Estate Planning Questionnaire — Law Offices of Leah Larkin

1Client 1 — General Information

Signature Name (as you sign on legal documents)

First Name *

Middle Name/Initial

Last Name *

Suffix (Jr., Sr., etc.)

My Driver's License name is the same as my Signature Name

Driver's License Name

First Name

Middle Name/Initial

Last Name

Suffix

Contact & Personal Information

Phone Number *

Email Address (optional — at least phone OR email required)

Date of Birth *

Home Address

Street Address *

City *

State *

Zip Code *

County *

Additional Information

Occupation

Number of Children

Do you have any memory or cognitive issues that would affect your ability or capacity to do estate planning? *

No Yes

Has anyone ever suggested you may have a memory or cognitive issue or impairment? *

No Yes

Are you married or registered as a domestic partner? *

No Yes

1Client 2 — Spouse / Domestic Partner

If you are married or registered as a domestic partner, Client 2 enters their information here.

Signature Name

First Name *

Middle Name/Initial

Last Name *

Suffix

My Driver's License name is the same as my Signature Name

Driver's License Name

First Name

Middle Name/Initial

Last Name

Suffix

Contact & Personal Information

Phone Number *

Email Address

Date of Birth

Occupation

Number of Children

Same children as Client 1

Do you have any memory or cognitive issues that would affect your ability or capacity to do estate planning? *

No Yes

Has anyone ever suggested you may have a memory or cognitive issue or impairment? *

No Yes

2Living Trust

Your successor trustee is like your executor — they step in to manage trust assets when you are unable to do so.

Do you own your home? *

Yes, I own my home No (renting)

Do you own any real property other than your home? *

No Yes

What is your estimated net worth?

Please provide a copy of the Grant Deed (not the Deed of Trust) for any properties you own. You can bring it to your meeting or email it to leah@inlandlaw.com.

Successor Trustees

1st Successor Trustee

2nd Alternate Successor Trustee

3rd Alternate Successor Trustee

4th Alternate Successor Trustee

Use the same people throughout all my documents

Trust Administration Settings

Do you want your trustee to provide an accounting to the beneficiaries? *

Yes No

Would you like your successor trustee to be paid for managing your trust?

No Yes I'm not sure

If a beneficiary might be young when they inherit, at what age should they receive the money? *

Do you want your trustee to have the power to manage your digital communications and assets? *

Yes No

Beneficiaries

Upon your death, who do you want to receive your trust assets? *

If a beneficiary predeceases you, how would you want their share to pass? *

2Pour-Over Will

Your Pour-Over Will is a back-up to your Trust. We typically name the same individuals as your successor trustees, but you may name someone different.

Executors — Client 1

1st Executor

2nd Executor

3rd Executor

4th Executor

3Durable Power of Attorney for Finances

Your Durable Power of Attorney for Finances allows a nominated individual (your "attorney in fact") to step into your shoes and act for you financially. Choose someone you have the utmost trust in.

Do you want your DPAF to be effective immediately when you sign it, or when you are incapacitated? *

Effective Immediately Upon Incapacity Unsure

DPAF Agents — Client 1

1st Agent (Attorney in Fact)

2nd Alternate Agent

3rd Alternate Agent

4th Alternate Agent

Do you want to restrict the power under this document in any way? *

No Yes

Do you want your attorney in fact to be compensated? *

Yes, allow compensation No compensation

4Durable Power of Attorney for Health Care

This document names who you want to make your health care decisions for you in the event you cannot make them for yourself. You can also outline your health care wishes here.

DPAHC Agents — Client 1

1st Health Care Agent

2nd Alternate Agent

3rd Alternate Agent

4th Alternate Agent

Health Care Wishes — Client 1

What are your feelings about life support? *

What are your feelings about organ donation? *

Yes, allow organ donation No organ donation

Do you want to be cremated or buried? *

Buried Cremated I've made my wishes known to my agent

Do you want Alzheimer's/dementia language added to your DPAHC? *

Yes, include Alzheimer's language No, let my agent decide

Do you have any other specific health care wishes? *

No Yes

5Additional Information

Do either of you have any existing estate planning documents?

No Yes

Did anyone help you fill out this form?

No Yes

Have you consulted another attorney about your estate planning?

No Yes

Is there anything else you'd like to discuss with the attorney?

Law Offices of Leah Larkin

Welcome — Let's Get Started

Thank You!