CONFIDENTIAL MARITAL TRUST QUESTIONNAIRE

Please take the time to complete this confidential questionnaire, designed to provide information needed in order to understand your particular estate planning situation
Kindly be prepared to forward a copy of the following documents that you may have:
1. Real Property Deed(s)
2. Present Wills, Trust, and any Codicils or Amendments

GENERAL INFORMATION (Spouse 1)

Full name:(Required)

AKA (if used):

Date of Birth:(Required)

Last four digits of Social Security Number(Required)

Are you a United States citizen?(Required)

Yes

If no, country of citizenship:

GENERAL INFORMATION (Spouse 2)

Full name:(Required)

AKA (if used):

Date of Birth:(Required)

Last four digits of Social Security Number(Required)

Are you a United States citizen?(Required)

Yes

If no, country of citizenship:

Date and place of marriage:(Required)

CHILDREN OF CURRENT MARRIAGE

1. Full name:

1. Date of Birth

2. Full name:

2. Date of Birth

3. Full name:

3. Date of Birth

4. Full name:

4. Date of Birth

If you have deceased children from this marriage, please list and include date of death:

PRIOR MARRIAGE(S) / REGISTERED DOMESTIC PARTNER(S)

SPOUSE 1

Name of Former Spouse:

Date Marriage Ended:

Please Check If Applicable

Divorce

Death

SPOUSE 2

Name of Former Spouse:

Date Marriage Ended:

Please Check If Applicable

Divorce

Death

If additional former spouses, please list.

(Name of former spouses, date of marriage ended, Divorced & Death)

CHILDREN OF PRIOR MARRIAGE (SPOUSE 1)

1. Full name:

1. Date of birth:

2. Full name:

2. Date of birth:

CHILDREN OF PRIOR MARRIAGE (SPOUSE 2)

1. Full name:

1. Date of birth:

2. Full name:

2. Date of birth:

If you have additional children from prior marriages, please list.

(Full names & date of birth)

If you have deceased children from prior marriages, please list and include date of death:

(Full names, date of birth & date of death)

DISTRIBUTION OF YOUR ESTATE

TRUST NAME:(Required)

(Choose your full names, simply your last name(s) or another alternative. For example, “ John and Jane Jones Family Trust; Jones Family Trust; or JJJ Trust”)

SUCCESSOR TRUSTEE: Please list the full name and relationship of your successor Trustee, to act upon both Spouses’ incapacity or death (you both are the initial Co-Trustees, the survivor of you will be the sole successor Trustee; please name the successor Trustee or successor Co-Trustees to act in the event that the surviving spouse is unable to act):

1. Surviving Spouse – Sole Trustee

2. Successor Trustee

Successor Trustee Name:(Required)

Relationship:(Required)

3. Alternate Successor Trustee

Alternate Successor Trustee Name:

Relationship:

4. Second Alternate Successor Trustee

Second Alternate Successor Trustee Name:

Relationship:

Do you want your Trustee(s) to receive compensation for their services?(Required)

Yes

GUARDIANS OF MINOR CHILDREN

In order of preference, please list the full names, relationships, and address of Guardians of any Minor Children:

1. Name

Relationship

Address

Phone Number:

Email:

2. Name

Relationship

Address

Phone Number:

Email:

3. Name

Relationship

Address

Phone Number:

Email:

4. Name

Relationship

Address

Phone Number:

Email:

SPECIAL NEEDS DUE TO A DISABILITY

Do you or any of your beneficiaries receive federal or state disability payments?

Yes

If yes, I will add provisions to protect those disability payments. Please explain the nature and value of the payments:

DISINHERITANCE

Do you wish to specifically disinherit an individual or group of people?

Yes

If yes, please list their full names and relationship to you and a brief explanation so that I may insert proper disinheritance language:

1. Name:

Relationship:

Explanation:

In lieu of disinheritance, would you prefer to provide a nominal gift so as to try to preclude the person(s) from filing legal action/trust contest against your trust? If yes, what amount/gift would you like to provide?

2. Name:

Relationship:

Explanation:

Add additional person(s) here:

(Names, relationship & explanation)

DISTRIBUTION OF PROPERTY ON DEATH

Please write down in the space below your wishes for distribution of your estate upon the passing of both spouses.

If any of the above-named beneficiaries should predecease the surviving spouse, would you like the predeceased beneficiary’s share to pass to his or her children? Or be distributed among the other surviving beneficiaries?

Children of predeceased child

or Surviving Beneficiaries

If all of your above-named beneficiaries pass away before the surviving spouse and there are no other beneficiaries, do you have alternate beneficiaries? If so, please list below:

In the alternative, you can specify that half of the estate will pass to each Spouse’s next of kin.

Next of kin:

ADVANCE HEALTH CARE DIRECTIVE

This document appoints an agent to make medical decisions for you in the event you are incapacitated and unable to make your own decisions. It also allows you to state your wishes regarding end-of-life decisions and donations of organs.

FOR SPOUSE 1

In order of preference, list the full names and relationship of your Agents for your Health Care.

1. Traditionally, SPOUSE 2 is Primary Agent

Primary Agent:

Relationship:

Address:

Phone #:

Email:

2. First Alternate Name

Relationship:

Address:

Phone #:

Email:

May your agent:

1. Authorize an autopsy?

Yes

2. Donate organs?

Yes

If yes, please check for what purposes donations may be used.

Transplant

Therapy

Research

Education

3. If you are in a long-term vegetative state or coma, would like to remain on life support and artificial feeding?

Yes

4. If you have a terminal condition due to illness or injury, do you want extraordinary measures used to resuscitate you?

Yes

5. If you have a terminal condition due to illness or injury and you are in pain, do you want sufficient pain killers to remove all pain even if it shortens the time you have left?

Yes

FOR SPOUSE 2

In order of preference, list the full names and relationship of your Agents for your Health Care.

1. Traditionally, SPOUSE 1 is Primary Agent

Primary Agent:

Relationship

Address:

Phone #:

Email:

2. First Alternate Name:

Relationship:

Address:

Phone #:

Email:

3. Second Alternate Name:

Relationship:

Address:

Phone #:

Email:

May your agent:

1. Authorize an autopsy?

Yes

2. Donate organs?

Yes

If yes, please check for what purposes donations may be used.

Transplant

Therapy

Research

Education

3. If you are in a long-term vegetative state or coma, would like to remain on life support and artificial feeding?

Yes

4. If you have a terminal condition due to illness or injury, do you want extraordinary measures used to resuscitate you?

Yes

5. If you have a terminal condition due to illness or injury and you are in pain, do you want sufficient pain killers to remove all pain even if it shortens the time you have left?

Yes

ADVANCE HEALTH CARE DIRECTIVE

This document appoints an agent to make financial decisions for you in the event you are incapacitated and unable to make your own financial decisions. This authority can be granted upon your incapacity (Springing) or right away (Immediate).

FOR SPOUSE 1

In order of preference, list the full names and relationship of your Agents:

1. Traditionally, SPOUSE 2 is Primary Agent

Primary Agent:

Relationship:

Address:

Phone #:

Email:

2. First Alternate Name:

Relationship:

Address:

Phone #:

Email:

3. Second Alternate Name:

Relationship:

Address:

Phone #:

Email:

FOR SPOUSE 2

In order of preference, list the full names and relationship of your Agents:

1. Traditionally, SPOUSE 1 is Primary Agent

Primary Agent:

Relationship:

Address:

Phone #:

Email:

2. First Alternate Name:

Relationship:

Address:

Phone #:

Email:

3. Second Alternate Name:

Relationship:

Address:

Phone #:

Email:

ASSET DOCUMENTATION

REAL ESTATE

Please provide the following information about all of your real property (including timeshares or rental property).

1. Primary Residence address:

Fair Market Value: $

Mortgage Balance: $

2. Additional Property address:

Fair Market Value: $

Mortgage Balance: $

Property Type:

Rental

Time Share

Vacation Home

Commercial

3. Additional Property address:

Fair Market Value: $

Mortgage Balance: $

Property Type:

Rental

Time Share

Vacation Home

Commercial

FINANCIAL ADVISORS

Please provide the following information about all of your real property (including timeshares or rental property).

Accountant Name:

Firm:

Address:

Phone:

Email:

Investment Advisor Name:

Firm:

Address:

Phone:

Email:

Life Insurance Agent Name:

Firm:

Address:

Phone:

Email:

MARKETABLE SECURITIES

(STOCKS, BONDS, MUTUAL FUNDS, BROKERAGE ACCOUNTS)

Securities Accounts:
For all securities accounts, please supply the requested information:

1. Account Name:

Last four numbers of account:

Current Value of Account: $

Securities Held in Certificate Form:
For stocks and bonds held by you outside a brokerage account (i.e., you have the certificates), please supply the requested information, including a photocopy of each stock certificate or bond.

1. Full Name of Issuing Company as it appears on stock certificate:

2. Full Name of Issuing Company as it appears on stock certificate:

BANK ACCOUNTS

For all bank accounts, please supply the information requested below.

1. Name of Institution:

Type of Account

Checking

Savings

Other

Last four numbers of account

Balance: $

2. Name of Institution:

Type of Account

Checking

Savings

Other

Last four numbers of account

Balance: $

3. Name of Institution:

Type of Account

Checking

Savings

Other

Last four numbers of account

Balance: $

4. Name of Institution:

Type of Account

Checking

Savings

Other

Last four numbers of account

Balance: $

LOANS, NOTES AND MORTGAGES RECEIVABLE

Notes Payable To You:

Exact name of holder as it appears on the note:

Exact name of debtor:

Face amount:

Due date:

Interest rate:

LIFE INSURANCE

For each life insurance policy you own, please supply the requested information, including the exact name of the owner. Alternatively, please provide a photocopy of the front page of the policy and a copy of the current beneficiary designation.

1. Carrier’s Name:

Face Value: $

Owner of Policy:

Name of Insured:

Beneficiary(ies):

Contingent Beneficiary(ies):

Type of Policy:

Term

Universal Life

Whole Life

2. Carrier’s Name:

Face Value: $

Owner of Policy:

Name of Insured:

Beneficiary(ies):

Contingent Beneficiary(ies):

Type of Policy:

Term

Universal Life

Whole Life

RETIREMENT, OTHER EMPLOYMENT BENEFITS, (IRAs), KEOGH ACCOUNTS

RETIREMENT AND EMPLOYMENT BENEFITS

For all employee benefits, please provide the following information and a copy of the current beneficiary designation.

Pensions or Keogh Plans

1. Name of Plan:

2. Name of Plan:

Deferred Compensation Contracts

1. Name of Recipient

Name of Company

Stock Options

1. Name of Participant:

Name of Company:

IRS 83(b) Election:

Yes

INDIVIDUAL RETIREMENT ACCOUNTS (IRAs)

For all Individual Retirement Accounts (IRAs), please provide the requested information and a copy of the current beneficiary designation.

1. Name of Participant:

Name of Custodial Institution:

Beneficiary(ies):

Contingent Beneficary(ies):

2. Name of Participant:

Name of Custodial Institution:

Beneficiary(ies):

Contingent Beneficary(ies):

CERTIFICATES OF DEPOSIT

1. Name of Financial Institution:

Last four numbers of account:

Cash Value: $

Pay on Death Provision:

Yes

Beneficiary(ies):

Contingent Beneficary(ies):

2. Name of Financial Institution:

Last four numbers of account:

Cash Value: $

Pay on Death Provision:

Yes

Beneficiary(ies):

Contingent Beneficary(ies):

BUSINESSES INTERESTS

Name of Business:

Type of entity (Sole Proprietorship, Partnership, LLC, Corporation:

Business Location:

Nature of Business:

Additional Owners and Percentage of Owner:

If there are additional owners, do you have a Buy/Sell Agreement?:

Yes

409A Valuation Price: $

List additional business interests if applicable

INTELLECTUAL PROPERTY

(Trademarks, Copyrights, Patents)

DIGITAL ASSETS/SOCIAL MEDIA ACCOUNTS

SAFE DEPOSIT BOX (*Grant successor Trustee(s) access*)

PERSONAL & HOUSEHOLD PROPERTY

Personal Property:
List all personal property of significant value, including, for example, antiques, artwork, other collectibles, and jewelry. Also, please list whether each item is either: Community property, SPOUSE 1’s separate property, or SPOUSE 2’s separate property.

Antiques, Artwork and Collectibles:

Jewelry:

Automobiles/Motorcycles/RVs/Boats:

1. Make and Model:

Name on registration:

2. Make and Model:

Name on registration:

3. Make and Model:

Name on registration:

Firearms:

1. Make and Model:

2. Make and Model: