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 doesnt 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 CLIENTS 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:

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
For example, bank accounts, CDs brokerage accounts, stocks, or corporate or U.S. bonds
Description and location of property
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
Total:

Value

Acct. #

__________
__________
__________
__________
__________
__________
__________
__________

____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________

In whose name
is asset?
______________
______________
______________
______________
______________
______________
______________
______________

__________________________

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

_________
_________
_________
_________
_________

___________________
___________________
___________________
___________________
___________________

________
________
________
________
________

________
________
________
________
________

____________________
____________________
____________________
____________________
____________________

__________
__________
__________
__________
__________

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?

_______________________
_______________________
_______________________
_______________________
_______________________

______________
______________
______________
______________
______________

__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________

Date made
_________________
_________________
_________________
_________________
_________________

Location of original
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________

Legal Papers
Last will and testament
Durable power of attorney (s)
Living will/health care
power of attorney
Living trust

Miscellaneous
Are you a legally appointed guardian? Yes ____ No ____. If yes, please explain:

___________________________________________________________________________________________________________
_
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?
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
______
___________________________________________________________________________________________________________
_
___________________________________________________________________________________________________________
_
___________________________________________________________________________________________________________
_
___________________________________________________________________________________________________________
_
___________________________________________________________________________________________________________
_
___________________________________________________________________________________________________________
_

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 Settlors:
____
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
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

[ ] Jointly, two at a time [ ] Spouse will serve jointly with Next

Name of Successor #1:

________________________________________________________________

Name of Successor #2:

________________________________________________________________

Name of Successor #3:

________________________________________________________________

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

[ ] Jointly, two at a time [ ] Spouse will serve jointly with Next

Name of Successor #1:

________________________________________________________________

Name of Successor #2:

________________________________________________________________

Name of Successor #3:

________________________________________________________________

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:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
__
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
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 childs 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.
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