TRUST QUESTIONNAIRE

I. PERSONAL DATA

A. CLIENT
CLIENT’S FULL NAME:
U.S. Citizen: YES NO If not U.S. Citizen, what Country:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE: ( ) -
ALTERNATE PHONE: ( ) -

B. CHILDREN

• Is there a physical possibility of more children? (Please circle one): YES NO
• 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 above deceased children:
_______________________________________________________________________________
CHILD’S NAME:
DATE OF BIRTH:
ADDRESS:
CITY:
STATE:
ZIP:
SPOUSE’S NAME:
CHILD’S CHILDREN (name & ages):
CHILD’S NAME:
DATE OF BIRTH:
ADDRESS:
CITY:
STATE:
ZIP:

SPOUSE’S NAME:
CHILD’S CHILDREN (name & ages):

CHILD’S NAME:
DATE OF BIRTH:
ADDRESS:
CITY:
STATE:
ZIP:
SPOUSE’S NAME:
CHILD’S CHILDREN (name & ages):

CHILD’S NAME:
DATE OF BIRTH:
ADDRESS:
CITY:
STATE:
ZIP:
SPOUSE’S NAME:
CHILD’S CHILDREN (name & ages):

C. PETS.
Do you want to provide for the care of your pets should you become disabled or pass away? 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. Please be aware
that you may have as many trustees as you wish, we ask that you please list them in order.
INITIAL TRUSTEE:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
CO-TRUSTEE/TRUSTEE:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
SUCCESSOR TRUSTEE:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
< If more than one trustee or successor trustee is chosen, how will they serve (one at a time or all
together)? If they serve together can they act independently of one another or must they act together?
__________________________________________________________________
< How will disagreements among multiple trustees serving together be resolved?
Will a majority decision to act suffice, or must the decision be unanimous? ____________________

III. TRUST DISTRIBUTION

A. Who are the intended beneficiaries?______________________________________________
______________________________________________________________________________
T What percentage or monetary amount will the above beneficiaries each receive?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

T If a beneficiary does not survive you, what is to happen to that beneficiaries share?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

B. If your children are under a specified age, should their share be held in trust until a particular age?
YES NO If so, what age?____________________
C. Do you want all of a child's share all to be distributed at one time or a percentage distributed at a
particular age? (Please indicate which choice you prefer)
One time distribution____________________ Age of distribution______________________
D. Are there any descendants who are to be omitted? If so, please state name(s) _________________
_________________________________________________________________________
_________________________________________________________________________

V. FINANCIAL DATA

A. REAL ESTATE OWNED
1. Legal Description________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Owner_______________________________Date Acquired________________
Cost_________________Lien_________________Value__________________
2. 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
_________________________________________
Please add additional sheets as necessary.