Client Questionnaire

Questionnaire

Trust and Estate Planning Questionnaire

The following questions are designed to understand your general plan of distributing your wealth, including who will receive which portion, who will help you manage the trust after your passing, although it will be revised thoroughly throughout our process of working together to meet your needs. Any answer below can be modified prior to your trust signing ceremony.

A typical Living Trust includes:

Revocable Living Trust
Certification of Trust
Individual Bequest Sheet
Pour-Over Wills
Advanced Health Care Directives
HIPAA Medical Information Releases
Children Guardianship
Dementia and End of Life Planning
Funding Documents (Grant Deed Transfers, PCOR)
Summary

GENERAL INFORMATION

What name would you like to give your Living Trust?

How would you like to establish your Trust?

Do you have Legal Insurance

Yes

Insurance Company Name

Policy Number

Attach Insurance Card

Choose File

Address

Home Address

County

City

State

Zip Code

First Name

Last Name

Date of Birth

Employment

US Citizen

Yes

Email Address

Cell Phone

Prior Marriage

Yes

Do you have any Children?

Yes

SUCCESSOR TRUSTEE(S), POA, AHCD.

Upon your death or incapacitation, these individuals will make decisions for you

Trustee(s) of the Trust: Please provide the name(s), address(es) and phone number(s) of the person(s) you want to be the decision maker concerning your estate upon your death

Successor First Name

Successor Last Name

Successor Address

Home Address

County

City

State

Zip Code

Country

Relationship

Phone

Successor Details

Successor Name	Successor Address	Successor Relationship	Successor Phone #

Will Trustee(s) get paid for helping you?

Yes

Power of Attorney – Financials: please provide the name, address, and phone number of the person(s) other than the surviving spouse that you want to make any financial decisions on your behalf

Same as Trustees?

Yes

Name

Address

Contact

Health Care Directive: Please provide the name, address, and phone number of the person(s) that you want to make any major medical decisions on your behalf in the event you are unable to

Same as Trustees?

Yes

Name

Address

Contact

Oral Feeding in the Event of Dementia: This option is to prepare a voluntary Advance Director for Oral Feeding and Fluids in the event of dementia

Choose which best states your desire:

No Feeding/Dehydration

Limited Feeding/Limited Hydration

BENEFICIARIES

In general, name the beneficiaries and their corresponding percentage of how you want your estate distributed among them after your death

Repeater Field

Name	Address	Relationship	Phone #	%

CONTINGENT BENEFICIARIES

State Contingent Beneficiaries in case your Primary Beneficiaries cannot inherit the inheritance upon your dealth.

Would you like to add a Contingent Beneficiary?

Yes

If your Beneficiary is a minor. What age would you like your Beneficiary to get the inheritance?

Concerns

ADDITIONAL QUESTIONS

Any deceased children?

Yes

Any adopted children?

Yes

Do any of your beneficiaries have a learning disability, special educational, medical or physical

Yes

Do you have any relatives (other than children) who depend on you for all or part of their support?

Yes

Do you think any of your beneficiaries have special problems with spouses, drugs, alcohol or handling money?

Yes

Do you wish to disinherit any of your children, grandchildren or any other close relative?

Yes

Do you have an existing Marital Property Agreement? (91 Yes 0 No Do you expect to inherit substantial assets ($100,000 +)?

Yes

Do you have existing Wills?

Yes

Do you have any existing trusts (either revocable or irrevocable)?

Yes

Have you ever filed a Federal Gift Tax Return?

Yes

Do you want assets passing to your beneficiaries to be held in trust until a specific age or ages?

Yes

If a named beneficiary dies before you, do you want the assets to go to that beneficiary's issue?

Yes

END-OF-LIFE DECISIONS

Choice to Prolong Life OR Choice Not to Prolong Life:

I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.

Should your health care agent have the authority to make a disposition of a part or parts of your body (i.e., make any anatomical gifts)?

Yes

Should your agent have the authority to authorize an autopsy even if an autopsy is not required by law?

Yes

Do you wish to designate a primary physician

Yes

BURIAL WISHES

At my death, I wish to be:

I have already made arrangements at:

ASSETS TO BE TRANSFERRED INTO TRUST

TYPES OF ASSETS:

REAL ESTATE: (fair market value, less loans)
List at least 1 Name is required

Address	Ownership

Questionnaire

Trust and Estate Planning Questionnaire

A typical Living Trust includes:

Revocable Living Trust
Certification of Trust
Individual Bequest Sheet
Pour-Over Wills
Advanced Health Care Directives
HIPAA Medical Information Releases
Children Guardianship
Dementia and End of Life Planning
Funding Documents (Grant Deed Transfers, PCOR)
Summary

GENERAL INFORMATION

What name would you like to give your Living Trust?

How would you like to establish your Trust?

Do you have Legal Insurance

Yes

Insurance Company Name

Policy Number

Attach Insurance Card

Choose File

Address

Home Address

County

City

State

Zip Code

First Name

Last Name

Date of Birth

Employment

US Citizen

Yes

Email Address

Cell Phone

Prior Marriage

Yes

Do you have any Children?

Yes

SUCCESSOR TRUSTEE(S), POA, AHCD.

Upon your death or incapacitation, these individuals will make decisions for you

Trustee(s) of the Trust: Please provide the name(s), address(es) and phone number(s) of the person(s) you want to be the decision maker concerning your estate upon your death

Successor First Name

Successor Last Name

Successor Address

Home Address

County

City

State

Zip Code

Country

Relationship

Phone

Successor Details

Successor Name	Successor Address	Successor Relationship	Successor Phone #

Will Trustee(s) get paid for helping you?

Yes

Power of Attorney – Financials: please provide the name, address, and phone number of the person(s) other than the surviving spouse that you want to make any financial decisions on your behalf

Same as Trustees?

Yes

Name

Address

Contact

Health Care Directive: Please provide the name, address, and phone number of the person(s) that you want to make any major medical decisions on your behalf in the event you are unable to

Same as Trustees?

Yes

Name

Address

Contact

Oral Feeding in the Event of Dementia: This option is to prepare a voluntary Advance Director for Oral Feeding and Fluids in the event of dementia

Choose which best states your desire:

No Feeding/Dehydration

Limited Feeding/Limited Hydration

BENEFICIARIES

In general, name the beneficiaries and their corresponding percentage of how you want your estate distributed among them after your death

Repeater Field

Name	Address	Relationship	Phone #	%

CONTINGENT BENEFICIARIES

State Contingent Beneficiaries in case your Primary Beneficiaries cannot inherit the inheritance upon your dealth.

Would you like to add a Contingent Beneficiary?

Yes

If your Beneficiary is a minor. What age would you like your Beneficiary to get the inheritance?

Concerns

ADDITIONAL QUESTIONS

Any deceased children?

Yes

Any adopted children?

Yes

Do any of your beneficiaries have a learning disability, special educational, medical or physical

Yes

Do you have any relatives (other than children) who depend on you for all or part of their support?

Yes

Do you think any of your beneficiaries have special problems with spouses, drugs, alcohol or handling money?

Yes

Do you wish to disinherit any of your children, grandchildren or any other close relative?

Yes

Do you have an existing Marital Property Agreement? (91 Yes 0 No Do you expect to inherit substantial assets ($100,000 +)?

Yes

Do you have existing Wills?

Yes

Do you have any existing trusts (either revocable or irrevocable)?

Yes

Have you ever filed a Federal Gift Tax Return?

Yes

Do you want assets passing to your beneficiaries to be held in trust until a specific age or ages?

Yes

If a named beneficiary dies before you, do you want the assets to go to that beneficiary's issue?

Yes

END-OF-LIFE DECISIONS

Choice to Prolong Life OR Choice Not to Prolong Life:

I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.

Should your health care agent have the authority to make a disposition of a part or parts of your body (i.e., make any anatomical gifts)?

Yes

Should your agent have the authority to authorize an autopsy even if an autopsy is not required by law?

Yes

Do you wish to designate a primary physician

Yes

BURIAL WISHES

At my death, I wish to be:

I have already made arrangements at:

ASSETS TO BE TRANSFERRED INTO TRUST

TYPES OF ASSETS:

REAL ESTATE: (fair market value, less loans)
List at least 1 Name is required

Address	Ownership