Law Offices of Robert Craig Wallach PA

12486 West Atlantic Avenue
Coral Springs, FL 33071

(954) 461-0015

Confidential Estate Planning Questionnaire

Thank you so much for contacting our law office! Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Your Social Security number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Security numbers are most often used to positively identify parties. Most courts require Social Security numbers of all parties in a case. Some other examples of how this information may be used include:

initial service
in court orders
in required reports or other documents filed with the State

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!

STEP 1: BACKGROUND INFORMATION

The information you provide in this section provides us with information about you, your age, marital status, where you live, and how best to contact you.

CLIENT'S INFORMATION

Contact information: Client

Prefix

First name *

Middle name

Last name *

Date of birth

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Pronouns Used:

Also Known As:

(other names used to title property and accounts)

Prefer to Be Called:

Social Security #:

Are you currently employed?

Yes

Are either of your parents still living?

Yes

Are any of your grandparents still living?

Yes

Are you a U.S. Citizen?

Yes

Client's Marital History

Are you currently married?

Yes

Date of Marriage:

if applicable

Were you ever divorced?

Yes

Date of Divorce:

if applicable

Were you ever widowed?

Yes

Date that Former Spouse/Partner Died:

if applicable

CHILDREN AND OTHER FAMILY MEMBERS

Child or Other Family Member #1

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

Child or Other Family Member #2

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

Child or Other Family Member #3

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

Child or Other Family Member #4

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

Child or Other Family Member #5

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

Child or Other Family Member #6

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

Child or Other Family Member #7

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

STEP 2: PLANNING OBJECTIVES/FAMILY VALUES

One of our goals is to assist you in identifying your estate planning objectives and family values so that we can focus our conversations on the issues most important to you.

Please rate the following planning objectives and family values on a scale of 1 to 5 as to how important they are to you. (5 critical, 4 very important, 3 important, 2 slightly important, 1 unimportant, N/A if inapplicable) Feel free to leave blank any item you do not wish to rank.

Protect Your Children or Other Beneficiaries

From predators who can discover inheritance amounts and target young or vulnerable beneficiaries:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From claims of divorced spouses to take half of your child or beneficiary’s inheritance:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From malpractice claims, for beneficiaries with a professional practice:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From other creditors’ claims (such as car accident plaintiffs):

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From the stress and delays of the average 6-16 month process of probate:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From the financial immaturity resulting in a quick loss of an inheritance:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From sharing assets with heirs you would rather disinherit:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From litigation claims by disinherited heirs:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

For parents only: from relatives who would be poor, abusive or even dangerous guardians or from foster care:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

For parents only: from acquaintances and relatives who should not be allowed to be alone with your children:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

For special needs beneficiary only: from neglect in the government care system:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Preserve and Maximize Assets

By minimizing taxes during your life (income taxes, capital gains taxes, estate taxes on inheritances you expect to receive):

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

By minimizing or eliminating estate taxes upon your death (up to 55% of your assets and life insurance benefits):

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

By reducing estate administration costs through probate avoidance:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Ensure that a special needs beneficiary has assets that are protected from government seizure while retaining eligibility for needed services:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Ensure that your family has enough life insurance to provide a comfortable lifestyle:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

By ensuring that your assets are passed to your descendants and not given away to outsiders, such as spouses, creditors or the government:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Protect Yourself

From malpractice or other creditor claims:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From conservatorship proceedings (aka “living probate”) if you become incapacitated:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From probate delays and stress upon your death or the death of your partner:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From hospital policies requiring life sustaining procedures when you would rather not endure them:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From healthcare decisions made by people other than those you trust most:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Taking Charge of Your Life

Get your financial life organized:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Have clarity about your life purpose, goals and dreams:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Benefit a charitable organization or activity:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Support a common family goal through coordinated planning:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Have a plan to leave the world a better place:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Leave behind specific intellectual, spiritual, and human assets in addition to your financial assets:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

For parents only: By specifying the values, insights, stories, and experiences you want passed on to your children and how you want the money you leave behind used for your children:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

For special needs beneficiary only: By providing instructions, people, and assets to support your special needs beneficiaries above a poverty lifestyle:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

For business owners only: By providing for the orderly continuation and transfer of family business interests rather than a distress sale:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Family Values

Cultural values such as art, music, travel:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Economic values such as financial responsibility, frugality, savings:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Educational values such as study, self-improvement, academic achievements, lifelong learning:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Emotional values such as compassion, kindness, generosity:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Ethical values such as honesty, fairness, justice:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Material values such as possessions, social standing, rank and title:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Material values such as possessions, social standing, rank and title:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Personal values such as modesty, loyalty, independence:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Philanthropic values such as volunteer work, donations (time and money):

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Physical values such as health, relaxation, exercise, appearance:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Public values such as citizenship, community involvement, public service:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Recreational values such as sports, leisure time, hobbies, vacations:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Relationship values such as family, friends, colleagues:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Spiritual values such as faith, belief in God, inner peace:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Other Concerns (Please list below):

STEP 3: ASSET INFORMATION

Instructions for completing the Property Information checklist:

General Headings

This Property Information checklist helps you list all the property you own and what it is worth. If you do not own property under a particular heading, just leave that section blank.

Type

Immediately after the heading for each kind of property is a brief explanation of what property you should list under that heading.

“Owner” of Property

How you own your property is extremely important for purposes of properly designing and implementing your estate plan. For each property, please indicate how the property is titled. When doing so, please use the following abbreviations:

Client's Name alone, with no other person.

JTS

If married, Joint Tenancy with spouse

JTO

Joint Tenancy with someone other than a spouse, i.e., a child, parent, etc.

If you cannot determine how the property is owned

Real Property

TYPE: Any interest in real estate including your family residence, vacation home, timeshare, vacant land, etc.

Real Property #1:

if applicable, please select "Fill Out Real Property Information" and add the appropriate information

Fill Out Real Property Information

Not Applicable

Real Property #2:

if applicable, please select "Fill Out Real Property Information" and add the appropriate information

Fill Out Real Property Information

Not Applicable

Real Property #3:

if applicable, please select "Fill Out Real Property Information" and add the appropriate information

Fill Out Real Property Information

Not Applicable

Real Property #4:

if applicable, please select "Fill Out Real Property Information" and add the appropriate information

Fill Out Real Property Information

Not Applicable

Real Property #5:

if applicable, please select "Fill Out Real Property Information" and add the appropriate information

Fill Out Real Property Information

Not Applicable

CLIENT - Total Value:

OTHER - Total Value:

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's column and 1/2 in Other's column.

Furniture and Personal Effects

TYPE: List separately only major personal effects such as jewelry, collections, antiques, furs, and all other valuable non-business personal property (indicate type below and give a lump sum value for miscellaneous, less valuable items.).

Furniture or Other Personal Effects #1:

if applicable, please select "Fill Out Furniture or Other Personal Effects Information" and add the appropriate information

Fill Out Furniture or Other Personal Effects Information

Not Applicable

Furniture or Other Personal Effects #2:

if applicable, please select "Fill Out Furniture or Other Personal Effects Information" and add the appropriate information

Fill Out Furniture or Other Personal Effects Information

Not Applicable

Furniture or Other Personal Effects #3:

if applicable, please select "Fill Out Furniture or Other Personal Effects Information" and add the appropriate information

Fill Out Furniture or Other Personal Effects Information

Not Applicable

Furniture or Other Personal Effects #4:

if applicable, please select "Fill Out Furniture or Other Personal Effects Information" and add the appropriate information

Fill Out Furniture or Other Personal Effects Information

Not Applicable

CLIENT - Total Value:

OTHER - Total Value:

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's column and 1/2 in Other's column.

Automobiles, Boats, and RVs

TYPE: For each motor vehicle, boat, RV, etc. please list the following: description, how titled, market value and encumbrance:

Vehicle #1:

if applicable, please select "Fill Out Vehicle Information" and add the appropriate information

Fill Out Vehicle Information

Not Applicable

Vehicle #2:

if applicable, please select "Fill Out Vehicle Information" and add the appropriate information

Fill Out Vehicle Information

Not Applicable

Vehicle #3:

if applicable, please select "Fill Out Vehicle Information" and add the appropriate information

Fill Out Vehicle Information

Not Applicable

Vehicle #4:

if applicable, please select "Fill Out Vehicle Information" and add the appropriate information

Fill Out Vehicle Information

Not Applicable

Vehicle #5:

if applicable, please select "Fill Out Vehicle Information" and add the appropriate information

Fill Out Vehicle Information

Not Applicable

CLIENT 1 - Total Value:

OTHER - Total Value:

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's column and 1/2 in Other's column.

Bank Accounts

TYPE: Checking Account “CA”, Savings Account “SA”, Certificates of Deposit “CD”, Money Market “MM” (indicate type below). Do not include IRAs or 401(k)s here

Bank Account #1:

if applicable, please select "Fill Out Bank Account Information" and add the appropriate information

Fill Out Bank Account Information

Not Applicable

Bank Account #2:

if applicable, please select "Fill Out Bank Account Information" and add the appropriate information

Fill Out Bank Account Information

Not Applicable

Bank Account #3:

if applicable, please select "Fill Out Bank Account Information" and add the appropriate information

Fill Out Bank Account Information

Not Applicable

Bank Account #4:

if applicable, please select "Fill Out Bank Account Information" and add the appropriate information

Fill Out Bank Account Information

Not Applicable

Bank Account #5:

if applicable, please select "Fill Out Bank Account Information" and add the appropriate information

Fill Out Bank Account Information

Not Applicable

CLIENT - Total Value:

OTHER - Total Value:

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's column and 1/2 in Other's column.

Stocks and Bonds

TYPE: List any and all stocks and bonds you own. If held in a brokerage account, lump them together under each account. (indicate type below)

Stock and/or Bond #1:

if applicable, please select "Fill Out Stock and/or Bond Information" and add the appropriate information

Fill Out Stock and/or Bond Information

Not Applicable

Stock and/or Bond #2:

if applicable, please select "Fill Out Stock and/or Bond Information" and add the appropriate information

Fill Out Stock and/or Bond Information

Not Applicable

Stock and/or Bond #3:

if applicable, please select "Fill Out Stock and/or Bond Information" and add the appropriate information

Fill Out Stock and/or Bond Information

Not Applicable

Stock and/or Bond #4:

if applicable, please select "Fill Out Stock and/or Bond Information" and add the appropriate information

Fill Out Stock and/or Bond Information

Not Applicable

Stock and/or Bond #5:

if applicable, please select "Fill Out Stock and/or Bond Information" and add the appropriate information

Fill Out Stock and/or Bond Information

Not Applicable

CLIENT - Total Value:

OTHER - Total Value:

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's column and 1/2 in Other's column.

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.

Life Insurance Policies and Annuities:

Total Value:

Retirement Plans

TYPE: Pension (P), Profit Sharing (PS), H.R. 10, IRA, SEP, 401(K).

ADDITIONAL INFORMATION: Describe the type of plan, the plan name, the current value of the plan, and any other pertinent information.

Retirement Plans:

Total Value:

Business Interests

TYPE: General and Limited Partnerships, Sole Proprietorships, privately-owned corporations, professional corporations, oil interests, farm, and ranch interests.

ADDITIONAL INFORMATION: Give a description of the interests, who has the interest, your ownership in the interests, and the estimated value of the interests.

Business Interests:

Total Value:

Money Owed To You

TYPE: Mortgages or promissory notes payable to you, or other moneys owed to you.

Money Owed to You #1:

if applicable, please select "Fill Out Money Owed to You Information" and add the appropriate information

Fill Out Money Owed to You Information

Not Applicable

Money Owed to You #2:

if applicable, please select "Fill Out Money Owed to You Information" and add the appropriate information

Fill Out Money Owed to You Information

Not Applicable

Money Owed to You #3:

if applicable, please select "Fill Out Money Owed to You Information" and add the appropriate information

Fill Out Money Owed to You Information

Not Applicable

Money Owed to You #4:

if applicable, please select "Fill Out Money Owed to You Information" and add the appropriate information

Fill Out Money Owed to You Information

Not Applicable

CLIENT - Total Value:

OTHER - Total Value:

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's column and 1/2 in Other's column.

Anticipated Inheritance, Gift, or Lawsuit Judgment

TYPE: Gifts or inheritances that you expect to receive at some time in the future; or moneys that you anticipate receiving through a judgment in a lawsuit. Describe in appropriate detail.

Anticipated Inheritance, Gift, or Lawsuit Judgment:

Total Estimated Value:

Other Assets

TYPE: Other property is any property that you have that does not fit into any listed category.

Other Asset #1:

if applicable, please select "Fill Out Other Asset Information" and add the appropriate information

Fill Out Other Asset Information

Not Applicable

Other Asset #2:

if applicable, please select "Fill Out Other Asset Information" and add the appropriate information

Fill Out Other Asset Information

Not Applicable

Other Asset #3:

if applicable, please select "Fill Out Other Asset Information" and add the appropriate information

Fill Out Other Asset Information

Not Applicable

Other Asset #4:

if applicable, please select "Fill Out Other Asset Information" and add the appropriate information

Fill Out Other Asset Information

Not Applicable

CLIENT - Total Value:

OTHER - Total Value:

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's column and 1/2 in Other's column.

E-Affirmation

E-Affirmation:

The undersigned understands that Attorney will need to rely on the asset and debt information supplied by you to develop an estate plan. The undersigned also understands that inaccurate or incomplete information could negatively impact the designed estate plan. Consequently, if Attorney is retained, you will need to provide us with complete and accurate information prior to the signing of any estate planning documents.

STEP 4: PEOPLE WHO ADVISE YOU

Your various advisors play a key role in the establishment of your estate plan. For example, your financial advisor and life insurance agent may need to be contacted to confirm/change beneficiary designations and titling of accounts.

Accountant/Tax Advisor:

Name + Phone

Financial Advisor:

Name + Phone

Life Insurance Agent:

Name + Phone

Family Law Attorney:

Name + Phone

Other Advisor:

Name + Phone

STEP 5: POTENTIAL BENEFICIARIES

This section asks you to identify all potential beneficiaries of your estate. NOTE: Listing a person or particular organization in this section is not a firm indication of your decision to provide for an individual or make a bequest. Rather, it is simply a way of identifying potential beneficiaries for discussion purposes.

Potential Individual Beneficiaries – Primary Beneficiaries

Potential Beneficiary #1:

if applicable, please select "Designate a Potential Beneficiary" and add the appropriate information

Designate a Potential Beneficiary

Not Applicable

Date of Birth:

if applicable

Potential Beneficiary #2:

if applicable, please select "Designate a Potential Beneficiary" and add the appropriate information

Designate a Potential Beneficiary

Not Applicable

Date of Birth:

if applicable

Potential Beneficiary #3:

if applicable, please select "Designate a Potential Beneficiary" and add the appropriate information

Designate a Potential Beneficiary

Not Applicable

Date of Birth:

if applicable

Potential Beneficiary #4:

if applicable, please select "Designate a Potential Beneficiary" and add the appropriate information

Designate a Potential Beneficiary

Not Applicable

Date of Birth:

if applicable

Potential Beneficiary #5:

if applicable, please select "Designate a Potential Beneficiary" and add the appropriate information

Designate a Potential Beneficiary

Not Applicable

Date of Birth:

if applicable

Potential Individual Beneficiaries – Alternate Beneficiaries

Alternate Beneficiary #1:

if applicable, please select "Designate an Alternate Beneficiary" and add the appropriate information

Designate an Alternate Beneficiary

Not Applicable

Date of Birth:

if applicable

Alternate Beneficiary #2:

if applicable, please select "Designate an Alternate Beneficiary" and add the appropriate information

Designate an Alternate Beneficiary

Not Applicable

Date of Birth:

if applicable

Alternate Beneficiary #3:

if applicable, please select "Designate an Alternate Beneficiary" and add the appropriate information

Designate an Alternate Beneficiary

Not Applicable

Date of Birth:

if applicable

Alternate Beneficiary #4:

if applicable, please select "Designate an Alternate Beneficiary" and add the appropriate information

Designate an Alternate Beneficiary

Not Applicable

Date of Birth:

if applicable

Alternate Beneficiary #5:

if applicable, please select "Designate an Alternate Beneficiary" and add the appropriate information

Designate an Alternate Beneficiary

Not Applicable

Date of Birth:

if applicable

Potential Charitable/Non-Profit Beneficiaries

church, college, social club, favorite philanthropy, etc.

Potential Charitable/Non-Profit Beneficiary #1:

if applicable, please select "Designate a Charitable Beneficiary" and add the appropriate information

Designate a Charitable Beneficiary

Not Applicable

Potential Charitable/Non-Profit Beneficiary #2:

if applicable, please select "Designate a Charitable Beneficiary" and add the appropriate information

Designate a Charitable Beneficiary

Not Applicable

Potential Charitable/Non-Profit Beneficiary #3:

if applicable, please select "Designate a Charitable Beneficiary" and add the appropriate information

Designate a Charitable Beneficiary

Not Applicable

STEP 6: NOMINATION OF POWERS

Identify all potential Trustees, Executors, Financial Agents, Health Care Agents, Long-Term Guardians, Short-Term Guardians, and Guardians for Pets

Guardian for Minor Children

If you have any children under the age of 18, list in order of preference who you wish to be guardian.

Guardian for Minor Children #1:

if applicable, please select "Designate a Guardian for Minor Children" and add the appropriate information

Designate a Guardian for Minor Children

Not Applicable

Guardian for Minor Children #2:

if applicable, please select "Designate a Guardian for Minor Children" and add the appropriate information

Designate a Guardian for Minor Children

Not Applicable

Personal Representative or Executor

Upon your death, who do you want to manage and distribute the assets you leave in your estate?

Personal Representative or Executor #1:

if applicable, please select "Designate a Personal Representative or Executor" and add the appropriate information

Designate a Personal Representative or Executor

Not Applicable

Personal Representative or Executor #2:

if applicable, please select "Designate a Personal Representative or Executor" and add the appropriate information

Designate a Personal Representative or Executor

Not Applicable

Personal Representative or Executor #3:

if applicable, please select "Designate a Personal Representative or Executor" and add the appropriate information

Designate a Personal Representative or Executor

Not Applicable

CLIENT - Trustee

Upon your death, who do you want to manage and distribute the assets you leave in your trust estate for children?

Trustee #1:

if applicable, please select "Designate a Trustee" and add the appropriate information

Designate a Trustee

Not Applicable

Trustee #2:

if applicable, please select "Designate a Trustee" and add the appropriate information

Designate a Trustee

Not Applicable

Trustee #3:

if applicable, please select "Designate a Trustee" and add the appropriate information

Designate a Trustee

Not Applicable

Guardian for Pets

If you are interested in setting up a pet trust, please complete this section.

Guardian for Pets #1:

if applicable, please select "Designate a Guardian for Pets" and add the appropriate information

Designate a Guardian for Pets

Not Applicable

Guardian for Pets #2:

if applicable, please select "Designate a Guardian for Pets" and add the appropriate information

Designate a Guardian for Pets

Not Applicable

Guardian for Pets #3:

if applicable, please select "Designate a Guardian for Pets" and add the appropriate information

Designate a Guardian for Pets

Not Applicable

Financial Power of Attorney

If you were unable to make financial decisions for yourself, who would you want to make those decisions for you?

Agent #1:

if applicable, please select "Designate an Agent" and add the appropriate information

Designate an Agent

Not Applicable

Agent #2:

if applicable, please select "Designate an Agent" and add the appropriate information

Designate an Agent

Not Applicable

Agent #3:

if applicable, please select "Designate an Agent" and add the appropriate information

Designate an Agent

Not Applicable

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

Yes

Living Will

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

Yes

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

Yes

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?

Agent #1:

if applicable, please select "Designate an Agent" and add the appropriate information

Designate an Agent

Not Applicable

Agent #2:

if applicable, please select "Designate an Agent" and add the appropriate information

Designate an Agent

Not Applicable

Agent #3:

if applicable, please select "Designate an Agent" and add the appropriate information

Designate an Agent

Not Applicable

OTHER ITEMS TO INCLUDE OR DISCUSS

Other Concerns (Please list below):

THANK YOU

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