TRUST QUESTIONNAIRE

Client's Name(s)____________________________________________________

Home Telephone___________________________________________________

Husband's Work___________________________________________________

Wife's Work______________________________________________________

Principal Residence

Street Address___________________________________________________

City__________________________State______Zip_____________________

Vacation Home

Street Address___________________________________________________

City__________________________State______Zip_____________________

I.PERSONAL DATA

A.HUSBAND AND WIFE

Husband'sfull name______________________________________________

U.S. Citizen_____________ If not, what Country___________________

Marriage date____________________

Previous marriages (list names of former spouse and children; provide a copy of the Divorce Decree)__________________________________________________________________________

Wife'sfull name_________________________________________________

U.S. Citizen_____________ If not, what Country___________________

Marriage date____________________

Previous marriages (list names of former spouse and children; provide a copy of the Divorce Decree) _________________________________________________________________________________

B. Children

Is there a physical possibility of more children_________________

Are any of your children adopted; if so, please list_______________________________________

Are any of your children handicapped or in poor health, if so, please list_______________________

Are any of your children deceased, if so, please list_______________________

Please list any grandchildren of such deceased children

_________________________________________________________________

1. Child's name________________________Date of Birth_______________

    Address______________________________________________________

    Spouse's name_________________________________________________

    Child's children (names and ages)____________________________________________________

    _______________________________________________________________________________

2. Child's name________________________Date of Birth_______________

    Address______________________________________________________

                Spouse's name_________________________________________________

    Child's children (names and ages)___________________________________________________

    ______________________________________________________________________________

3. Child's name________________________Date of Birth_______________

    Address______________________________________________________

Spouse's name_________________________________________________

    Child's children (names and ages)_____________________________________________________

    ________________________________________________________________________________

4. Child's name________________________Date of Birth_______________

    Address______________________________________________________

    Spouse's name_________________________________________________

    Child's children (names and ages)_____________________________________________________

    ________________________________________________________________________________

C. Pets. Do you want to provide for the care of your pets should you become disabled or pass away?

HUSBAND YES________ NO________

WIFE YES________ NO________

Caregiver choice_________________________________________

Name/Type of Pet(s)______________________________________

II. CHOICE OF TRUSTEE(The trustee is responsible for managing assets held in trust for the benefit of specified beneficiaries.)

HUSBAND

Initial Trustee__________________________________________________ Address________________________________________________________

City________________________State______Telephone_________________

Co-Trustee_____________________________________________________

Address________________________________________________________

City________________________State______Telephone_________________

Successor Trustee________________________________________________

Address_________________________________________________________

City________________________State______Telephone_________________

WIFE

Initial Trustee __________________________________________________

Address________________________________________________________

City________________________State______Telephone_________________

Co-Trustee_____________________________________________________

Address________________________________________________________

City________________________State______Telephone_________________

Successor Trustee________________________________________________

Address_________________________________________________________

City________________________State______Telephone_________________

III. TRUST ARRANGEMENTS

A. Do you want the trust funds to be held in one common fund until your youngest has the opportunity to obtain a college education?

HUSBAND YES________ NO________

WIFE YES________ NO________

B. If your children are under a specified age, should their share be held in trust until a particular age?

HUSBAND YES________ NO________ If so, what age?________________________

WIFE YES________ NO________If so, what age?________________________

C. Do you want all of a child's share to be distributed at one time or a percentage distributed at a particular age?

HUSBAND One time distribution_________________________________

Age of distribution______________________________________________

WIFEOne time distribution____________________________________

Age of distribution______________________________________________

D. Does your child's children take his/her parents' share if your child does not survive you?

HUSBAND YES________ NO________

WIFE YES________ NO________

E. CHOICE OF GUARDIAN FOR MINOR CHILDREN IF BOTH GRANTORS ARE DECEASED_____________________________________________________________

F. CARE INSTRUCTIONS FOR ANY MINOR CHILDREN

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

V. FINANCIAL DATA(Designate whether owned by husband(H) or wife (W), or jointly owned (J).

A. REAL ESTATE OWNED

1. Legal Description_________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Owner_______________________________Date Acquired________________

Cost_________________Lien_________________Value__________________

2. Legal Description_________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Owner_______________________________Date Acquired________________

Cost_________________Lien_________________Value__________________

3. Legal Description_________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Owner_______________________________Date Acquired________________

Cost_________________Lien_________________Value__________________

B. STOCKS AND BONDS

Company__________________________________________________________

Type____________________# of Shares__________ Value_________________

Owner____________________________________________________________

Company__________________________________________________________

Type____________________# of Shares__________ Value_________________

Owner____________________________________________________________

C. BANK ACCOUNTS

Bank____________________________________Type_____________________

Owner___________________________________Balance__________________

Bank____________________________________Type_____________________

Owner___________________________________Balance__________________

Bank____________________________________Type_____________________

Owner___________________________________Balance__________________

Bank____________________________________Type_____________________

Owner___________________________________Balance__________________

D. BUSINESS INTERESTS

Name____________________________________Type*___________________

Owner___________________________________Value____________________

*Type: C-Corporation P-Partnership S-S Corporation SP-Sole Partnership

G. PLEASE DESCRIBE ANY RETIREMENT PLAN, PROFIT SHARING PLAN, ETC. (LIST EQUITY)

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

H.LIFE INSURANCE OR ANNUITIES

Company_______________________________________Type_______________

Amount______________________________Cash value____________________

Beneficiary________________________________________________________

Accountant or Tax Preparer _________________________________________

Address__________________________________________________________

Phone____________________________________

Stock Broker______________________________________________________

Address__________________________________________________________

Phone____________________________________

Financial Planner__________________________________________________

Address__________________________________________________________

Phone____________________________________

I. ESTIMATED GROSS ESTATE

Husband only__________________________________

Wife only_____________________________________

Joint_________________________________________

Total_________________________________________

Please add additional sheets as necessary.