LIVING TRUST FORM
PLEASE PRINT CLEARLY TO PREVENT SPELLING ERRORS IN YOUR TRUST DOCUMENTS
NOTE: It is important that all questions be responded to. Use “N/A” if question doesn’t apply to you TRUST TYPE: ____ Single Person ____Couple (Small Estate) ____Couple (Over $1million estate) ____Couple ($600,000 - $1million)
CLIENT INFORMATION
First, Middle & Last Name, include Jr, III, etc. ___________________________________________________________________ Address: _____________________________________________________________ U.S. Citizen? Yes ____ No ____ City, State, Zip: _______________________________________________________ Sex: Male: ____ Female: ____ County of residence: ___________________________________________________ Birth date: _____/_____/_____ Telephone number: (____) ___________________________ SSN: ____________________________ Marital Status: Single: ____ Married: ____ Unmarried: ____ Date of Marriage: ___________________________ If separated, date of separation: ________________ Any previous marriages? ________________________
SPOUSE INFORMATION
First, Middle & Last Name, include Jr, III, etc. ___________________________________________________________________ Address: _____________________________________________________________ U.S. Citizen? Yes ____ No ____ City, State, Zip: _______________________________________________________ Sex: Male: ____ Female: ____ County of residence: ___________________________________________________ Birth date: _____/_____/_____ Telephone number: (____) ___________________________ SSN: ____________________________ Any previous marriages? ________________________
INFORMATION ABOUT CLIENT’S LIVING CHILDREN
Does client have any living children? Yes ____ No ____ Full name of first living child: _______________________________________________________ Date of Birth: _____/_____/_____ Is this child of the current marriage? Yes ____ No ____ Full name of second living child: _______________________________________________________ Date of Birth: _____/_____/_____ Is this child of the current marriage? Yes ____ No ____ Full name of third living child: _______________________________________________________ Date of Birth: _____/_____/_____ Is this child of the current marriage? Yes ____ No ____ Full name of fourth living child: _______________________________________________________ Date of Birth: _____/_____/_____ Is this child of the current marriage? Yes ____ No ____
List information about additional children on a separate piece of paper
Do you or your spouse have any children by previous relationships? Yes ____ No ____ If yes, please explain: ___________________________________________________________________
Do you or your spouse have children who died leaving children? Yes ____ No ____ If yes, please explain: ___________________________________________________________________ Do you want any minors (such as children and/or grandchildren) to whom you may be leaving all or part of your estate to receive their money:
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Outright (regardless of their age) in a trust until a specified age
Yes ____ No ____ Yes ____ No ____
or
INFORMATION REGARDING THE ASSETS IN YOUR ESTATE Income-Producing Assets
Description and location of property ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ Value __________ __________ __________ __________ __________ __________ __________ __________
For example, bank accounts, CD’s brokerage accounts, stocks, or corporate or U.S. bonds Acct. # ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ In whose name is asset? ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________
Total:
__________________________
Real Estate Description and location of property ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________
Value __________ __________ __________ __________ __________
Mortgage ___________ ___________ ___________ ___________ ___________
Purchase price __________ __________ __________ __________ __________
In whose name is the asset? _____________ _____________ _____________ _____________ _____________
Note: You will need to know the legal description for each property listed or you will need to provide a copy of the most recent deed at the time of the initial meeting. Is any property listed above, held as joint tenants? Yes ____ No ____. If yes, please explain: __________________________________________________________________________________________________
Is any property listed above, a separate property asset? Yes ____ No ___. If yes, please explain: __________________________________________________________________________________________________
Do you or your spouse have any interest in any business? Yes ____ No ____ If yes, please explain; _________________________________________________________________________________________________
Life Insurance Whose life? Is insured Company Name Face Value Cash Value Policy Number Beneficiary
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_________ _________ _________ _________ _________
___________________ ___________________ ___________________ ___________________ ___________________
________ ________ ________ ________ ________
________ ________ ________ ________ ________
____________________ ____________________ ____________________ ____________________ ____________________
__________ __________ __________ __________ __________
Are the owners of any policy different from the person whose life is insured? Yes ____ No ____. If yes, please explain
Other Property with Designated Beneficiaries Do you have IRAs, vested pension plans, annuities, or other assets that would pass on your death to a particular beneficiary that you have designated? Yes ____ No ____. If yes, please provide the following information: Description _______________________ _______________________ _______________________ Value ______________ ______________ ______________ Designated beneficiary __________________________________________ __________________________________________ __________________________________________
Do you or your spouse expect an inheritance? Yes ____ No ____. If yes, please explain: _________________________________________________________________________________________________ Do you or your spouse expect the value of your estate to increase by a significant amount? Yes ____ No ___. If yes, please explain: _________________________________________________________________________________________________
Personal Property For example, autos, RVs, boats, antiques, heirlooms, jewelry, and collections Description of property _______________________ _______________________ _______________________ _______________________ _______________________ Value ______________ ______________ ______________ ______________ ______________ In whose name? __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________
Legal Papers Last will and testament Durable power of attorney (s) Living will/health care power of attorney Living trust Date made _________________ _________________ _________________ _________________ _________________ Location of original ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________
Miscellaneous Are you a legally appointed guardian? Yes ____ No ____. If yes, please explain: ____________________________________________________________________________________________________________
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Have you been appointed under a power of attorney? Yes ____ No ____. If yes, please explain: ____________________________________________________________________________________________________________ Do you currently serve as executor or administrator of an estate? Yes ____ No ____. If yes, please explain: ____________________________________________________________________________________________________________ Are you involved in a lawsuit? Yes ____ No ____. If yes, please explain: ____________________________________________________________________________________________________________
DISTRIBUTION OF YOUR ESTATE:
Special gifts of Personal Property Before your estate is distributed, will there be any special gifts of personal property made? Yes ____ No ____. If yes, Recipient of gift Description of gift Pay at death of :
________________________ ________________________
______________________________________ ______________________________________
[ ]Single Settlor [ ]Surviving Spouse [ ]Husband [ ]Wife [ ]Single Settlor [ ]Surviving Spouse [ ]Husband [ ]Wife [ ]Single Settlor [ ]Surviving Spouse [ ]Husband [ ]Wife [ ]Single Settlor [ ]Surviving Spouse [ ]Husband [ ]Wife
________________________
______________________________________
_______________________
______________________________________
Special cash gifts Before your estate is distributed, will there be any special cash gifts made? Yes ____ No ____. If yes, Recipient of cash gift Amount of cash gift Pay at death of :
________________________ ________________________
______________________________________ ______________________________________
[ ]Single Settlor [ ]Surviving Spouse [ ]Husband [ ]Wife [ ]Single Settlor [ ]Surviving Spouse [ ]Husband [ ]Wife [ ]Single Settlor [ ]Surviving Spouse [ ]Husband [ ]Wife [ ]Single Settlor [ ]Surviving Spouse [ ]Husband [ ]Wife
________________________
______________________________________
_______________________
______________________________________
How do you want the remainder of your estate distributed after the death of the surviving spouse, if applicable? ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________
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____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________
TRUSTEE INFORMATION
Who will be the initial Trustee(s): ____ Single Settlor (unmarried person) ____ Both Settlors (Husband and Wife) ____ One of the Settlors (Husband only or Wife only): ______________________ ____ One Settlor and another individual (Specify) ______________________________________ ____ One Settlor and a corporation (Specify) __________________________________________ ____ Corporation (Specify) _______________________________________________________ ____ Other (Specify) _____________________________________________________________ Successor Trustee(s): On death of one of the Settlor’s: ____ The remaining Settlor serves alone ____ Named individual becomes co-trustee with the surviving Settlor Name of individual: _____________________________________ ____ ____ Named individual becomes trustee Name of individual: Named individuals becomes co-trustees Name of individual: Name of individual: ____
____________________________________ ____________________________________ ____________________________________
Other: ____________________________________________________________
SPRINKLING TRUST
Note: The Sprinkling Trust provides a Trustee with discretion to make payments of income and/or principal to the Settllors children and/or grandchildren. The beneficiaries of the Trust are usually the grandchildren. Note: The children of the Settlors should not become the sole trustee where a sprinkle provision is in place Do the Settlors want the trust to include a sprinkle provision for their children or for the children of any deceased child? Yes ____ No ____
POUR-OVER WILL EXECUTOR CHOICES
Same persons and order as Trustees above [ ] If married, Executor will be surviving spouse Yes ____ No ____ Executors (after surviving spouse) will serve [ ] Jointly [ ] In Succession
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Name of Successor #1: Name of Successor #2:
________________________________________________________________ ________________________________________________________________
Name of Successor #3: ________________________________________________________________ If serving jointly, and one of the executors can no longer serve, the remaining co-executor will [ ] serve alone [ ] choose an acceptable co-executor. Guardian of minor children, if any: I/We nominate as Guardians for my/our minor children in the event of requirement of same: Name: ______________________________________________ Name: ______________________________________________ WE DO NOT WANT THE FOLLOWING PERSON(S) TO BE APPOINTED: ____________________________________________________
DURABLE POWER OF ATTORNEY FOR PROPERTY/FINANCIAL AGENT CHOICES
Same persons and order as Trustees above [ ] If married, Agent will be spouse Yes ____ No ____ Agents (after surviving spouse) will serve [ ] In Succession Successor Name of Successor #1: Name of Successor #2: Name of Successor #3: [ ] Jointly, two at a time [ ] Spouse will serve jointly with Next
________________________________________________________________ ________________________________________________________________ ________________________________________________________________
DURABLE POWER OF ATTORNEY FOR HEALTH CARE AGENT CHOICES
Same persons and order as Trustees above [ ] If married, Agent will be spouse Yes ____ No ____ Agents (after surviving spouse) will serve [ ] In Succession Successor Name of Successor #1: Name of Successor #2: Name of Successor #3: [ ] Jointly, two at a time [ ] Spouse will serve jointly with Next
________________________________________________________________ ________________________________________________________________ ________________________________________________________________
Health Care/Anatomical Gifts/Internment Desires Client states: [ ] I DO authorize my Agent to make Anatomical Gifts [ ] I DO NOT authorize my Agent to make Anatomical Gifts Desires regarding life-sustaining treatment: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________
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Desires regarding funeral/burial: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Spouse states: [ ] I DO authorize my Agent to make Anatomical Gifts [ ] I DO NOT authorize my Agent to make Anatomical Gifts Desires regarding life-sustaining treatment: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Desires regarding funeral/burial: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________
DO YOU NEED A SPECIAL NEEDS TRUST FOR A DISABLED CHILD? Yes ____ No ____
General Information regarding the special need child First, Middle & Last Name of child: _____________________________________________________________________ Address where child lives: _____________________________________________________________________ City, State, Zip code: _____________________________________________________________________ Is child employed? Yes ____ No ____ Name of employer: _________________________________________________________ Address, City, State, Zip: _________________________________________________________ SSN: __________________________ Date of Birth: _____/_____/_____ Is the special needs child married? Yes ____ No ____ Name of spouse: ________________________________________________________ Does the special needs child have any children of his/her own? Yes ____ No ____ Name of first child: __________________________________________ Name of second child: __________________________________________ Does the special needs child receive governmental benefits? Yes ____ No ____
Will the Trustee be allowed discretion to sprinkle payments from the trust among the spouse of the special needs child (if child is married) and any living children of the special needs child? If Yes, ____ Income only ____ Income and Principal What standard should the Trustee use when making payments: ____ Ascertainable standard (health, education, support, maintenance) ____ Broad standard (comfort, welfare, happiness) ____ Broad standard, but use ascertainable standard for distributions where the Trustee is also a Beneficiary
Note: Sprinkling beneficiaries should not become sole-trustee
During the term of the special needs trust, the trustee should be permitted to make discretionary payments to the special needs child of: ____ Income only ____ Income and principal
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Alternate Income Beneficiaries for the Special Needs Trust (SNT) Note: The special needs child is the initial beneficiary of the SNT If payment of income to the special needs child would disqualify the special needs child for benefits, the alternate beneficiaries should be: (Ascertainable standard is used) ____ The child or children of the special needs child ____ The husband of the special needs child ____ Other (Specify): ______________________ Termination Beneficiaries Note: The Trustee of the Special Needs Trust should not be the termination beneficiary Note: Where the special needs trust terminates due to the death of the special needs child, the beneficiaries would be the children of the special needs child (if any) or, if none, the children of the Settlors Where the SNT is terminated because further payment would disqualify the special needs child for continued benefits, the termination beneficiaries should be: ____ the children of the special needs child; or ____ to the following named individuals ____________________________ ____________________________ ____________________________ Where all the termination beneficiaries are deceased with no issue, disposition of the Special Needs Trust should be to: ______________________________________________________________________________
Should the Trustee be authorized to pay the death taxes for the special needs child from the Trust principal? Yes ____ No ____ Will any part of the Special Needs Trust be funded with assets from the special needs child, that child’s spouse (if applicable) or a person or entity with legal authority to act on behalf of either of them? Yes ____ No ____ f yes, list assets that are to be included in the special needs trust: ____________________________________ ____________________________________ ____________________________________ ____________________________________ If yes, ownership of these assets should be transferred to the Settlors, or another individual before the special needs trust is drafted. Otherwise, upon the death of the special needs child, the Trustee must give the State the amounts remaining in the trust up to an amount equal to the to the total Medi-Cal benefits paid on behalf of the beneficiary. Do you have any other legal concerns? Yes ____ No ____. If yes, please explain: ____________________________________________________________________________________________________________
PLEASE BRING THE FOLLOWING DOCUMENTS WITH YOU TO YOUR MEETING WITH THE ATTORNEY.
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1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Your existing Will, codicil, trust agreement Real estate deeds, appraisals Mortgage statement for each piece of encumbered real estate Statements of account for savings Certificates, brokerage statements for stocks, bonds, and securities Divorce decree or the date of the final divorce decree Prenuptial agreements, adoption papers, guardianship documents Living will, powers of attorney Business papers: for example, partnership agreements, articles of incorporation If not otherwise set forth in this questionnaire, a list of full names, addresses, and telephone numbers of people who will serve as successor trustees, executors, beneficiaries, and Agents or Attorneys-InFact
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