Questionnaire
Les Klein & Associates
TRUST QUESTIONARIRE
Dear Client:
Please fill out this questionnaire by printing it on your browser and filling in the blank spaces. You should bring it to your appointment, or the lecture you plan on attending.
DECLARATION OF TRUSTEE
Name: ( First, Middle, Last) __________________________________
Address: (#, Street, City, State, Zip) _________________________________
_______________________________________________________________
County of Residence: ____________________________
Telephone: (H)___________________ (W) _____________________
DECLARATION OF FAMILY STATUS
Check applicable lines.
1. ______ I am unmarried
2. ______ I am married
3. ______ I had a prior marriage, Dissolved by Decree
4. ______ I had a prior marriage, Terminated by death
5. ______ I have living or adopted children
6. ______ I have deceased children
COMPLETE APPLICABLE SECTIONS
A-1. Spouse's Full Name: ___________________________________
A-2. Prior Marriage Terminated by Decree;
Former Spouse's Full Name: __________________________________
Court, State and date of Decree: ___________________________________
A-3. Prior Marriage Terminated by Death;
Former Spouse's Full Name: ___________________________________
Date of Death: ________________________
A-4. Names of Living or Adopted Children;
#1. Full Name: __________________________________
Address: ____________________________________
Date of Birth: ________________________________
#2. Full Name: __________________________________
Address: ____________________________________
Date of Birth: ________________________________
If you have additional children please write the information on a separate piece of paper and attach it to the form.
A-5. Names of Deceased Children
Full Name: ___________________________
Date of Death: _________________________
APPOINTMENT OF GUARDIAN
1. If you have minor children, who do you wish to be Guardian of your minor children if both parents should die prior to any of the children reaching the age of majority (18 years of age)?
Full Name: _____________________________________
2. In the event that your designated Guardian predeceases you, please list the full Name of the Alternate Guardian.
Full Name: ____________________________
I recommend, but it is not mandatory, that my Executor use Les Klein & Associates as attorneys for their estate.
TRUSTEE NOMINATION
1. Who do you wish to be Trustee of your Trust?
Full Name: __________________________________
Relationship: ________________________________
2. Successor Trustee
Full Name: ____________________________
Relationship: ___________________________
DISINHERITANCE (if desired)
1. List individuals you specifically desire to disinherit.
a. Full Name: _________________________ Relationship: _______________
b. Full Name : ________________________ Relationship: _______________
GIFT OF ESTATE
A. Complete this section if 100% of your estate is to go to one individual
(Complete section "B" if more that one person is to receive estate):
Full Name of person to receive 100%: ___________________________
Relationship: _________
Address: _______________________________________
B. In the event the above individual is deceased, I desire the above share go to the following, to share according to the percentage indicated:
EITHER (CHECK ONE)
_______ my children to share equally OR
_______ the following distribution
Full Name: __________________________ Relationship: __________
Percentage: _____
Full Name: __________________________ Relationship: __________
Percentage: _____
Full Name: __________________________ Relationship: __________
Percentage: _____
C. Who will receive the residue (balance) of your estate?
a. Full Name _________________________________
Percentage _______________
b. Full Name _________________________________
Percentage _______________
ASSETS
1. Do you _______ Rent or ________ own your home?
2. If you own your home, how is title held?
(To answer this question refer to your Deed or Title Insurance Policy.)
____________________________________________________________
3. Do you own other Real Property? _____ Yes ____ No. If Yes how is it titled?
_________________________________________________________
4. Aside from your employment, do you have any additional business interests?
____ Yes ____ No. If yes give a brief description of such interest.
_____________________________________________________________
_____________________________________________________________
5. What is your Net Worth? ________________________
6. List the approximate value of your assets as of this date
(e.g., life insurance policies, real estate, stocks, bonds, checking and savings accounts, etc.)
a.___________________________________________________________
b.___________________________________________________________
c.___________________________________________________________
d.___________________________________________________________
e.___________________________________________________________
Any specific instructions you desire to be included in your Trust that may not
have been covered, such as Burial Instructions, etc., please list below:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
_____________________
Date
_____________________________
Signature
|
|