General Information:

Home Phone _______________ Business Phone_______________Cell Phone_____________

Your Legal Name _________________________________________Married____Single____

Your Social Security #_____________________ _____________ Widowed____Divorced___

Spouse's Legal Name ________________________Social Security #____________________

Home Address__________________________City__________________State____Zip______

E-mail address___________________________________

Name of Trust:
(do you have a specific name other than your names that you want for the trust?)

____________________________________________________________________________

Name(s) of prior spouses:
(Important to know to prevent claims against your estate)

ExHusband______________________Date of death ___________Year of Divorce___________

ExWife__________________________Date of death ___________Year of Divorce___________

* actual form will have space for additional Spouses and Children

Your Children:

Name____________________________Date of Birth __________ Natural ____Adopted____

Goes by: _________________________Need Special Care?______Male/Female___________

Address ________________________________________________ Phone #______________

City ______________________________________State__________________Zip__________

(If you or your spouse have children not from this marriage, list their information in the space provided. Include name of their father/mother. )

Deceased children:
List the names and date of death of any deceased children, and whether from present union or prior marriage, and whether they left any living children.

Successor Trustees:
Person or persons to manage your trust after both you and your spouse pass. Indicate if you want them to be co-trustees or act alone.

Act Alone____ Act Together______

Legal Name________________________________ Legal Name _______________________________

Address ___________________________________ Address __________________________________

__________________________________________ __________________________________________

Phone ____________________________________ Phone ____________________________________

Cell phone-------------------------------------------------- Cell phone-------------------------------------------------

Relationship to you_________________________ Relationship to you_________________________

Back-up Trustees:
Take over if above people can not serve for any reason

Act Alone____ Act Together_____

Legal Name________________________________ Legal Name _______________________________

Address ___________________________________ Address __________________________________

__________________________________________ __________________________________________

Phone ____________________________________ Phone ____________________________________

Relationship to you_________________________ Relationship to you__________________________

Primary Beneficiaries:
Who do you want to receive the rest of your assets after your special gifts have been distributed? You can designate dollar amounts or percentages.

Name_______________________________Relationship_________________ Amount/percentage_______

Name_______________________________Relationship_________________ Amount/percentage_______

Name_______________________________Relationship_________________ Amount/percentage_______

Name_______________________________Relationship_________________ Amount/percentage_______

Name_______________________________Relationship_________________ Amount/percentage_______

Inheriting Instructions:
Do you want your children/grandchildren/other beneficiaries to receive their inheritances in installments; at certain ages, or all at once at your demise?.

_______________________________________________________________________________________

Guardians for Minor Children:
Responsible adults to raise your minor children after your demise.

Legal Name________________________________ Legal Name _______________________________

Address ___________________________________ Address __________________________________

__________________________________________ __________________________________________

Phone ____________________ Phone ___________________________

Relationship to you_________________________ Relationship to you_________________________

Special Gifts:
Are there any specific items you wish to give to an individual, charity, foundation, religious or fraternal organization?

Name_____________________Relationship____________________ Gift___________________________

Name_____________________Relationship ____________________ Gift___________________________

Name_____________________Relationship____________________ Gift___________________________

Alternate Beneficiaries:
Who do you want to receive your estate if you (and your spouse) outlive the beneficiaries you've named above?

Name___________________________________Relationship_____________________ Phone___________

Name___________________________________Relationship______________________Phone___________

Do You provide for someone who requires special care? Do any of your dependents (aging parents, disabled) require special care? Are they currently receiving government benefits? Is there someone else you want to provide for who is not related to you?)_________________________________________________________

Disinheriting:
Are there any persons you specifically do not want to receive anything from your estate?

Financial Information:
It is important to list all titled assets and to make sure the titles are changed to your Living Trust, so everything is included in the Trust for your heirs.

Your Home and/or any other Real Property. (Include copy of Deed & Real Estate tax bill)

Address and Legal Description from each deed, ie;

Lot_______Tract__________Book_________Page________Assessors Parcel No___________________________

Your Bank or cash equivalent accounts? (Savings, CDs, money market, etc.) (Do not need balances.)

Name of Financial Institution/Bank Account number

_______________________________________________________________________________________

Your stocks, bonds, or mutual funds (including company stock)?

Name of Institution/Company Account number

_______________________________________________________________________________________

Business or other partnership interests?

Name & Description of business Value and/or percentage of business

_______________________________________________________________________________________

Other titled property such as a motor home, boat, trailer, etc.?

Description and Location:_________________________________________________________

Does anyone owe you and/or your spouse money (2nd TD/Prom. note) that you want to include in the Trust?

Name Address Description of debt Amount

_______________________________________________________________________________

Special items of value such as coin collections, antiques, jewelry, etc.?

Description: _____________________________________________________________________

Any other items of value that you or your spouse own:

_______________________________________________________________________________

Profit sharing plans, IRA's and/or pension plans are usually NOT included in a Trust, but discuss the way you have listed your beneficiaries with me. Life insurance policies and/or annuities are usually not included in Trust, as they also have their own beneficiaries, ie: spouse, children, etc.

Durable Power of Attorney-Appointee:
Makes health care decisions when you are unable to do so. Your Spouse is automatically first, usually need at least one more. Can have two.

#1 Choice

Name___________________________Address________________________________________

Phone _________________Cell ____________

#2 Choice

Legal Name _____________________Address________________________________________

Phone _________________Cell ____________

Do you need a Durable Power of Attorney for property management?__________________________________

Do you already have a Durable Power(s) of Attorney for Health Care?_________ ________________________

Do you want Instructions to your doctor to NOT prolong your life if you are brain dead included in your Durable Power of Attorney? _____________________________________________________________________

What are your wishes regarding Life Support?______________________________________________________

______________________________________________________________________________________________

Are you an organ donor?_________________________Do you wish to be?_______________________________

Any other special instructions for your Trust_______________________________________________

Pour-Over Will
The Successor Trustees will be named as the Executors in your Pour-Over Wills unless you desire other people. Please inform me of your wishes.

Executor of Pour-Over Will:
Steps in at your death ONLY if will is probated. Can be adult children, trusted friends, and/or a corporate trustee acting alone or together.

#1 Choice Act Alone _____ Act Together______

Name_________________________Address________________________________________________________

Phone _________________ ____________________________________________________________

#2 Choice Act Alone _ ____ Act Together______

Name_________________________Address__________________________________________

Phone _________________ _________ ___________________________________________________

#3 Choice Act Alone ______ Act Together______

Name_________________________Address__________________________________________

Phone _________________ ______________________________________

Include a copy of all deeds to real property, and copies of real property tax bills, (Assessor's id number) There is an additional charge of $50 for every deed beyond the primary residence which is included in the price. A deposit of $250 is expected with these forms.