Questionnaire for Couples

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Full Legal Name

Phone

Date of Birth (YYYY-MM-DD)

Is Client a U.S. Citizen? *

Yes No

Spouse Full Legal Name

Spouse Date of Birth (YYYY-MM-DD)

Is Spouse a U.S. Citizen?*

Yes No

Spouse Email

Spouse Phone

What is Your Address?

Date of Marriage (YYYY-MM-DD)

Have you been previously married to someone else?

Yes No

Has Your Spouse ever been married to someone else?

Yes No

Children’s Information: for all children, please include full legal name, gender, date of birth, who are parents of this child.

Do any members of your family have special physical or mental challenges?

Yes No

Successor Trustees: Who do you want to select as successor trustees? If neither of you are able to manage the trust, these people will manage your estate according to the instructions outlined in the trust. Please include a full legal name, gender, address, and phone number for EACH of your choices in order from first to third.

For Client: Who do you want in control of financial decisions? Typically, your spouse will be the first choice, followed by second and third choices. Please include a full legal name, gender, address, and phone number for EACH of your choices in order from first to third.

For Spouse: Who do you want in control of financial decisions? Typically, your spouse will be the first choice, followed by second and third choices. Please include a full legal name, gender, address, and phone number for EACH of your choices in order from first to third.

Proposed Guardian of any minor children: Please include full legal name, gender, address, and phone number for EACH of your three choices in order.

For Client: Who do you want to name as your patient advocate? This is someone you would want in control of medical decisions. Please include full legal name, gender, address, and phone number for EACH of your three choices in order.

For Client: Do you want to provide that your patient advocate have authority to end life support if there is no hope of recovery?

Yes No

For Client: Do you want to provide that your organs and tissues be made available for transplant and/or research purposes?

Neither Transplant only Research only Both

For Client: Do you prefer your remains be cremated or buried?

Cremated Buried

For Spouse: Who do you want to name as your patient advocate? This is someone you would want in control of medical decisions. Please include full legal name, gender, address, and phone number for EACH of your three choices in order.

For Spouse: Do you want to provide that your patient advocate have authority to end life support if there is no hope of recovery?

Yes No

For Spouse: Do you want to provide that your organs and tissues be made available for transplant and/or research purposes?

Neither Transplant Only Research Only Both

For Spouse: Do you prefer your remains be cremated or buried?

Cremated Buried

Please list the full legal name, gender, address, and phone number (if available) of those who are to be the primary beneficiaries of your estate. (i.e. spouse first, children second, etc. and ages you would like minors to receive any distribution and the amount of that distribution by percentage). For example, all children receive 10% at age 21, 50% at age 30, and 40% at age 35.

Please provide full legal name, gender, address, and phone number of those to whom you would leave your estate (final takers) and the percentages for each in case all of your primary beneficiaries predecease you or perish with you.

If you wish to make any charitable or other special gifts, please indicate the charity and the amount you wish to donate.

Do either the client or the spouse have a safety deposit box? If so, where is each safety deposit box located?

What is your net worth?

Do you own a life insurance policy?

Does your spouse own a life insurance policy?

Do you own real estate? If so, please provide addresses for each property owned.

Do you own a business? If so, please indicate the name of the business, address of the business, and ownership percentage of each party.

Present documents: please list wills (and dates), Trusts created by the client/spouse (and dates), Trusts created for the client/spouse (and dates), and gift tax returns (and dates).