REVOCABLE TRUST APPLICATION
Mr_______________________________________DOB _____-_____-_____ SS # _________-_________-_________ Ms/Miss/Mrs_______________________________DOB _____-_____-_____ SS _________-_________-__________ Address: ____________________________________________________________Phone (____)_________________ City________________________________State_________County___________________ZIP___________________ _________________________________________________________________________________________________
FINAL DISTRIBUTION 1. The Quiet Hour, Inc. ________%
(25% minimum)
2. ____________________________________
Name
________%
_______________________________________
Relationship to trustor (son, daughter, brother, etc.)
______________________________________
Address
______________________________________
City, State, ZIP
(____)_________________________________
Phone
3. ____________________________________
Name
_________%
_______________________________________
Relationship to trustor (son, daughter, brother, etc.)
______________________________________
Address
______________________________________
City, State, ZIP
(____)_________________________________
Phone
4. ____________________________________
Name
_________%
_______________________________________
Relationship to trustor (son, daughter, brother, etc.)
______________________________________
Address
______________________________________
City, State, ZIP
(____)_________________________________
Phone
5. ____________________________________
Name
_________%
_______________________________________
Relationship to trustor (son, daughter, brother, etc.)
______________________________________
Address
______________________________________
City, State, ZIP
(____)_________________________________
Phone
SPECIAL REQUESTS ____yes ____no ____yes ____no ____yes ____no I/We request that the detail of this trust be kept confidential, even after my/our death(s). I/We have discussed these plans with my/our child(ren). I/We request The Quiet Hour to serve as Trustee of my/our Revocable Trust.
FAMILY INFORMATION WORKSHEET
MARITAL STATUS: First Middle Single Last Married ____/____/____ Widowed M/F Divorced ____/____/____ Birthdate
CHILDREN: (indicate if any are deceased) His - Hers - Ours 1_________________________________________________ ____ (___ - ____ - _____) ____-____-____ (___ - ____ - _____) ____-____-____ (___ - ____ - _____) ____-____-____ (___ - ____ - _____) ____-____-____
2_________________________________________________ ____ 3_________________________________________________ ____ 4_________________________________________________ ____
ASSETS
REAL PROPERTY Property #1________________________________________________________________FMV__________ City____________________________County_________________________State________________ Cost Basis________________________Encumbrance_____________________________________ Title____________________________________Date Purchased_____________________________ Property #2________________________________________________________________FMV__________ City____________________________County_________________________State________________ Cost Basis________________________Encumbrance_____________________________________ Title____________________________________Date Purchased_____________________________ Property #3________________________________________________________________FMV__________ City____________________________County__________________________State_______________ Cost Basis________________________Encumbrance_____________________________________ Title____________________________________Date Purchased_____________________________ Name of Insurance Company: _____________________________________________________________ Name of Agent: ___________________________________________________________________________ Address of Insurance Company: ___________________________________________________________ I/We declare the above information is true to the best of my/our knowledge.
Signature:_____________________________________________________ Date______________________
Signature:______________________________________________________ Date______________________
12/31/2008
-2-
BANK ACCOUNTS Bank Name & Address Account # Balance
Checking: ____________________________________________ ____________________ $____________ ____________________________________________ Checking: ____________________________________________ ____________________ $____________ ____________________________________________ Savings: _____________________________________________ ____________________ $___________ ____________________________________________ CD: ____________________________________________ _____________________ $___________ ____________________________________________ SECURITIES (Stocks, Bonds, Mortgages, Notes, or Trust Deeds) Shares Company Date of Purchase Cost Basis _________ ___________________________________________ __________________ ____________ _________ ___________________________________________ __________________ ____________ INSURANCE (Life, Mortgage) Insurance Co.__________________________________________________________ $_____________ Primary Beneficiary____________________________________________________________________ RETIREMENT BENEFITS: (IRA, KEOGH, Retirement/Pension Fund) _______________________________________________________________________ $______________ _______________________________________________________________________ $______________ BUSINESS (Equipment, Inventory, etc.) _______________________________________________________________________ $______________ _______________________________________________________________________ $______________ OTHER ASSETS: (Mutual Funds, Annuities, etc.) _______________________________________________________________________ $______________ _______________________________________________________________________ $______________ ______________________________________________________________________ $______________ ______________________________________________________________________ $______________
12/31/2008
-3-
COMPANION WILL INFORMATION
EXECUTOR: ________________________________________________ PHONE:( ALTERNATE: _______________________________________________PHONE ( )__________________ )__________________
ADDRESS: _______________________________________________________________________________ ADDRESS: _______________________________________________________________________________
WHEN SPOUSE SURVIVES: Do you wish to leave all your estate to your spouse? ( )yes ( )no - If no, please state other desire. __________________________________________________________________________________________ WHEN BOTH HUSBAND AND WIFE ARE DECEASED: Specific Legacies, Etc. - Be specific: automobiles, jewelry, furniture, pictures, books, etc. Relationship to Testator Article Bequeathed Name______________________________________________________________________________________ Address____________________________________________________________________________________ Name______________________________________________________________________________________ Address____________________________________________________________________________________ Name______________________________________________________________________________________ Address____________________________________________________________________________________ Name______________________________________________________________________________________ Address____________________________________________________________________________________ I wish the “CONTEST CLAUSE” to be included in my document. ( )yes ( )no
REQUEST FOR SERVICES
I/We hereby request THE QUIET HOUR, INC., of Redlands, CA. to process my/our application for services in harmony with the above information, and to prepare the documents indicated below to reflect my/our wishes. The above information is true to the best of my knowledge and may be used in the preparation of my documents for estate planning. I/We elect to use The Quiet Hour attorney to draft the following documents: Revocable Trust ______ ______
(Initials)
Companion Wills ______ ______
(Initials)
Signed_______________________________________________________ Date___________________ Signed_______________________________________________________ Date___________________
12/31/2008
-4-