Are you Married or Unmarried?

Married

Full Name: Date of Marriage: Birth Date: Address: Phone Number: Email:

Unmarried

Do you have any children?

Yes

No

Children and Other Family Members:

Child or family member #1

Information:

Name: Birth Date: Parent or Relationship: Address:

Child or family member #2

Information:

Name: Birth Date: Parent or Relationship: Address:

Child or family member #3

Information:

Name: Birth Date: Parent or Relationship: Address:

Child or family member #4

Information:

Name: Birth Date: Parent or Relationship: Address:

Child or family member #5

Information:

Name: Birth Date: Parent or Relationship: Address:

Advisors:

Personal Attorney:

Information

Name: Phone Number:

Accountant:

Information:

Name: Phone Number:

Financial Advisor:

Information:

Name: Phone Number:

Life Insurance Agent:

Information:

Name: Phone Number:

Your Concerns:

Desire to get affairs in order and create a comprehensive plan to manage affairs in case of death or disability.

Level Of Concern:

Client: Spouse:

Providing for and protecting a spouse.

Level of Concern:

Client: Spouse:

Providing for and protecting children.

Level of Concern:

Client: Spouse:

Providing for and protecting grandchildren.

Level of Concern:

Client: Spouse:

Disinheriting a family member.

Level of Concern:

Client: Spouse:

Providing for charities at the time of death.

Level of Concern:

Client: Spouse:

Plan for the transfer and survival of a family business.

Level of Concern:

Client: Spouse:

Avoiding or reducing your estate taxes.

Level of Concern:

Client: Spouse:

Avoiding probate.

Level of Concern:

Client: Spouse:

Reduce administration costs at time of your death.

Level of Concern:

Client: Spouse:

Avoiding a conservatorship (“living probate”) in case of a disability.

Level of Concern:

Client: Spouse:

Avoiding will contests or other disputes upon death.

Level of Concern:

Client: Spouse:

Protecting assets from lawsuits or creditors.

Level of Concern:

Client: Spouse:

Preserving the privacy of affairs in case of disability or at time of death from business competitors, predators, dishonest persons and curiosity seekers.

Level of Concern:

Client: Spouse:

Plan for a child with disabilities or special needs, such as medical or learning disabilities.

Level of Concern:

Client: Spouse:

Protecting children’s inheritance from the possibility of failed marriages.

Level of Concern:

Client: Spouse:

Protect children’s inheritance in the event of a surviving spouse’s remarriage.

Level of Concern:

Client: Spouse:

Provide that your death shall not be unnecessarily prolonged by artificial means or measures.

Level of Concern:

Client: Spouse:

Other Concerns (Please list below):

Level of Concern:

Client: Spouse:

Important Family Questions

Are you (or your spouse) receiving Social Security, disability, or other governmental benefits?

Yes

Describe:

No

Are you (or your spouse) making payments pursuant to a divorce or property settlement order? Please furnish a copy

Yes

No

If married, have you and your spouse signed a pre- or post-marriage contract? Please furnish a copy

Yes

No

Have you (or your spouse) been widowed? If a federal estate tax return or a state death tax return was filed, please furnish a copy

Yes

No

Have you (or your spouse) ever filed federal or state gift tax returns? Please furnish copies of these returns

Yes

No

Have you (or your spouse) completed previous will, trust, or estate planning? Please furnish copies of these documents

Yes

No

Do you support any charitable organizations now that you wish to make provisions for at the time of your death?

Yes

If so, please explain below.

No

Are there any other charitable organizations you wish to make provisions for at the time of your death?

Yes

If so, please explain below

No

If married, have you lived in any of the following states while married to each other? Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin

Yes

No

Are you (or your spouse) currently the beneficiary of anyone else’s trust?

Yes

If so, please explain below

No

Do any of your children have special educational, medical, or physical needs?

Yes

No

Do any of your children receive governmental support or benefits?

Yes

No

Do you provide primary or other major financial support to adult children or others?

Yes

No

Part II Property Information

Real Property

#1

Furniture and Personal Effects

Type or Description: Owner: Market Value:

#2

Furniture and Personal Effects

Type or Description: Owner: Market Value:

#3

Furniture and Personal Effects

Type or Description: Owner: Market Value:

#4

Furniture and Personal Effects

Type or Description: Owner: Market Value:

Total Amount of ALL Market Value:

Automobiles, Boats, and RVs

Vehicle #1

Information:

Description: How titled: Market Value: Encumbrance:

Vehicle #2

Information:

Description: How titled: Market Value: Encumbrance:

Vehicle #3

Information:

Description: How titled: Market Value: Encumbrance:

Bank Accounts

Bank Account #1

Information:

Name of Institution & Account #: Type: Owner: Amount:

Bank Account #2

Information:

Name of Institution & Account #: Type: Owner: Amount:

Bank Account #3

Information:

Name of Institution & Account #: Type: Owner: Amount:

Calculate ALL Bank Account Amounts:

Stocks and Bonds

Type #1

Information:

Stocks, Bonds or Investment Accounts: Type: Acct. Number: Owner: Amount:

Type #2

Information:

Stocks, Bonds or Investment Accounts: Type: Acct. Number: Owner: Amount:

Type #3

Information:

Stocks, Bonds or Investment Accounts: Type: Acct. Number: Owner: Amount:

Type #4

Information:

Stocks, Bonds or Investment Accounts: Type: Acct. Number: Owner: Amount:

Calculate ALL Amounts:

Life Insurance Policies and Annuities

TYPE: Term, whole life, split dollar, group life, annuity. ADDITIONAL INFORMATION: Insurance company, type, face amount (death benefit), whose life is insured, who owns the policy, the current beneficiaries, who pays the premium, and who is the life insurance agent.

Retirement Plans

Type #1

Information:

Type of Plan: Plan Name: Value of Plan: Any other pertinent information:

Type #2

Information:

Type of Plan: Plan Name: Value of Plan: Any other pertinent information:

Type #3

Information:

Type of Plan: Plan Name: Value of Plan: Any other pertinent information:

Calculate ALL Amounts:

Business Interests

Business Interest #1

Information:

Discription: Who has the interest: Your ownership in the interest: Estimated Value of the interest:

Business Interest #2

Information:

Discription: Who has the interest: Your ownership in the interest: Estimated Value of the interest:

Business Interest #3

Information:

Discription: Who has the interest: Your ownership in the interest: Estimated Value of the interest:

Calculate ALL Amounts:

Money Owed To You

Debtor #1

Information:

Name of Debtor: Date of Note: Maturity Date: Owed to: Current Balance:

Debtor #2

Information:

Name of Debtor: Date of Note: Maturity Date: Owed to: Current Balance:

Debtor #3

Information:

Name of Debtor: Date of Note: Maturity Date: Owed to: Current Balance:

Debtor #4

Information:

Name of Debtor: Date of Note: Maturity Date: Owed to: Current Balance:

Calculate ALL Amounts:

Anticipated Inheritance, Gift, or Lawsuit Judgment

Describe in appropriate detail alongside the Total Estimated Value

Other Assets

Asset #1

Information:

Type: Owner: Value:

Asset #2

Information:

Type: Owner: Value:

Asset #3

Information:

Type: Owner: Value:

Calculate ALL Amounts:

Summary of Values

Client

Assets & Amount

Real Property: Furniture and Personal Effects: Automobiles, Boats and RV’s: Bank and Savings Accounts: Stocks and Bonds: Life Insurance and Annuities: Retirement Plans: Business Interests: Money owed to you: Anticipated Inheritance, Etc:

Spouse

Assets & Amount

Real Property: Furniture and Personal Effects: Automobiles, Boats and RV’s: Bank and Savings Accounts: Stocks and Bonds: Life Insurance and Annuities: Retirement Plans: Business Interests: Money owed to you: Anticipated Inheritance, Etc:

Client & Spouse:

Total Amount:

Real Property: Furniture and Personal Effects: Automobiles, Boats and RV’s: Bank and Savings Accounts: Stocks and Bonds: Life Insurance and Annuities: Retirement Plans: Business Interests: Money owed to you: Anticipated Inheritance, Etc:

Part III Design Information

Guardian #1

Information:

Name: Address: Relationship:

Guardian #2

Information:

Name: Address: Relationship:

Initial Trustee #1

Information:

Name: Address: Relationship:

Initial Trustee #2

Information:

Name: Address: Relationship:

Disability Trustee #1

For CLIENT:

Name: Address: Relationship:

Disability Trustee #2

For CLIENT:

Name: Address: Relationship:

Disability Trustee #1

For SPOUSE:

Name: Address: Relationship:

Disability Trustee #2

For SPOUSE:

Name: Address: Relationship:

Death Trustee #1

For CLIENT:

Name: Address: Relationship:

Death Trustee #2

For CLIENT:

Name: Address: Relationship:

Death Trustee #1

For SPOUSE:

Name: Address: Relationship:

Death Trustee #2

For SPOUSE:

Name: Address: Relationship:

Client Power of Attorney

Agent #1:

Name: Address: Relationship:

Client Power of Attorney

Agent #2:

Name: Address: Relationship:

Spouse Power of Attorney

Agent #1:

Name: Address: Relationship:

Spouse Power of Attorney

Agent #1:

Name: Address: Relationship:

Do you want to authorize your Financial Agent to make gifts on your behalf during any period of time you are incapacitated?

Client Response:

Yes

No

Do you want to authorize your Financial Agent to make gifts on your behalf during any period of time you are incapacitated?

Spouse Response:

Yes

No

Gifting Power Details:

Client Response:

Gifting Power Details:

Spouse Response:

HEALTH CARE: If you were unable to make decisions for yourself, who would you want to make decisions for you with regard to your medical treatment?

Clients Agent #1

Infiormation:

Name: Relationship: Instructions or Guidelines:

Clients Agent #2

Infiormation:

Name: Relationship: Instructions or Guidelines:

LIVING WILL;

Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?

Do you want to provide that your organs and tissues should be made available for transplant purposes?

Spouses Agent #1

Infiormation:

Name: Relationship: Instructions or Guidelines:

Spouses Agent #2

Infiormation:

Name: Relationship: Instructions or Guidelines:

Do you want to authorize your Medical Agent to take whatever steps are necessary to keep you in a personal residence rather than nursing home?

Client Response:

Yes

No

Do you want to authorize your Medical Agent to take whatever steps are necessary to keep you in a personal residence rather than nursing home?

Spouse Response:

Yes

No

Do you want to provide that upon certification by 2 physicians of need for psychological or substance treatment, Agent may arrange for voluntary admission?

Client Response:

Yes

No

Do you want to provide that upon certification by 2 physicians of need for psychological or substance treatment, Agent may arrange for voluntary admission?

Spouse Response:

Yes

No

In making distributions during any period of time the client is incapacitated, the successor Trustee shall give primary consideration to:

Disabled spouse, the needs of others.

Disabled spouse and other spouse, and then needs of others.

Disabled spouse needs and the needs of others equally.

DISTRIBUTIONS OF PERSONAL PROPERTY AND SPECIFIC GIFTS

USE OF PERSONAL PROPERTY MEMORANDUM: Do you want to provide that your personal property will be distributed pursuant to a written list you may prepare later?

Yes

No

Any property not listed on the memorandum should be distributed to:

FOR CLIENT:

Spouse, then children equally.

Spouse, then to balance of trust.

Spouse, then other named individuals.

Children.

To the balance of the trust.

Other named individuals.

List other named individuals:

FOR SPOUSE:

Spouse, then children equally.

Spouse, then to balance of trust.

Spouse, then other named individuals.

Children.

To the balance of the trust.

Other named individuals.

List other named individuals:

SPECIFIC GIFTS: List any specific gifts of real estate or cash gifts you wish to make to either individuals or charities. Indicate whether these gifts are to be made even if the other spouse is alive.

FOR CLIENT:

Individual or Charity #1

Name: Amount of property: Contingent on Spouse predeceasing?

FOR CLIENT:

Individual or Charity #2

Name: Amount of property: Contingent on Spouse predeceasing?

FOR CLIENT:

Individual or Charity #3

Name: Amount of property: Contingent on Spouse predeceasing?

FOR SPOUSE:

Individual or Charity #1

Name: Amount of property: Contingent on Client predeceasing?

FOR SPOUSE:

Individual or Charity #2

Name: Amount of property: Contingent on Client predeceasing?

FOR SPOUSE:

Individual or Charity #3

Name: Amount of property: Contingent on Client predeceasing?

PROVIDING FOR THE SURVIVING SPOUSE UPON DEATH OF FIRST SPOUSE TO DIE

TO SURVIVING SPOUSE WITHOUT TAX PLANNING: We recognize this does not provide any tax planning which may result in our beneficiaries paying significant optional estate taxes.

All to surviving spouse.

_________% to surviving spouse.

Minimum allowed by law to surviving spouse.

DESIGN OF MARITAL SHARE:

OUTRIGHT: We want to leave property outright to the surviving spouse. We recognize that this offers no protection from creditors or predators. Allows surviving spouse to leave property to whomever surviving spouse wants. Also allows a new spouse to possibly make claim on property in case of death or divorce

GENERAL APPOINTMENT TRUST: All income and principal are available to the surviving spouse upon demand. The surviving spouse is free to do as he or she pleases. This would include the ability to remove all property in the Marital Share from the trust.

ALL INCOME – PRINCIPAL FOR NEEDS: All income is distributed to surviving spouse; principal is available for his or her needs (health, education, maintenance, and support).

ONLY INCOME: Only income is distributed to surviving spouse. Principal is not available to the surviving spouse.

DESIGN OF FAMILY SHARE:

ALL INCOME – PRINCIPAL FOR NEEDS: All income is distributed to surviving spouse; principal is available for needs (health, education, maintenance, and support).

Are descendants permissible beneficiaries of principal?

INCOME AND PRINCIPAL FOR NEEDS: All income and principal is available for needs. Income may be accumulated and not distributed.

Are descendants permissible beneficiaries of income and/or principal?

ONLY INCOME: Only income is distributed to surviving spouse. Principal is not available to the surviving spouse.

WHO IS RESPONSIBLE FOR DETERMINING LIFETIME DISTRIBUTIONS: Is surviving spouse the sole trustee with a right to appoint co-trustees (surviving spouse then determines the management and distributions for his or her needs)? Do you wish to name someone to be the co-trustee with the surviving spouse?

LIMITED POWER OF APPOINTMENT: Do you want the surviving spouse to be able to modify the way property is distributed upon the surviving spouse’s death?

If so, to whom may the surviving spouse distribute your property:

Your descendants

Your descendants and their spouses

Your descendants and charities

Your descendants, their spouses and charities

Anyone, no limitations

DIVISION OF PROPERTY UPON DEATH OF SECOND SPOUSE TO DIE

DIVISION OF PROPERTY UPON DEATH OF SECOND SPOUSE TO DIE

DIVIDE EQUALLY BETWEEN OUR CHILDREN AND THE DESCENDANTS OF ANY DECEASED CHILDREN:

DIVIDE AMONG NAMED INDIVIDUALS and/or CHARITIES:

State info here:

HOW AND WHEN TO DISTRIBUTE MY PROPERTY:

DISTRIBUTE OUTRIGHT TO OUR BENEFICIARIES: Provides no protection from creditors, predators, or from themselves.

TRUCTURED TRUST: You determine how long the property is to remain in trust. During the period of time the property is held in trust it is available to the beneficiary for needs (health, education, maintenance, and support). You may give written instructions to the trustee outlining guidelines to follow in determining the beneficiary’s needs. You may provide for a staggered distribution of principal. For example:. 1/3 at age 30 and balance at age 40. You decide who will manage the property and to carry out your distribution instructions. Does the beneficiary have a right to be a co-trustee and/or choose his or her own co-trustee? You decide how the trust is designed.

List your desires:

REMOTE CONTINGENT BENEFICIARY: Who do you want to receive your property in the remote event that no one listed above is alive to receive your property? Determining the remote contingent beneficiary is not so important that it should cause you to delay completion of your entire estate plan. It can always be changed at a later date. In the remote event no one listed above is alive to receive my property I want my property distributed as follows:

To each spouse’s heirs-at-law.

One-half to Client’s heirs-at-law and one-half to Spouse’s heirs at law.

To the following named individuals and/or charities:

List here:

OTHER ITEMS TO INCLUDE OR DISCUSS: Obviously your estate plan should address all your hopes, fears, and wishes. Please list any other items you want included or want to discuss: