Trust Questionaire

Have you ever had a Trust created before? If so, what was the exact name and date.

Yes (If yes please type the name and date in the 'other' box below

No

Other

Any specific gifts (ie. financial)

Yes (If yes, please input the information in the 'other' box)

No

Other

Primary Durable Power of Attorney ( This will be your spouse)

1st Alternate (Name, Address & Phone Number)

2nd Alternate (Name, Address & Phone Number)

Primary Durable Power of Attorney (This will be your spouse)

1st Alternate (Name, Address & Phone Number)

2nd Alternate (Name, Address & Phone Number)

HIPPA Waiver, Who can have access to your medical records?

Who is your Trust Protector (This is the individual who can 'fire' the third party trustee on behalf of the beneficiaries.)

2nd Choice

Final Disposition Requests

Cremation

Burial

Pre-made Arrangements (If so, please input the arrangements in the 'other' box)

Other

Are there children from this current marriage (if applicable)

Yes (If yes, please write how many children there are and from side of the family)

No

Other

Are there any children from a pervious marriage?

Yes ( If yes, please state how many and who has the child from the pervious marriage in the 'other' box)

No

Other