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WV Dairy Farm Consultation and Reinvestment Questionnaire

"*" indicates required fields

Family Information

List the person or person for whom estate plan is being developed. (List "NA" if there is no spouse or partner to list) (Click the + sign on the right to add additional people)*

First Name

Last Name

Birth Year

Spouse / Partner Name

Spouse / Partner Birth Year

Farm Name*

Address*

Street Address Address Line 2 City State ZIP Code

Email Address*

Phone*

Children (Click the + sign on the right to add multiple children)

Name

Birth Year

Married (yes or no)

# of Children

Interested in farm? (yes or no)

Occupation

Are there others, such as parents, brothers, sisters, in-laws, employees, who are relevant to an estate plan? If yes, list their names. (Click the + sign on the right to add additional people)

Advisory Data (List “NA” if you don’t have an advisor in a particular field)

Accountant Name*

Accountant Email*

Accountant Phone*

Attorney Name*

Attorney Email*

Attorney Phone*

Financial Advisor Name*

Financial Advisor Email*

Financial Advisor Phone*

Insurance Agent Name*

Insurance Agent Email*

Insurance Agent Phone*

Business Information

What type of business do you have?*

Sole Proprietorship

Partnership or LLC

Corporation

Name of Farm*

Name of LLC*

Year Initiated*

Co-Owner Information

Name of Co-Owner

% Owned

Name of Corporation*

Year Initiated*

Type of Corporation*

S-Corp

C-Corp

Shareholder Information*

Shareholder Name

# of Shares Owned

Is there a buy-sell written agreement to continue after death of a principal owner?*

Yes

No

Please attach a copy of the agreement or outline of key terms, or have it available

Max. file size: 15 MB.

Other businesses in which you have an ownership interest

Name

Type of Ownership

% of Ownership

Approx. Market Value

How and When Acquired

Head Marketed Annually:

Cows sold for:

Dairy Purposes

Culled

Heifers sold for:

Dairy Purposes

Culled

List other livestock sales:

List number of other livestock sold:

How much real estate is rented? (Excluding family agreements) List number of acres.*

List your primary goals:*

What are the main issues that you want this planning to address?*

Other Data

Include the following information for years 2022, 2023 and 2024.

2022 – Total Acres Farmed

Includes owned, rented, and pasture

2022 – If not on DHIA, avg. # of mature cows

2022 – Total lbs milk shipped

2022 – Total hours of all workers

2023 – Total Acres Farmed

Includes owned, rented, and pasture

2023 – If not on DHIA, avg. # of mature cows

2023 – Total lbs milk shipped

2023 – Total hours of all workers

2024 – Total Acres Farmed

Includes owned, rented, and pasture

2024 – If not on DHIA, avg. # of mature cows

2024 – Total lbs milk shipped

2024 – Total hours of all workers

Workers (Click the + sign on the right to add additional workers)*

Type of Employee (Examples: Owner / Unpaid Family / Hired Employee)

# of hours

List if these hours are per week, month or year

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Comments
This field is for validation purposes and should be left unchanged.

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