $______________________

Miscellaneous (clothing, utilities, etc. ) $______________________

Other:

Income Taxes $______________________

Savings & Investments $______________________

Other Loan Payments $______________________

Education $______________________

Life Insurance $______________________

Other $______________________

TOTAL Annual Expenditures $______________________