Client Asset Information - Law Offices of Cheryl David

Personal and Confidential

General Information

Congratulations on your decision to protect your family with a comprehensive estate plan. Now that you have made this important decision, the next step is to gather and provide us with information about your assets so we can assist you with the funding of your trust. Remember, having a trust that is not funded means your family may have to go through a court probate proceeding, and may lose the benefit of other protections offered by your estate plan.

Please complete this online form to enter information about your assets.

Fill out the information on the form as completely as possible for each asset
Provide copies of your most recent statements, policies, deeds, or other ownership documents to us.

If you have any questions, please contact our office by phone at 336-547-9999 or email at [email protected].

Client 1 First Name**
Client 1 Last Name**
Email*
Spouse/Client 2 First Name:
Spouse/Client 2 Last Name:
Email
Click on the checkbox next to each asset type you own. Only assets that you select will be available for you to complete. Complete as much information as you have about each asset.
Cash Accounts
- Checking
- Savings
- Certificate of Deposit
- Money Market
Checking

Please provide complete address information for each institution or provide a copy of your latest bank statement.

Checking

Institution Name	Address 1	Address 2	City	State	ZIP Code	Account number	Balance	Owner

Attach Documents
Drop files here or

Max. file size: 50 MB.
Savings

Please provide complete address information for each institution or provide a copy of your latest bank statement.

Savings

Institution Name	Address 1	Address 2	City	State	Zip Code	Account number	Balance	Owner

Attach Documents
Drop files here or

Max. file size: 50 MB.
Certificate of Deposit

Please provide complete address information for each institution or provide a copy of your latest statement.

Certificate of Deposit

Institution Name	Address 1	Address 2	City	State	Zip code	Account number	Balance	Owner

Attach Documents
Drop files here or

Max. file size: 50 MB.
Money Market

Please provide complete address information for each institution or provide a copy of your latest statement.

Money Market

Institution Name	Address 1	Address 2	City	State	Zip code	Account number	Balance	Owner

Attach Documents
Drop files here or

Max. file size: 50 MB.

Click on the checkbox next to each asset type you own. Only assets that you select will be available for you to complete. Complete as much information as you have about each asset.
Investments
- Brokerage Account
- Stock Name
- Bonds (Corporate and Municipal)
- Mutual Fund
- Limited Partnership
- Treasury Direct
- US Savings Bond
- Dividend Reinvestments
- REIT
Assets
Brokerage Account

Please list all accounts with brokerage firms that hold stock certificates, bonds, mutual funds, money market accounts and CDs for you. Please provide complete address information for the brokerage firm or provide a copy of your latest statement.

Brokerage Account

Name	Address 1	Address 2	City	State	Zip code	Account number	Account Value	Owner

Stock

Please list all stock in publicly-traded corporations in which you hold the actual stock certificates (this includes stock traded on an exchange or over the counter). Note: Stock owned in family or non-publicly-traded companies should be listed under the Business Interest section.

Stock

Name	Ticker Symbol	Address 1	Address 2	City	State	Zip code	Certificate number	Number of Shares	Owner

Bonds – Corporate and Municipal

Please list all bonds where you hold the actual bond certificates. Please provide the complete address to which change of ownership should be directed, or provide a photocopy of your bond certificates.

Bonds (Corporate and Municipal)

Name	Ticker Symbol	Address 1	Address 2	City	State	Zip code	Account number	Face Value	Owner

Mutual Funds

Mutual Funds

Name	Ticker Symbol	Address 1	Address 2	City	State	Zip code	Account Number	Fair Market Value	Owner

Limited Partnership

For each limited partnership, list all your general and/or limited partnership interests. Please provide complete address information for notice to the Partnership for change of ownership.

Limited Partnerships

Partnership Name	Ticker Symbol	Partnership Address 1	Partnership Address 2	Partnership City	Partnership State	Partnership Zip code	General Partner%	Limited partner%	Account Number	Value	Owner

Treasury Direct

Please list all U.S Treasury Investment where you purchase was made through a Treasury Direct Account.

Treasury Direct

Name	Address 1	Address 2	City	State	Zip code	Account Number	Fair Market Value	Owner

US Savings Bond

US Savings Bond

Name	Ticker Symbol	Address 1	Address 2	City	State	Zip code	Account Number	Face Value	Owner

Dividend Reinvestments

Please list all accounts in corporations in which you hold stock in dividend reinvestment accounts (this includes stock traded on an exchange or over the counter).

Dividend Reinvestments

Name	Ticker Symbol	Address 1	Address 2	City	State	Zip code	Account Number	Number Of Shares	Owner

REIT (Real Estate Investment Trusts)

Please list all ownership in real-estate reinvestment trusts.

REIT

Name	Ticker Symbol	Address 1	Address 2	City	State	Zip code	Account Number	Value	Owner

Attach Documents
Drop files here or

Max. file size: 50 MB.

Click on the checkbox next to each asset type you own. Only assets that you select will be available for you to complete. Complete as much information as you have about each asset.
Real Property
- Real Property - Quit Claim
- Real Property - Grant Deed
- Real Property - Trust Deed
- Real Property - Warranty Deed
Assets
Quit Claim
Loan Information

Loan Holder

Loan Holder	Holder Address 1	Holder Address 2	Holder City	Holder State	Holder Zip	Loan Number	Estimated Value	Owner

Property

Please list all details about the Property.

Property

Asset Name	Property	PropertyAddress 1	Property Address 2	Property City	Property State	Property Zip	Encumbrances Value	Parcel ID

Deeds (Include Copy of Deeds)

Please list all Real Property that you own, including Burial Plots, Time Shares or Oil and Gas Interest for which you have a deed.

Deed

Deed Vested To	Deed of trust recoding date	Deed Instrument number	Deed County	Deed State	Deed Loan Number

Title Insurance

Title Insurance

Company	Address1	Address 2	City	State	Zip	Policy Number

Grant Deed
Loan Information

Loan Holder

Loan Holder	Holder Address 1	Holder Address 2	Holder City	Holder State	Holder Zip	Loan Number	Estimated Value	Owner

Property

Please list all details about the Property.

Property

Asset Name	Property	PropertyAddress 1	Property Address 2	Property City	Property State	Property Zip	Encumbrances Value	Parcel ID

Deeds (Include Copy of Deeds)

Please list all Real Property that you own, including Burial Plots, Time Shares or Oil and Gas Interest for which you have a deed.

Deed

Deed Vested To	Deed of trust recording date	Deed Instrument number	Deed County	Deed State	Deed Loan Number

Title Insurance

Title Insurance

Company	Address1	Address 2	City	State	Zip	Policy Number

Trust Deed
Loan Information

Loan Holder

Loan Holder	Holder Address 1	Holder Address 2	Holder City	Holder State	Holder Zip	Loan Number	Estimated Value	Owner

Property

Please list all details about the Property.

Property

Asset Name	Property	PropertyAddress 1	Property Address 2	Property City	Property State	Property Zip	Encumbrances Value	Parcel ID

Deeds (Include Copy of Deeds)

Please list all Real Property that you own, including Burial Plots, Time Shares or Oil and Gas Interest for which you have a deed.

Deed

Deed Vested To	Deed of trust recording date	Deed Instrument number	Deed County	Deed State	Deed Loan Number

Title Insurance

Title Insurance

Company	Address1	Address 2	City	State	Zip	Policy Number

Warranty Deed
Loan Information

Loan Holder

Loan Holder	Holder Address 1	Holder Address 2	Holder City	Holder State	Holder Zip	Loan Number	Estimated Value	Owner

Property

Please list all details about the Property.

Property

Asset Name	Property	PropertyAddress 1	Property Address 2	Property City	Property State	Property Zip	Encumbrances Value	Parcel ID

Deeds (Include Copy of Deeds)

Please list all Real Property that you own, including Burial Plots, Time Shares or Oil and Gas Interest for which you have a deed.

Deed

Deed Vested To	Deed of trust recording date	Deed Instrument number	Deed County	Deed State	Deed Loan Number

Title Insurance

Title Insurance

Company	Address1	Address 2	City	State	Zip	Policy Number

Attach Documents
Drop files here or

Max. file size: 50 MB.

Click on the checkbox next to each asset type you own. Only assets that you select will be available for you to complete. Complete as much information as you have about each asset.
Business Interest
- C-Corp
- S-Corp
- Professional Corp
- Limited Liability Company
- General Partnership
- Sole Proprietorship
C-Corp

C Corp

Corporation Name	Company Address 1	Company Address 2	City	State	Zip Code	# of Shares	Total Value of Shares	Ownership %	Owner

S Corp

S Corp

Name	Address 1	Address 2	City	State	Zip Code	# of Shares	Total Value of Shares	Ownership %	Owner

Professional Corp

Professional Corp

Name	Address 1	Address 2	City	State	Zip Code	# of Shares	Total Value of Shares	Ownership %	Type: C-Corp / S-Corp / Professional Corp	Owner

Limited Liability Company

For each Limited Liabillity Company, list your ownership interests. Please provide complete address information for notice to the Limited Liabillity Company for change of ownership.

Limited Liability Company

Name	Address 1	Address 2	City	State	Zip Code	Ownership %	Total Value of Shares	Owner

Attach Documents
Drop files here or

Max. file size: 50 MB.
General Partnership

For each partnership, list your partnership interests. Please provide complete address information for notice to the Partnership for change of ownership.

Partnership

Name	Address 1	Address 2	City	State	Zip Code	General Partner %	Total Value of Shares	Owner

Attach Documents
Drop files here or

Max. file size: 50 MB.
Sole Proprietorship

For each Sole Propprietorship, please provide business name and address.

Sole Proprietorships

Name	Address 1	Address 2	City	State	Zip Code	Total Value of Shares	Owner

Asset Name	Description	Address (if applicable)	Address 2 (if applicable)	City	State	Zip Code	Appraised (Y/N)	Estimated Value	Parcel ID	Insurance Company Name	Insurance Company Address 1	Insurance Company Address 2	Insurance Company City	Insurance Company State	Insurance Company Zip	Insurance Company Policy Number	Registered Title(Y/N)	Owner

Personal and Confidential

General Information

Checking

Savings

Certificate of Deposit

Money Market

Assets

Brokerage Account

Stock

Bonds – Corporate and Municipal

Mutual Funds

Limited Partnership

Treasury Direct

US Savings Bond

Dividend Reinvestments

REIT (Real Estate Investment Trusts)

Assets

Quit Claim

Loan Information

Property

Deeds (Include Copy of Deeds)

Title Insurance

Grant Deed

Loan Information

Property

Deeds (Include Copy of Deeds)

Title Insurance

Trust Deed

Loan Information

Property

Deeds (Include Copy of Deeds)

Title Insurance

Warranty Deed

Loan Information

Property

Deeds (Include Copy of Deeds)

Title Insurance

Assets

Life Insurance

Annuity

IRA (Individual Retirement Accounts)

Qualified Pension Plan

Assets

Burial Plot

Membership

Animal-registered

Building Co-Op

High Value Personal Property

Lawsuit Judgments (Awarded to You)

Leases (You are the Landlord)

Liquor License

Livestock Brands

Oil and Gas

Time Share

C-Corp

S Corp

Professional Corp

Limited Liability Company

General Partnership

Sole Proprietorship

Intellectual Property Interests

Copyright

Patent

Royalty Interest

Trademark

Deeds of Trust & Mortgages

Deed of Trust

Mortgages

Promissory Notes

Boat (Large Vessel Registered with Coast Guard)

Mobile Home (Registered with HUD)

Aircraft

DMV Registered

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