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Name of Trust: The ______________ Living Trust

Client Information - Strictly Confidential

Spouse/Partner #1:

First Name

Middle Name

Last Name

Aliases Used

Phone Number

Birth Date

Gender

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Spouse/Partner #2:

First Name

Middle Name

Last Name

Aliases Used

Phone

Birth Date

Gender

IF NOT, please indicate how you would like them to be referenced throughout the trust:

(e.g., "Significant Other", "Partner", "Life Partner", "Friend", etc.)

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Address:

Street Address 1

Apt Suite Number

City

Zip Code

County

Home Phone Number

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Children of Marriage

All children of both spouses must be listed, including children who are disinherited. If additional space is needed, please use the Final Supplementary Page

We DO NOT have any children of this marriage/life partnership

(If you checked this box, skip this section)

Child #1

Full Name

Middle

Birth Date

Gender

Child #2

Full Name

Middle

Birth Date

Gender

Child #3

Full Name

Middle

Birth Date

Gender

Child #4

Full Name

Middle

Birth Date

Gender

Child #5

Full Name

Middle

Birth Date

Gender

Child #6

Full Name

Middle

Birth Date

Gender

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Children of Prior Marriages/
Other Beneficiaries

We DO NOT have any children from prior marriages/relationships.

(If you checked this box, skip this section)

Beneficiary #1

Full Name

Birth Date

Relationship

Relation to Who

Gender

Beneficiary #2

Full Name

Birth Date

Relationship

Relation to Who

Gender

Beneficiary #3

Full Name

Birth Date

Relationship

Relation to Who

Gender

Beneficiary #4

Full Name

Birth Date

Relationship

Relation to Who

Gender

Beneficiary #5

Full Name

Birth Date

Relationship

Relation to Who

Gender

Beneficiary #6

Full Name

Birth Date

Relationship

Relation to Who

Gender

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If you answered YES:

Please enter the full name(s) of each child(ren)

Please enter the full name(s) of each surviving child(ren)

If you answered YES:

Please enter the full name(s) of each child(ren)

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Prior Marriages

Spouse/Partner #1:

If you answered YES:

Please enter the full name(s) of your previous spouse(s):

Date of Termination

Spouse/Partner #2:

If you answered YES:

Please enter the full name(s) of your previous spouse(s):

Date of Termination

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Miscellaneous Information

11-A. IF YES - List Separate Assets/Owners

12. Do you have any specific concerns (not already mentioned) regarding your estate?

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Current Assets

Please check all that apply and provide the requested details
for the assets you want this specific trust to hold.

Bank Account/Safety Deposit Box Details

Please include:
- Bank or Institution
- Name on the Account
- Type of Account

Retirement Accounts Details

Please include:
- Bank or Institution
- What kind of account it is (401K, IRA, etc.)
- Name on the account

Real Property Details

Please include:
- Property Address
- Indicate if its personal/investment property

Business Entities Details

Please Include:
- Name of Business
- Purpose of Business

Stocks and Bonds: Details

Insurances/Annuities Details:

Additional assets may be listed on Supplementary Page

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Specific Distributions

IF YES: List the name of the business and beneficiary

IF YES: List preferred age of inheritance

IF YES: Please list the details

IF YES: List the name of the beneficiary

Residual Distributions

In general, how would you like the remaining assets of your estate to be distributed among your beneficiaries after BOTH spouses/partners pass away?

NOTE: Any unspecified assets, typically split into percentages between chosen beneficiaries.

If a beneficiary passes before you/the time of distribution, would you like their share to pass to their children, if any (Per Stirpes) or to the remaining beneficiaries (Per Capita)?

Per Stirpes: Deceased beneficiary's share goes to their children in equal shares. If no children exist, the share will then be distributed to the remaining beneficiaries.

Per Capita: Deceased beneficiary's share is distributed to the remaining beneficiaries.

If ALL beneficiaries were to die at the same time, who would you like to list as a contingent beneficiary? (individual, church, school, organization)

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Trust & Will Information

Each of you will automatically be listed in the trust as the first successor trustee and first successor medical agent for your spouse/partner. Please list who you would like to act, should you both pass away or become incapacitated.

*Individuals MUST be a legal adult (At least 18 years old)

Who would you like to administer your estate after your deaths?

Successor Trustee: The person who assumes control of the trust after the initial trustee(s) dies or becomes unable to continue with his or her (their) responsibilities. Once the successor trustee has assumed control, he or she is responsible to ensure that your property is distributed to your beneficiaries according to the trust terms.

First Successor Trustee:

First Successor Trustee: Full Name

First Successor Trustee: Relationship

Second Successor Trustee:

Second Successor Trustee: Full Name

Second Successor Trustee: Relationship

Third Successor Trustee:

Third Successor Trustee: Full Name

Third Successor Trustee: Relationship

Only Chose One Option

I would like my Successor Trustees to act in succession, in the order provided.

I would like my Successor Trustees to act together as Co-Trustees.

IF YES: List Amount/Percentage or "general language to be added"

Who would you like to help administer Medical Decisions if you become incapacitated?

Successor Agent: The person you choose in advance to make health care related decisions on your behalf in the event that you become unable to do so. They may also follow through with your predetermined wishes. Your spouse/partner (if applicable) is generally your first Medical Agent.

*Must be at least 18 years old or older.

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If you will be using the same Successor Agent(s) for both of you, please check the box below.

We will be using the same Successor Agent.

IF NOT, then please list the full names and relationship to the individual for each spouse/partner in the sections below.

Spouse/Partner #1:

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Spouse/Partner #2:

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First Successor Agent:

Full Name

Relationship

First Successor Agent:

Full Name

Relationship

Second Successor Agent:

Full Name

Relationship

Second Successor Agent:

Full Name

Relationship

Third Successor Agent:

Full Name

Relationship

Third Successor Agent:

Full Name

Relationship

Guardians

A legal guardian is a person who has the legal authority to care for the personal and property interests of another person. In most cases, minor children. Your spouse/partner if applicable is generally the first Successor Guardian.

*Any individual listed must be a legal adult (at least 18 years old).

First Successor Guardian:

Full Name

Relationship

Second Successor Guardian:

Full Name

Relationship

Third Successor Guardian:

Full Name

Relationship

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Burial Wishes

Spouse/Partner #1:

If you choose to be cremated, where would you like your ashes placed?

If you choose to be buried, where would you like your remains interred?

If YES, please specify:

Spouse/Partner #2:

If you choose to be cremated, where would you like your ashes placed?

If you choose to be buried, where would you like your remains interred?

If YES, please specify:

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Additional Beneficiaries,
Concerns, and Wishes

Please list any additional beneficiaries, concerns, and/or wishes not covered in this form:

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WAIVER OF POTENTIAL CONFLICT OF INTEREST

We have each read the foregoing material and understand that there are potential conflicts of interest between myself and my spouse in the matters about which we are consulting you. If either of us desire to have separate counsel or desire you not to be involved at all, that spouse shall notify you. We each hereby consent to having you represent both of us in the drafting of our estate planning documents and we each hereby waive any potential or actual conflicts of interest. We understand that since you will be representing both of us on the same matter, as between ourselves and you, there are no confidential communications.

Dated This Day:

We have read and understand the information regarding the Waiver of Potential Conflict of Interest

Online Signature: Spouse/Partner #1 - (Please type your name below)

Online Signature: Spouse/Partner #2 - (Please type your name below)

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for the assets you want this specific trust to hold.

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