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

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 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

Spouse is 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.

Maximum number of children reached.

Are any children minors?

Some or all of the children above are minors

Guardians

Name	Actions

There are no Guardians.

Maximum number of guardians reached.

I would like to specifically disallow someone from being guardian of my children (this will remain private even once in place)

Yes, I would like to disallow someone from being a guardian

Disallowed Persons

Name	Actions

There are no Disallowed People.

Maximum number of disallowed people reached.

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.

Maximum number of properties reached.

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.

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.

Maximum number of financial agents reached.

Spouse Financial Agent

Financial Agents are the same for my Spouse

Spouse Financial Agents

Name	Actions

There are no Financial Agents.

Maximum number of financial agents reached.

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.

Maximum number of medical agents reached.

Spouse Medical Agent

Medical Agents are the same for Spouse

Spouse Medical Agent

Name	Actions

There are no Medical Agents.

Maximum number of medical agents reached.

Living Will

How many days do you want to be kept alive through artificial means such as medicines and hospital equipment if you are in a TERMINAL state?

Enter 0 if you would rather opt for comfort care and no artificial life extension

Please enter a number greater than or equal to 0.

How many days does your spouse want to be kept alive through artificial means such as medicines and hospital equipment if you are in a TERMINAL state?

Enter 0 if your spouse would rather opt for comfort care and no artificial life extension

Please enter a number greater than or equal to 0.

How many days do you want to be kept alive through artificial means such as medicines and hospital equipment if you are in a VEGETATIVE state?

Enter 0 if you would rather opt for comfort care and no artificial life extension

Please enter a number greater than or equal to 0.

How many days does your spouse want to be kept alive through artificial means such as medicines and hospital equipment if you are in a VEGETATIVE state?

Enter 0 if your spouse would rather opt for comfort care and no artificial life extension

Please enter a number greater than or equal to 0.

If you are pregnant, should all natural and artificial measures be taken to deliver the child safely even if it may hasten the death of the mother?

If your spouse is pregnant, should all natural and artificial measures be taken to deliver the child safely even if it may hasten the death of the mother?

Are there any other directives you’d like to make such as “No CPR” or “No blood transfusions”?

Are there any other directives your spouse would like to make such as “No CPR” or “No blood transfusions”?

Do you want to give your medical agent the power to override the decisions you’ve made about artificial extension of life?

Does your spouse want to give their medical agent the power to override the decisions they’ve made about artificial extension of life?

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.

Maximum number of personal representatives reached.

Spouse Personal Representative

Personal Representatives are the same for Spouse

Spouse Personal Representative

Name	Actions

There are no Personal Representatives.

Maximum number of personal representatives reached.

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.

Maximum number of trustees reached.

Spouse Trustee

Trustees are the same for Spouse

Spouse Trustee

Name	Actions

There are no Trustees.

Maximum number of trustees reached.

Your Concerns

Disinheriting a family member

Planning for a child or family member with special needs

Protecting my children’s inheritance in the event that I pass away and my spouse remarries

Protecting the assets I give my children from a potential divorce they go through, they’re creditors, or substance abuse.

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

Is there anything you’d like to alert us of that did not show up in this questionnaire?

ARAG

I was sent to this firm through ARAG

ARAG Member Number

What is your favorite flavor of pie?

How did you hear about us?