TRUST WORKSHEET

Please complete as much as possible and we will review together during our consultation..

How were you referred to our office?

BASIC INFORMATION

First and Middle Name

As appears on legal ID.

Last Name

As appears on legal ID

Other name(s) used/also known as (AKA)

Date of birth

Cell Phone

Please follow this format (xxx) xxx xxxx

E-mail

Business/Employer

Occupation

Primary Residence

Use same address for mailing?

Yes
No

US Citizen?

Yes
No

MARITAL STATUS

DECEASED SPOUSE/PARTNER INFORMATION

2ND SPOUSE/PARTNER INFORMATION

CHILDREN

How many children do you have?

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

DISTRIBUTION OF ASSETS

Who should inherit your assets, and how should they be divided?

Examples:
A. Equally to our children upon the death of the surviving spouse.
B. Equally to our children when they each reach age _____.
C. Half at age ____ and the remaining half at age ____.
D. Other: ________________________________________

your a as

CONTINGENT BENEFICIARY

If, in the very unlikely event your entire immediate family does not survive you, who should inherit your assets?

Examples:
A. 50% to each spouse’s parents, or the survivor; if neither survives, then equally to that spouse’s siblings.
B. 50% to each spouse’s siblings, in equal shares, or to the survivor(s).
C. Equally to our nieces and nephews.
D. Other: ____________________.

PET

Do you have pet(s)?

Yes
No

LIFE ESTATE

Is anyone else living in your home with you now besides your spouse and/or children?

Yes
No

Click the (+) button to add more people to the list.

Full Legal Name

Relationship (be specific)

Example: Wife’s mother, Husband’s brother, etc.

Nomination of Guardianship

Who should raise your minor children if both parents pass away?

Please list full legal name and relationship (e.g., husband’s sister, wife’s mother), in order of priority.

First and Middle Name

Last Name

Relationship

Refer to Trustee As

He/him
She/her

TRUSTEES

Other than your spouse or partner, who should manage your financial affairs and carry out your trust after your death?

Should be a U.S. resident. Please list full legal name and relationship in order of priority.

Trustee

Please be specific when describing the relationship (e.g., Husband’s brother or Wife’s mother).

First and Middle Name

Last Name

Relationship

Refer to Trustee As

He/him
She/her

Trustee #2

Please be specific when describing the relationship (e.g., Husband’s brother or Wife’s mother).

First and Middle Name

Last Name

Relationship

Refer to Trustee As

He/him
She/her

HEALTHCARE AGENTS

Other than your spouse or partner, who should make health care decisions for you if you’re unable to (e.g., in a coma)?

Please list full legal name and relationship, in order of priority.

Healthcare Directive Agent

Please be specific when describing the relationship (e.g., Husband’s brother or Wife’s mother).

First and Middle Name

Last Name

Relationship

Refer to Agent As

He/him
She/her

Healthcare Directive Agent #2

Please be specific when describing the relationship (e.g., Husband’s brother or Wife’s mother).

First and Middle Name

Last Name

Relationship

Refer to Agent As

He/him
She/her

POWER OF ATTORNEY

Enter the name and relationship of the person, other than your spouse or partner, whom you would like to make financial decisions on your behalf if you become unable to make them yourself.

Please list in order of priority.

Power of Attorney Agent

Please be specific when describing the relationship (e.g., Husband’s brother or Wife’s mother).

First and Middle Name

Last Name

Relationship

Refer to Agent As

He/him
She/her

Power of Attorney Agent #2

Please be specific when describing the relationship (e.g., Husband’s brother or Wife’s mother).

First and Middle Name

Last Name

Relationship

Refer to Agent As

He/him
She/her

LIST OF ASSETS

Do you have more than $15 million in assets?

No
Yes

Real Property

List the full address or Assessor’s Parcel Number (APN) of all real property titled in your name, including vacant land.

Other Assets

List assets other than real property (e.g., banking institutions, retirement plans, investment firms, life insurance companies, and business interests)

Do not include account numbers, balances, or other sensitive information.

END-OF-LIFE DECISIONS

If you are ever in a permanent vegetative state or irreversible coma with no reasonable chance of recovery, would you want to:

Remove life support (“pull the plug”)
Remain on life support to keep you alive as long as possible.
Undecided

Organ Donation

Would you like to donate your organs or part of your body? (Check all that apply)

BURIAL WISHES

SPOUSE'S HEALTHCARE DIRECTIVE

Enter the name and relationship of the person, other than your spouse or partner, whom you would like to make health care decisions on your behalf if you become unable to make them yourself.

Please list in order of priority

Use same choices as my spouse?

Yes
No, I want different individuals

Spouse's Healthcare Directive – Agent

Please be specific when describing the relationship (e.g., Husband’s brother or Wife’s mother).

First and Middle Name

Last Name

Relationship

Refer to Agent As

He/him
She/her

Spouse's Healthcare Directive – Agent #2

Please be specific when describing the relationship (e.g., Husband’s brother or Wife’s mother).

First and Middle Name

Last Name

Relationship

Refer to Agent As

He/him
She/her

SPOUSE'S POWER OF ATTORNEY

Enter the name and relationship of the person, other than your spouse or partner, whom you would like to make financial decisions on your behalf if you become unable to make them yourself.

Please list in order of priority

Use same choices as my spouse?

Yes
No, I want different individuals

Spouse's Power of Attorney – Agent

Please be specific when describing the relationship (e.g., Husband’s brother or Wife’s mother).

First and Middle Name

Last

Relationship

Refer to Agent As

He/him
She/her

Spouse's Power of Attorney – Agent #2

Please be specific when describing the relationship (e.g., Husband’s brother or Wife’s mother).

First and Middle Name

Last

Relationship

Refer to Agent As

He/him
She/her

SPOUSE'S END-OF-LIFE DECISIONS

Spouse – At my death, I wish to be:

cremated
buried
other
green/natural burial

I have already made pre-arrangements at:

Anything Else We Should Know?

Do you have any other concerns?

Yes – I have a deceased child who is survived by children.
Yes – I have a disabled beneficiary who receives government assistance.
Yes – I have a beneficiary that may be involved with drug addiction, gambling or alcoholism.
Yes – I have to provide financial support for someone (aging parents, siblings, relative, etc.)
Yes – I have child(ren) from a previous relationship.
Yes – I want to disinherit somebody.

Disinherit Person

Full Legal Name

Relationship (be specific)

Example: Wife’s mother, Husband’s brother, etc.

Receiving Financial Support

Full Legal Name

Relationship (be specific)

Example: Wife’s mother, Husband’s brother, etc.

Deceased Child

Full Name

Date of Death

Previous Relationship – Child

Full Name

Date of Birth

Which Spouse?

Additional Information

Do you have any special requests, concerns, or unique circumstances you’d like to discuss with us? Please include anything you believe would help us better understand your goals and wishes.

Submission Disclaimer

I have reviewed my responses and confirm they are accurate to the best of my knowledge. I understand this information will be used to prepare for my estate planning consultation, and I may update or correct any information with my attorney before any estate planning documents are prepared.

Communication Disclaimer

By submitting this Trust Worksheet, you authorize the Law Offices of Katie Le to use the contact information you have provided to communicate with you by email, text message (SMS), telephone, or other reasonable means. Such communications may include, but are not limited to, requests for information, appointment scheduling, reminders, document delivery, billing, status updates, and other communications related to our representation or your relationship with our office. Standard message and data rates may apply to text messages.

TRUST WORKSHEET

BASIC INFORMATION

DECEASED SPOUSE/PARTNER INFORMATION

2ND SPOUSE/PARTNER INFORMATION

CHILDREN

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

DISTRIBUTION OF ASSETS

CONTINGENT BENEFICIARY

PET

LIFE ESTATE

Nomination of Guardianship

TRUSTEES

Trustee

Trustee #2

HEALTHCARE AGENTS

Healthcare Directive Agent

Healthcare Directive Agent #2

POWER OF ATTORNEY

Power of Attorney Agent

Power of Attorney Agent #2

LIST OF ASSETS

END-OF-LIFE DECISIONS

Organ Donation

BURIAL WISHES

Pre-arrangements

SPOUSE'S HEALTHCARE DIRECTIVE

Spouse's Healthcare Directive – Agent

Spouse's Healthcare Directive – Agent #2

SPOUSE'S POWER OF ATTORNEY

Spouse's Power of Attorney – Agent

Spouse's Power of Attorney – Agent #2

SPOUSE'S END-OF-LIFE DECISIONS

SPOUSE’S – BURIAL WISHES

Anything Else We Should Know?

Disinherit Person

Receiving Financial Support

Deceased Child

Previous Relationship – Child