Estate Planning Questionnaire

USING THIS ORGANIZER WILL ASSIST US IN DESIGNING AN ESTATE PLAN THAT MEETS YOUR GOALS. ALL INFORMATION PROVIDED IS STRICTLY CONFIDENTIAL.

You can pause answering this questionnaire at any time and come back later by clicking the "Save and Continue Later" link at the bottom. Note that the progress is only saved for 30 days.

Your Anzen Legal Attorney

Please select the Attorney you are working with so we can notify them when you have completed this form.

Personal Information

Client's Legal Name

(name most often used to title property and accounts)

Other names you use to title property and accounts

I prefer to be called

Home Address

Street Address Address Line 2 City State ZIP Code

Mobile Phone

Work Phone

Enter Email Confirm Email

US Citizenship

I am a United States Citizen

Spouse Information

Are you currently married?

Did you have a wedding ceremony?

In what state was your wedding ceremony?

Did you register or receive a license to be married?

Name of Spouse

Spouse also known as

Spouse prefers to be called

Does your spouse live at an address different from yours?

Spouse address

Street Address Address Line 2 City State ZIP Code

Spouse Phone

Spouse Work Phone

Spouse Email

Enter Email Confirm Email

Are you in a domestic partnership?

Do you live with someone not related to you by blood (other than spouse)?

Spouse US Citizenship

I am a United States Citizen

Children and Other Family Members

Do you have children (by blood, marriage, or adoption)

Children

Child's Name	Actions

There are no Children.

Important Family Questions

Are you (or your spouse) making payments pursuant to a divorce or property settlement order?

Have you and your spouse signed a pre- or post-marriage contract?

Have you (or your spouse) completed previous will, trust, or estate planning?

Have you lived in any of the following states while married to each other?

Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin

Are you (or your spouse) currently the beneficiary of anyone else’s trust? If so, please explain below.

Trust beneficiary explanation

Do any of your minor children have special educational, medical, or physical needs?

Do any of your minor children receive governmental support or benefits?

Do you provide major financial support to your adult children or to other relatives?

Real Property

Please add any interest in real estate including your family residence, vacation home, timeshare, vacant land, etc.

Do you have any property interests?

Properties

Property Address	Actions

There are no Properties.

Business Interests

General and Limited Partnerships, Sole Proprietorships, privately-owned corporations, professional corporations, oil interests, farm, and ranch interests. ADDITIONAL INFORMATION: Give a description of the interests, who has the interest, your ownership in the interests, and the estimated value of the interests.

Designer Information

Would you like to appoint a guardian for minor children?

Guardian

Name	Actions

There are no Guardians.

Financial Agent

If you are incapacitated, is there anyone you want to give authority to make legal or financial decisions on your behalf?

Client Financial Agents

Name	Actions

There are no Financial Agents.

Spouse Financial Agents

Name	Actions

There are no Financial Agents.

Do you want to authorize your Financial Agent to make gifts on your behalf during any period of time you are incapacitated?

Client Authorizes Financial Agent to make gifts?

Client Gifting Power Details

Spouse Authorizes Financial Agent to make gifts?

Spouse Gifting Power Details

Living Will

What, if any, medical technologies should your agent request to prolong your life if you are incapacitated? And for how long?

Do you want your organs and tissues donated for transplant, research, science purposes? Any limitations on which organs?

Disposition of Last Remains

Do you want to be cremated or buried?

Do you have any specific wishes for the cremation or burial process?

Health Care

If you are incapacitated, is there anyone you want to give authority to make medical decisions on your behalf?

Client Medical Agent

Name	Actions

There are no Medical Agents.

Spouse Medical Agent

Name	Actions

There are no Medical Agents.

Personal Representatives

When you pass away, who do you want to designate in your will to close out your estate and distribute your assets to beneficiaries?

Client Personal Representative

Name	Actions

There are no Personal Representatives.

Spouse Personal Representative

Name	Actions

There are no Personal Representatives.

Trustee

If you create a trust for your estate plan, who would you want to give responsibility to for carrying out the instructions of your trust?

Client Trustee

Name	Actions

There are no Trustees.

Spouse Trustee

Name	Actions

There are no Trustees.

Your Concerns

Providing for children and/or grandchildren

Disinheriting a family member

Reducing your estate tax

Planning for a child or family member with special needs

Protecting children’s inheritance in the event of my spouse remarrying after you pass away

Providing for a pet after my death

Distributions of Property

How would you like to distribute your assets and property upon your death? This is for general distributions such as “half of my assets to my son and the other half to X charity.”, not for smaller gifts like “my guitar to my sister.” You will have the chance to gift specific items in another document. However, if you want to provide a specific gift of real estate, please list it here. For each person you list, please provide their full name and address.

Client instructions for distribution of property

Spouse Instructions for distribution of property

Client alternate distributions

If the people you listed above pass away before you, is there anyone (other than their descendants) that you would like their shares to go to?

Spouse alternate distributions

If the people your spouse listed above pass away before them, is there anyone (other than their descendants) that your spouse would like their shares to go to?

Backstop Beneficiary

In a very rare situation where none of your beneficiaries can take their share, what charities would you like to benefit? You may choose as many charities as you wish and allocate percentages how you wish. You must select charitable institutions or organizations, not individual people. You are selecting one or more charities as a fallback in the case that all of your named beneficiaries are disqualified. This ensures that the government cannot ultimately control where your assets go.

Client Backstop Beneficiary

Spouse Backstop Beneficiary

How did you hear about us?