Licensed California Attorney - Bar #208356
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(818) 291-6217
LAW OFFICES OF ROZSA GYENE
Estate Planning & Probate Specialists Since 2001
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Estate Planning Questionnaire
Complete this comprehensive form to help us prepare your estate planning documents
Email Address
*
CLIENT INFORMATION
First Name
*
Middle Name
Last Name
*
Also Known As
Gender
Male
Female
Date of Birth
*
Social Security Number
U.S. Citizen?
Yes
No
Street Address
*
City
*
State
*
Zip Code
County
Contact Phone
Marital Status
Select...
Single
Married
Separated
Divorced
Widowed
Date of Marriage
Do you currently have a Living Trust?
Yes
No
SPOUSE INFORMATION
Spouse First Name
*
Spouse Middle Name
Spouse Last Name
*
Spouse Also Known As
Spouse Gender
Male
Female
Spouse Date of Birth
*
Spouse SSN
Spouse U.S. Citizen?
Yes
No
Did you sign a pre-nuptial agreement?
Yes
No
CHILDREN INFORMATION
Add Child
EXCLUDED FAMILY MEMBERS
Are there any family members you want to exclude from your Living Trust?
Yes
No
List names and relationships:
INITIAL TRUSTEE(S)
Who will serve as Initial Trustee(s)?
Client to serve as Initial Trustee
Client and Spouse to serve together
Spouse to serve as Initial Trustee
SUCCESSOR TRUSTEE(S)
Add Successor Trustee
How should Successor Trustees serve?
In the order listed above
Together as Co-Trustees
Other arrangement
SPECIFIC GIFTS
Add Specific Gift
DISTRIBUTION OF REMAINING TRUST ESTATE
How should your estate be distributed?
Divide equally among beneficiaries
Divide by specific percentages
Add Beneficiary
When should beneficiaries receive their inheritance?
Immediate distribution upon death
Hold in trust until specific age
Periodic distributions at specified ages
At what age?
If a beneficiary dies before receiving their inheritance:
Goes to their children
Divided among remaining beneficiaries
FINAL CONTINGENCY
Final distribution if all beneficiaries predecease you:
To my heirs at law
To specific individuals or charities
Add Individual/Charity
SPECIAL PROVISIONS
List any special concerns for beneficiaries:
POUR-OVER WILL EXECUTORS
Client's Executors:
Add Executor
Do you desire cremation?
Yes
No
Spouse's Executors:
Add Executor
Does your spouse desire cremation?
Yes
No
GUARDIANS FOR MINOR CHILDREN
Add Guardian
FINANCIAL POWER OF ATTORNEY
Client's Financial Power of Attorney:
Add Agent
When effective?
Immediately
Upon Incapacity
Spouse's Financial Power of Attorney:
Add Agent
When effective?
Immediately
Upon Incapacity
HEALTHCARE POWER OF ATTORNEY
Client's Healthcare Power of Attorney:
Add Agent
When effective?
Immediately
Upon Incapacity
Do you wish to make anatomical gifts?
Yes
No
For what purpose?
Select...
For transplantation only
For research only
For transplantation or research
For any purpose
Spouse's Healthcare Power of Attorney:
Add Agent
When effective?
Immediately
Upon Incapacity
Does your spouse wish to make anatomical gifts?
Yes
No
For what purpose?
Select...
For transplantation only
For research only
For transplantation or research
For any purpose
GROSS VALUE OF CURRENT ESTATE
Your approximate current net worth is:
Less than $1,000,000
$1,000,000 - $2,000,000
$2,000,000 - $4,000,000
More than $4,000,000
Estate includes:
Farm Property
Family Owned Business
Professional Practice
LIFE INSURANCE
Add Insurance Policy
Submit Questionnaire
Questionnaire Summary:
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