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1
 Name of Estate
2
 Date
This is a draft, a suggestion, a template on what to gather and consider in case you die unexpectedly while you are still seeing clients as a medical or mental health professional. 
3
 Value at Time of Death Estate's 1/2 Comment
4
This is not legal advice. You should consult with your lawyer. 
5
 REAL ESTATE
6
It is my understanding that if your small company is not listed in your Will, your loved ones will have to go through probate. 
7
 Residence
8
 Address:
The point of doing this document is that it is much easier for your loved ones to wrap up your affairs. 
9
 Parcel No.:
10
 Titled in the name of:
11
12
13
 STOCKS/BONDS/MUTUAL FUNDS
14
15
 Savings Bond
16
 Serial No.:
17
 Name(s) on acct.:
18
19
20
21
22
23
24
 NAME
25
 Acct. No.:
26
 Type of acct.:
27
 Name(s) on acct.:
28
 Beneficiary designation:
29
30
 BANK ACCOUNTS/CASH/RECEIVABLES
31
32
 Bank Acount #1
33
 Acct. No.:
34
 Type of acct.:
35
 Name(s) on acct.:
36
37
 Bank Account #2
38
 Acct. No.:
39
 Type of acct.: Joint Checking
40
 Name(s) on acct.:
41
42
 Bank Account #3
43
 Acct. No.:
44
 Type of acct.: Joint Savings
45
 Name(s) on acct.:
46
 Beneficiary designation:
47
48
 LIFE INSURANCE/IRAs/ANNUITIES/RETIREMENT
49
50
 Life Insurance
51
 Policy No.:
52
 Type of acct.:
53
 Name(s) on acct.:
54
 Beneficiary designation:
55
56
 Name of Retirement Account
57
 Acct. No.:
58
 Type of acct.:
59
 Name(s) on acct.:
60
 Beneficiary designation:
61
62
 Name of Retirement Account
63
 Acct. No.:
64
 Type of acct.:
65
 Name(s) on acct.:
66
 Beneficiary designation:
67
68
 Name of Retirement Account
69
 Acct. No.:
70
 Type of acct.:
71
 Name(s) on acct.:
72
 Beneficiary designation:
73
74
75
 MISCELLANEOUS PROPERTY
76
77
 Personal Business Bank Accounts
78
 Business Checking Account No.:
79
 Business Savings Account No. :
80
81
82
 Student Loans
83
 Acct. No.:
84
 Type of acct.:
85
 Name(s) on acct.:
86
87
88
89
90
91
92
 PERSONAL PROPERTY
93
 Cars - Fully Owned
94
 Year Make Model (VIN: 000000000000)
95
 Year Make Model (VIN: 000000000000)
96
97
 FURNITURE/FURNISHINGS/PERSONAL EFFECTS
98
 Jewelry
99
 Artwork
100
 Furniture