ESTATE PLANNING QUESTIONNAIRE

CLIENT INFORMATION

Name:(First, Middle, Last)

Social Security No:

Date of Birth:

Street Address:

City:

State:

Zip:

County:

Primary Phone (Include Area Code):

Alternate Phone (Include Area Code):

Marital Status: Married Single Divorced Widowed

US Citizen: Yes No

Date of Marriage to Current Spouse:

Previous Marriage(s), Indicate Date of Termination and if by Death or Divorce:

SPOUSE INFORMATION

Name:(First, Middle, Last)

Social Security No:

Date of Birth:

Street Address:

City:

State:

Zip:

County:

Primary Phone (Include Area Code):

Alternate Phone (Include Area Code):

Marital Status: Married Single Divorced Widowed

US Citizen: Yes No

Previous Marriage(s), Indicate Date of Termination and if by Death or Divorce:

CHILDREN INFORMATION

(1)

Name:(First, Middle, Last)

Age:

Date of Birth:

Date of Death (If applicable):

Street Address:

City:

State:

Zip:

County:

Primary Phone (Include Area Code):

Alternate Phone (Include Area Code):

(2)

Name:(First, Middle, Last)

Age:

Date of Birth:

Date of Death (If applicable):

Street Address:

City:

State:

Zip:

County:

Primary Phone (Include Area Code):

Alternate Phone (Include Area Code):

(3)

Name:(First, Middle, Last)

Age:

Date of Birth:

Date of Death (If applicable):

Street Address:

City:

State:

Zip:

County:

Primary Phone (Include Area Code):

Alternate Phone (Include Area Code):

Do you have grandchildren from a deceased child?...................................................................................... Yes No

If “YES” do you want such grandchild(ren) to receive their parent’s share?.............................................. Yes No

If “YES”, do you want such grandchild(ren) to equally share his/her/their deceased parent’s share?.......... Yes No

If “YES” specify how you would like to provide for such grandchild(ren):

CHILDREN FROM PREVIOUS MARRIAGE(S)

Client’s Child(ren) Spouse’s Child(ren)

(1)

Name:(First, Middle, Last)

Age:

Date of Birth:

Date of Death (If applicable):

Street Address:

City:

State:

Zip:

County:

Primary Phone (Include Area Code):

Alternate Phone (Include Area Code):

(2)

Name:(First, Middle, Last)

Age:

Date of Birth:

Date of Death (If applicable):

Street Address:

City:

State:

Zip:

County:

Primary Phone (Include Area Code):

Alternate Phone (Include Area Code):

(3)

Name:(First, Middle, Last)

Age:

Date of Birth:

Date of Death (If applicable):

Street Address:

City:

State:

Zip:

County:

Primary Phone (Include Area Code):

Alternate Phone (Include Area Code):

INITIAL TRUSTEE(S)

Trustee(s)- Manages your trust now. The trustee is usually you (and your spouse however you can name other people)
Client Spouse Client & Spouse Other

SUCCESSOR TRUSTEE(S)

Successor Trustee(s)- Manages your trust upon your disability or death. The successor trustee(s) is usually your adult children, or a trusted friend. The trustee has a fiduciary duty to the trust so it is critical you trust this person!

1st Choice:

Relationship:

Phone Number:

Address:

2nd Choice:

Relationship:

Phone Number:

Address:

3rd Choice:

Relationship:

Phone Number:

Address:

Individually in Order Set Forth Co-Successor Trustees

DURABLE POWER OR ATTORNEY-FINANCIAL MANAGEMENT

Same as the Successor Trustee(s) Listed Above (If different, fill out information below)

1st choice for Power of Attorney and Conservator (other than spouse):

Name:

Relationship:

Phone Number:

Address:

2nd choice for Power of Attorney and Conservator (other than spouse):

Name:

Relationship:

Phone Number:

Address:

Individually in Order Set Forth Joint Attorney-In Fact

DURABLE POWERS OF ATTORNEY- HEALTH CARE

Client for Spouse/Spouse for Client if applicable
Same as the Successor Trustee(s) Listed Above (If different, fill out information below)

1st Power of Attorney and Conservator (other than spouse)

Name:

Relationship:

Phone Number:

Address:

2nd Power of Attorney and Conservator (other than spouse)

Name:

Relationship:

Phone Number:

Address:

Individually in Order Set Forth Joint Attorney-In Fact

POUR-OVER WILL

Client for Spouse/Spouse for Client if applicable
Same as the Successor Trustee(s) Listed Above (If different, fill out information below)

Executor:

Phone Number:

Address:

Alternate Executor:

Phone Number:

Address:

Individually in Order Set Forth Co-Executors

“GUARDIAN OF THE PERSON” FOR ANY MINOR CHILDREN

Who do you choose as the Guardian? This person is a responsible adult who will raise your child(ren) if something happens to you.

1st Choice Name:

Relationship:

Phone Number:

Address:

2nd Choice Name:

Relationship:

Phone Number:

Address:

****I typically advise clients not to choose a married couple due to the potential chance of a separation/divorce. Please choose an individual.***

“GUARDIAN OF THE ESTATE” FOR ANY MINOR CHILDREN

This person manages your child(ren)’s inheritance from the trust and outside the trust- can be the same person as the guardian or another adult but someone who is also fiscally responsible.

1st Choice Name:

Relationship:

Phone Number:

Address:

2nd Choice Name:

Relationship:

Phone Number:

Address:

BENEFICIARIES

Unless otherwise advised by you, no distributions will take place for minors until they are 25 years of age, except for health needs, educational needs, support & maintenance needs.

1st Choice: Spouse for Client/ Client for Spouse All Children Divided Equally
2nd Choice: All Children Divided Equally As Noted Below:

ALTERNATE BENEFICIARIES

Whom do you wish to receive your estate if you outlive any of the above-named beneficiaries?
Surviving Beneficiaries Issue (Children) of Deceased Beneficiary in Equal Shares

SPECIAL CARE NEEDS

Name any beneficiary who receives Supplemental Security Income (SSI), Medicaid or Medi-Care:

DISINHERITING

(1)

Name

Relationship

(2)

Name

Relationship

(3)

Name

Relationship

(4)

Name

Relationship

(5)

Name

Relationship

SPECIAL BEQUESTS (SPECIFIC GIFTS) OF ANY PROPERTY

Do you have any specific gifts?............................................................................................................ YES NO

Who do you want to receive the gift if the person named predeceases you? Choose from the following list below:
Return to remainder of Trust Estate Issue (Child(ren)) of deceased

If the same gift goes to more than one person, and one of them predeceases, does the survivor receive the gift? YES NO

SEPARATE PROPERTY INFORMATION

Separate property is property you or your spouse owned before marriage or property either of you have acquired after marriage by gift or inheritance. This property can still be put in the trust and either managed separately or it becomes community property.

CLIENT:
Do you have separate property?....................................................................................................... …. YES NO

Sole Ownership to client
Use, Control & Income to client for lifetime
Immediate Distribution to Children
Other: Explain to whom, amount of distribution and when:

SPOUSE:
Do you have separate property?....................................................................................................... …. YES NO

Sole Ownership to spouse
Use, Control & Income to spouse for lifetime
Immediate Distribution to Children
Other: Explain to whom, amount of distribution and when:

LIST OF ASSETS

Real Estate: Please include residence, time shares, and investment properties

**INCLUDE COPY OF GRANT DEEDS W/ LEGAL DESCRIPTION TO THE PROPERTY**

(1)

Name(s) Currently on Title:

Value$:

Street:

City:

Zip:

County:

Accessor’s Parcel Number:

(2)

Name(s) Currently on Title:

Value$:

Street:

City:

Zip:

County:

Accessor’s Parcel Number:

(3)

Name(s) Currently on Title:

Value$:

Street:

City:

Zip:

County:

Accessor’s Parcel Number:

DEEDS OF TRUST PAYABLE TO YOU

(1)

Name of Payor:

Accessor’s Parcel Number:

Address of Real Estate

County:

(2)

Name of Payor:

Accessor’s Parcel Number:

Address of Real Estate

County:

PARTNERSHIP INTEREST SOLE PROPRIETORSHIPS AND/OR BUISNESS INTERESTS

(1)

Business Name:

Owner: Client Spouse Both

Sole Proprietor: Partnership Corporation Other

Total Business Interests $:

(2)

Business Name:

Owner: Client Spouse Both

Sole Proprietor: Partnership Corporation Other

Total Business Interests $:

PROMISSORY NOTES PAYABLE TO YOU (PROVIDE PHOTOCOPY OF NOTE)

(1)

Name of Payor:

Owner: Client Spouse Both

Secured Unsecured

Principal Balance $:

(2)

Name of Payor:

Owner: Client Spouse Both

Secured Unsecured

Principal Balance $:

INFORMATION FOR ADVANCE HEALTH CARE DIRECTIVE

Client Information:

Physician Name:

Address:

City:

State:

Zip:

Office Name:

Office Phone Number:

Do you wish to be taken off of life support if you have a terminal condition? YES NO

Do you wish to be taken off of life support if you are in an irreversible coma? YES NO

If yes, How many days?

How would you like your remains disposed of? Burial Cremation Other

Do you wish to be an organ or tissue donor?............................................................................................. YES NO

If yes, Any Organs Needed Any Tissues Needed Leave my Body to Science Other

Authorize Autopsy?................................................................................................................................... . YES NO

Spouse Information:

Physician Name:

Address:

City:

State:

Zip:

Office Name:

Office Phone Number:

Do you wish to be taken off of life support if you have a terminal condition? YES NO

Do you wish to be taken off of life support if you are in an irreversible coma? YES NO

If yes, How many days?

How would you like your remains disposed of? Burial Cremation Other

Do you wish to be an organ or tissue donor?............................................................................................. YES NO

If yes, Any Organs Needed Any Tissues Needed Leave my Body to Science Other

Authorize Autopsy?................................................................................................................................... . YES NO

ADDITONAL INFORMATION

Thank you. Your form has been submitted

Submit

Call Now For A Case Evaluation

Folsom: (530) 317-5556

Jackson: (209) 881-9222

ESTATE PLANNING QUESTIONNAIRE

CLIENT INFORMATION

SPOUSE INFORMATION

CHILDREN INFORMATION

CHILDREN FROM PREVIOUS MARRIAGE(S)

INITIAL TRUSTEE(S)

SUCCESSOR TRUSTEE(S)

DURABLE POWER OR ATTORNEY-FINANCIAL MANAGEMENT

DURABLE POWERS OF ATTORNEY- HEALTH CARE

POUR-OVER WILL

“GUARDIAN OF THE PERSON” FOR ANY MINOR CHILDREN

“GUARDIAN OF THE ESTATE” FOR ANY MINOR CHILDREN

BENEFICIARIES

ALTERNATE BENEFICIARIES

SPECIAL CARE NEEDS

DISINHERITING

SPECIAL BEQUESTS (SPECIFIC GIFTS) OF ANY PROPERTY

SEPARATE PROPERTY INFORMATION

LIST OF ASSETS

DEEDS OF TRUST PAYABLE TO YOU

PARTNERSHIP INTEREST SOLE PROPRIETORSHIPS AND/OR BUISNESS INTERESTS

PROMISSORY NOTES PAYABLE TO YOU (PROVIDE PHOTOCOPY OF NOTE)

INFORMATION FOR ADVANCE HEALTH CARE DIRECTIVE

ADDITONAL INFORMATION

ESTATE PLANNING QUESTIONNAIRE

**CLIENT INFORMATION**

**SPOUSE INFORMATION**

**CHILDREN INFORMATION**

**CHILDREN FROM PREVIOUS MARRIAGE(S)**

**INITIAL TRUSTEE(S)**

**SUCCESSOR TRUSTEE(S)**

**DURABLE POWER OR ATTORNEY-FINANCIAL MANAGEMENT**

**DURABLE POWERS OF ATTORNEY- HEALTH CARE**

**POUR-OVER WILL**

**“GUARDIAN OF THE PERSON” FOR ANY MINOR CHILDREN**

**“GUARDIAN OF THE ESTATE” FOR ANY MINOR CHILDREN**

**BENEFICIARIES**

**ALTERNATE BENEFICIARIES**

**SPECIAL CARE NEEDS**

**DISINHERITING**

**SPECIAL BEQUESTS (SPECIFIC GIFTS) OF ANY PROPERTY**

**SEPARATE PROPERTY INFORMATION**

**LIST OF ASSETS**

**DEEDS OF TRUST PAYABLE TO YOU**

**PARTNERSHIP INTEREST SOLE PROPRIETORSHIPS AND/OR BUISNESS INTERESTS**

**PROMISSORY NOTES PAYABLE TO YOU (PROVIDE PHOTOCOPY OF NOTE)**

INFORMATION FOR ADVANCE HEALTH CARE DIRECTIVE

ADDITONAL INFORMATION

CLIENT INFORMATION

SPOUSE INFORMATION

CHILDREN INFORMATION

CHILDREN FROM PREVIOUS MARRIAGE(S)

INITIAL TRUSTEE(S)

SUCCESSOR TRUSTEE(S)

DURABLE POWER OR ATTORNEY-FINANCIAL MANAGEMENT

DURABLE POWERS OF ATTORNEY- HEALTH CARE

POUR-OVER WILL

“GUARDIAN OF THE PERSON” FOR ANY MINOR CHILDREN

“GUARDIAN OF THE ESTATE” FOR ANY MINOR CHILDREN

BENEFICIARIES

ALTERNATE BENEFICIARIES

SPECIAL CARE NEEDS

DISINHERITING

SPECIAL BEQUESTS (SPECIFIC GIFTS) OF ANY PROPERTY

SEPARATE PROPERTY INFORMATION

LIST OF ASSETS

DEEDS OF TRUST PAYABLE TO YOU

PARTNERSHIP INTEREST SOLE PROPRIETORSHIPS AND/OR BUISNESS INTERESTS

PROMISSORY NOTES PAYABLE TO YOU (PROVIDE PHOTOCOPY OF NOTE)