Information Form - Pasternak & Fidis, P.C.Pasternak & Fidis, P.C.

View our old EPIF form for comparison

Date

Client 1

Legal Name(Required)

First Middle Last

Nickname (Or other name used)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Mobile Phone(Required)

Present Occupation(Required)

Employer(Required)

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone

Business Fax

Email(Required)

Social Security #(Required)

Date of Birth(Required)

Place of Birth(Required)

Are you a U.S. citizen?(Required)

Yes

If not, what is your country of citizenship?(Required)

Do you have a spouse/partner?(Required)

Yes

Will we also represent your spouse/partner?(Required)

Yes

Date and place of union(Required)

Type of union(Required)

Marriage

Civil Union

Domestic Partnership

Do you have a pre- or post-marital agreement (or any other agreement relating to ownership of property) with each other?(Required)

Yes

Prior marriages for client 1 (if any)

Former Spouse

Terminated by (Death/divorce):

Date Terminated

Divorce obligation to or from former spouse?

Client 2

Legal Name(Required)

First Middle Last

Nickname (Or other name used)

Is home address same as above?(Required)

Yes

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone (if different from above)

Mobile Phone(Required)

Present Occupation(Required)

Employer(Required)

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone

Business Fax

Email(Required)

Social Security #(Required)

Date of birth(Required)

Place of birth(Required)

Are you a U.S. citizen?(Required)

Yes

If not, what is your place of origin?(Required)

Prior marriages for client 2 (if any)

Former Spouse

Terminated by (Death/divorce):

Date Terminated

Divorce obligation to or from former spouse?

Additional Client Information

All correspondence, documents and billing statements will be sent via email to the preferred address(es).

Confirmed

Change Preferences

Correspondence:

U.S. Mail

Documents:

U.S. Mail

Billing Statements:

U.S. Mail

PAYMENTS MADE BY CREDIT CARD WILL INCUR A 2.5% SURCHARGE.

Have you made any gifts to individuals which exceeded the annual gift tax exclusion? If so, please list the date(s) of such Gift(s), the recepient, the value of the gift(s). This question may be answered simply by providing copies of gift tax returns you have filed.

Who referred you to the firm?(Required)

Children (and Deceased children)

Do you have any children?(Required)

Yes

If yes, how many?(Required)

Please enter a number from 0 to 40.

Name of child 1(Required)

First Middle Last

Is Child 1 Deceased?(Required)

Yes

Social Security #(Required)

Date of Birth(Required)

Date of Death(Required)

Phone

Child of(Required)

Client 1

Client 2

Both

Child 1's spouse/partner

First Last

Children of child 1 (if any)

Name

Date of birth

Name of child 2(Required)

First Middle Last

Is Child 2 Deceased?(Required)

Yes

Social Security #(Required)

Date of Birth(Required)

Date of Death(Required)

Phone

Child of(Required)

Client 1

Client 2

Both

Child 2's spouse/partner

First Middle Last

Children of child 2 (if any)

Name

Date of birth

Name of child 3(Required)

First Middle Last

Is Child 3 Deceased?(Required)

Yes

Social Security #(Required)

Date of Birth(Required)

Date of Death(Required)

Phone

Child of(Required)

Client 1

Client 2

Both

Child 3's spouse/partner

First Middle Last

Children of child 3 (if any)

Name

Date of birth

Name of child 4(Required)

First Middle Last

Is Child 4 Deceased?(Required)

Yes

Social Security #(Required)

Date of Birth(Required)

Date of Death(Required)

Phone

Child of(Required)

Client 1

Client 2

Both

Child 4's spouse/partner

First Middle Last

Children of child 4 (if any)

Name

Date of birth

Name of child 5(Required)

First Middle Last

Is Child 5 Deceased?(Required)

Yes

Social Security #(Required)

Date of Birth(Required)

Date of Death(Required)

Phone

Child of(Required)

Client 1

Client 2

Both

Child 5's spouse/partner

First Middle Last

Children of child 5 (if any)

Name

Date of birth

Name of child 6(Required)

First Middle Last

Is Child 6 Deceased?(Required)

Yes

Social Security #(Required)

Date of Birth(Required)

Date of Death(Required)

Phone

Child of(Required)

Client 1

Client 2

Both

Child 6's spouse/partner

First Middle Last

Children of child 6 (if any)

Name

Date of birth

Name of child 7(Required)

First Middle Last

Is Child 7 Deceased?(Required)

Yes

Social Security #(Required)

Date of Birth(Required)

Date of Death(Required)

Phone

Child of(Required)

Client 1

Client 2

Both

Child of(Required)

Client 1

Client 2

Both

Child 7's spouse/partner

First Middle Last

Children of child 7 (if any)

Name

Date of birth

Name of child 8(Required)

First Middle Last

Is Child 8 Deceased?(Required)

Yes

Social Security #(Required)

Date of Birth(Required)

Date of Death(Required)

Phone

Child of(Required)

Client 1

Client 2

Both

Child 8's spouse/partner

First Middle Last

Children of child 8 (if any)

Name

Date of birth

Name of child 9(Required)

First Middle Last

Is Child 9 Deceased?(Required)

Yes

Social Security #(Required)

Date of Birth(Required)

Date of Death(Required)

Phone

Child of(Required)

Client 1

Client 2

Both

Child 9's spouse/partner

First Middle Last

Children of child 9 (if any)

Name

Date of birth

Additional Family Information

Identify any persons who (a) have special needs or (b) are, or who may become wholly or partially dependent upon you for support:

(a)

(b)

Are you (or your children) beneficiaries of any trust or estate? If so, please describe the nature and extent of such interest(s).

Do you have any power of appointment under any will or trust? If so, please describe.

Any especially important estate planning objectives or problems which you wish to discuss?

Have you or any descendant of yours (to your knowledge) preserved any genetic material?

Yes

Advisor Information

Please provide name(s), address(es), telephone number(s), and additional contact information (if any) for your advisor(s).

Stockbroker/Investment advisor

Name

Address

Phone

Additional Contact Info

Life insurance advisor

Name

Address

Phone

Additional Contact Info

Financial planner

Name

Address

Phone

Additional Contact Info

Other attorney

Name

Address

Phone

Additional Contact Info

Accountant

Name

Address

Phone

Additional Contact Info

We need some information on your assets. First, we will ask you about assets you own together. Then we will ask you about assets you own individually.

Joint Asset Inventory (Please provide dollar values for each of the following asset classes)

Principal Residence ($)

Second Residence ($)

Commercial/Investment Property ($)

Business interests ($)

Checking accounts ($)

Savings accounts (CDs and money market accounts) ($)

Market securities (non-retirement) ($)

Tangible Personal Property ($)

Other Assets (please describe)

Other Assets (value) ($)

Joint Asset Total

Asset Inventory for Client 1

Principal Residence ($)

Second Residence ($)

Commercial/Investment Property ($)

Life insurance ($)

Business interests ($)

Checking accounts ($)

Savings accounts (CDs and money market accounts) ($)

Market securities (non-retirement) ($)

Employee & Retirement Benefits (or provide statements)

IRA(s) ($)

Roth IRA(s) ($)

SEP IRA(s) ($)

401(k) Plan(s) ($)

Profit-sharing plan ($)

Pension plan ($)

Deferred compensation plan(s) ($)

Post-death salary ($)

Continuation plan(s) ($)

Stock option plan(s) ($)

Restricted stock plan(s) ($)

TSP ($)

FERS ($)

CSRS ($)

Other government or military retirement benefit plan(s) ($)

Annuity ($)

Other benefit plan(s) ($)

Bitcoin, Asset based tokens, or other forms of Cryptocurrency ($)

Tangible Personal Property ($)

TOTAL

Annual income

Annual expenses

Asset Inventory for Client 2 (Only if different)

Principal Residence ($)

Second Residence ($)

Commercial/Investment Property ($)

Life insurance ($)

Business interests ($)

Checking accounts ($)

Savings accounts (CDs and money market accounts) ($)

Market securities (non-retirement) ($)

Employee & Retirement Benefits (or provide statements)

IRA(s) ($)

Roth IRA(s) ($)

SEP IRA(s) ($)

401(k) Plan(s) ($)

Profit-sharing plan ($)

Pension plan ($)

Deferred compensation plan(s) ($)

Post-death salary ($)

Continuation plan(s) ($)

Stock option plan(s) ($)

Restricted stock plan(s) ($)

TSP ($)

FERS ($)

CSRS ($)

Other government or military retirement benefit plan(s) ($)

Annuity ($)

Other benefit plan(s) ($)

Bitcoin, Asset based tokens, or other forms of Cryptocurrency ($)

Tangible Personal Property ($)

TOTAL

Annual income

Annual expenses

Additional Asset Information

Do you expect to inherit property, or receive life insurance on another person’s life, in the near future, which should be taken into account in planning your estate?(Required)

Yes

If yes, please describe briefly.(Required)

Do you have any liabilities?(Required)

Yes

If yes, please describe the liability and the approximate balance due.(Required)

Do you have a safe deposit box?(Required)

Yes

Name of bank:

Branch location:

Box number:

In name of:

Other person(s) with access (and contact information if not provided herein)

Name

Contact Information

Do you own any intellectual property rights (patents, copyrights, trademarks, etc.)?(Required)

Yes

If yes, please describe briefly.(Required)

PLEASE SEND OR BRING WITH YOU TO OUR MEETING COPIES OF THE FOLLOWING

1. Any existing wills, trusts, powers of attorney, living wills or other health care directives.

This field is hidden when viewing the form

Please note the location of the originals of your existing documents:

1. Any existing wills, trusts, powers of attorney, living wills or other health care directives.
2. Recent statement for each bank, investment and retirement account.
3. List of primary and contingent beneficiaries of each account.
4. Deeds for all real estate.
5. Last premium notice for each life insurance policy.
6. All partnership agreements and LLC operating agreements.
7. By-laws, buy-sell agreements and/or other contracts affecting your interests in closely held corporations.
8. Financial statements for any closely held businesses.
9. Information about any intellectual property you own or have created.
10. Any gift tax returns filed (Form 709).
11. Pre-marital, post-marital and domestic partnership agreements with current spouse or partner.
12. Property settlement agreement with former spouse or partner.
13. All wills or trusts under which you have a power of appointment.
14. Promissory notes and/or mortgages payable to you.

Extended Family

Client 1 parents & siblings

Client 1, Parent 1

Name(Required)

First Last

Deceased?(Required)

Yes

Age(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Client 1 Parent 2

Name(Required)

First Last

Deceased?(Required)

Yes

Age(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Client 1 Siblings

Name

Address

Telephone

Age (or date of death)

Spouse

Children

Client 2 parents & siblings

Client 2, Parent 1

Name(Required)

First Last

Deceased?(Required)

Yes

Age(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Client 2, Parent 2

Name(Required)

First Last

Deceased?(Required)

Yes

Age(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Client 2 Siblings

Name

Address

Phone

Age (or date of death)

Spouse

Children

Special Provisions For Your Estate Plan

Do you wish to make any charitable gifts during life?(Required)

Yes

At death?(Required)

Yes

Only if other beneficiaries are not living?(Required)

Yes

If you have minor children (under age 18), whom do you wish to nominate as their guardian?

Name

Address

Relationship

Do you plan to omit (or are you considering omitting) from your estate plan any person, such as a child, who ordinarily might expect to receive some benefit from your estate?(Required)

Yes

If yes, please explain.(Required)

Are you interested in providing specifically for the distribution of certain items of tangible personal property (i.e., jewelry, artwork, heirlooms) in your estate plan?(Required)

Yes

If yes, please describe the items and intended recipient.(Required)

Does any person have access to your passwords and PINs in the event of your incapacity or death (i.e., email, PayPal®, online banking, social networking, online media storage sites, etc.)? Please note it is important that you provide this information to a person other than your spouse/partner.(Required)

Yes

If yes, please provide the name of that person and contact information.(Required)

Do you have any long-term care insurance?(Required)

Yes

If yes, please specify insured.(Required)