Estate Planning Questionnaire

SECTION 1: Donor Contact Information

Person 1

Title

Mr. Dr. Rev.

Full Name

DOB

Occupation

No. of Marriages

SSN

Marriage Status

Spouse

Title

Miss. Ms. Mrs. Dr.

Full Name

DOB

Occupation

No. of Marriages

SSN

County

CONTACT DETAILS

Street

County

City

State

Zip

Home Phone

Mobile Phone

Email

His Phone

His Email

Her Phone

Her Email

SECTION 2: Family Details

Children’s Details

Do you plan to have more children?

Yes No

1. After the death of both you and your spouse, who would you appoint to have physical custody and care over your minor children?

Guardian 1:

Guardian 2:

2. Who would you appoint to manage and distribute any property received in trust for your minor children?

Trustee 1:

Trustee 2:

3. Who will collect your assets, pay the debts and expenses of your estate, and distribute your remaining property?

Is your spouse your personal representative?

Yes No

(Please name alternates below in the event your spouse is unable to serve.)

His 1st Alternate Personal Representative

Name

Phone

Street Address

City

State

Zip

His 2nd Alternative Representative

Name

Phone

Street Address

City

State

Zip

Her 1st Alternate Personal Representative

Name

Phone

Street Address

City

State

Zip

Her 2nd Alternative Representative

Name

Phone

Street Address

City

State

Zip

4. Who would make health care decisions on your behalf if you were incapacitated?

Is your spouse your surrogate health care representative?

Yes No

(Please name alternates below in the event your spouse is unable to serve.)

His 1st Alternate:

Name:

Phone Number:

Street Address:

City:

State:

Zip:

Her 1st Alternate:

Name:

Phone Number:

Street Address:

City:

State:

Zip:

Her 2nd Alternate:

Name:

Phone Number:

Street Address:

City:

State:

Zip:

His 2nd Alternate:

Name:

Phone Number:

Street Address:

City:

State:

Zip:

5. Who would continue your day-to-day business, pay bills, etc. if you were incapacitated?

Is your spouse your Power of Attorney?

Yes No

(Please name alternates below in the event your spouse is unable to serve.)

His 1st Alternate:

Name:

Phone Number:

Street Address:

City:

State:

Zip:

His 2nd Alternate:

Name:

Phone Number:

Street Address:

City:

State:

Zip:

Her 1st Alternate:

Name:

Phone Number:

Street Address:

City:

State:

Zip:

Her 2nd Alternate:

Name:

Phone Number:

Street Address:

City:

State:

Zip:

Do you have any specific estate planning concerns?

SECTION 3: Distribution of Your Estate

It is assumed unless you indicate otherwise that your entire estate will pass to your spouse, if surviving.

Will you be passing you entire estate to your spouse or church where you are a member or active at the time of my death?

Please describe below your desired distribution after both husband and wife are passed.

1. Personal effects and household furnishings to be distributed.

by separate list attached to will/trust at discretion of personal representative to children in equal shares as they choose as follows:

2. Specific Charitable Request(s) of cash or property:

Desire to leave a bequest to upon your death? (Example: 10%, a tithe of your estate, or $XXXX?)

If you have chosen to make a charitable gift, do you want us to inform the charity?

Yes No

3. Specific Non-Charitable Bequests of cash or property:

(to specifically named person or persons)

4. The Rest and Residue of my estate:

A

I (we) leave % to my children in trust for their care support, maintenance and education.

Trust terminates when youngest reaches years of age, or when, in the opinion of the trustee, has completed education.

At termination of the trust, remaining trust property passes:

(1)

% or $ to

and/or other named ministries/charities

(2)

% to the children in equal shares. In the event any child predeceases me or does not survive termination of the trust, their portion shall pass:

% per stripes (the property will pass through the generation i.e. to your children’s children) or

% per capita (the property will pass only to the surviving of your children)

B

Beneficiary

% to

First Name

Initial

Last Name

C

Beneficiary

% to

First Name

Initial

Last Name

D

Beneficiary

% to

First Name

Initial

Last Name

E

Beneficiary

% to

First Name

Initial

Last Name

(Note: The percentages listed above for distribution of the rest and residue of your estate must add up to 100%! Please list additional information in the NOTES section at the bottom of page 3 or by attaching additional pages to this form.)

SECTION 4: Additional Notes

NOTES/ADDITIONAL INFORMATION/QUESTIONS

BILLING Estimated Fee: $

SECTION 5: Asset Inventory

(This information is collected to determine if you require Federal and/or State estate tax avoidance planning.)

SECTION 6: Deeds

(Only needed for RLT preparation)

Street Address:

County:

City:

State:

Zip:

Purchase Date:

M/P:

Grantor:

Deed Book:

page:

Street Address:

County:

City:

State:

Zip:

Purchase Date:

M/P:

Grantor:

Deed Book:

page:

Street Address:

County:

City:

State:

Zip:

Purchase Date:

M/P:

Grantor:

Deed Book:

page:

Review Your Questionnaire

Review the answers below before submitting.

Estate Planning Questionnaire

SECTION 1: Donor Contact Information

Person 1

Marriage Status

Spouse

CONTACT DETAILS

SECTION 2: Family Details

Children’s Details

1. After the death of both you and your spouse, who would you appoint to have physical custody and care over your minor children?

2. Who would you appoint to manage and distribute any property received in trust for your minor children?

3. Who will collect your assets, pay the debts and expenses of your estate, and distribute your remaining property?

His 1st Alternate Personal Representative

His 2nd Alternative Representative

Her 1st Alternate Personal Representative

Her 2nd Alternative Representative

4. Who would make health care decisions on your behalf if you were incapacitated?

His 1st Alternate:

Her 1st Alternate:

Her 2nd Alternate:

His 2nd Alternate:

5. Who would continue your day-to-day business, pay bills, etc. if you were incapacitated?

His 1st Alternate:

His 2nd Alternate:

Her 1st Alternate:

Her 2nd Alternate:

SECTION 3: Distribution of Your Estate

1. Personal effects and household furnishings to be distributed.

2. Specific Charitable Request(s) of cash or property:

3. Specific Non-Charitable Bequests of cash or property:

4. The Rest and Residue of my estate:

SECTION 4: Additional Notes

SECTION 5: Asset Inventory

SECTION 6: Deeds

Review Your Questionnaire

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