California Estate Planning Questionnaire

Should you need an estate plan, this is the basic form that you will be filling out if you'd like to get things started with a licensed paralegal.

You can also download the document here:

Estate Planning and Trust Questionnaire

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Estate Planning and Trust Questionnaire

Your Paralegal Assistant: Carol Highfill

Telephone Number: (909) 451-9819

Your Full Name: ___________________________________

Your Spouse’s Full Name: ___________________________ ( ) None

Primary Residence: _______________________________________

_______________________________________

Your Telephone Number ( ) _________________________________

Do you have children? If so what are their names, age and date of birth?

1.______________________________________________________________________

2.______________________________________________________________________

3.______________________________________________________________________

4.______________________________________________________________________

Do you have any children that you want to disinherit?____________________________

Do you own any other real property ( ) yes OR ( ) no

If yes, please provide the address: ____________________________________

____________________________________

For all real property please attach a copy of the most current deed showing the legal description and how title is currently held (i.e. tenants in common, joint tenancy).

__________________________________________________________________

__________________________________________________________________

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Estate plans are generally established to divide your estate equally among your beneficiaries, if this is acceptable please initial_____________________________

Do you have any special gifts of your personal property you would like to give to family members upon your passing? If so, please list any special gifts you may want to give. If Not, please write in “NONE” in the space below.

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Do you want your bank accounts to be included in the trust? If you want to fund your trust with your bank accounts you will have to re-title the accounts. For example: Jane Doe as trustee of the Doe family trust dated 12/12/2021. If not, I can provide a general letter to be given to your financial institutions to instruct them to handle this for you. Please provide your wishes in the following space. ________________________________________________________________________

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Who would you like to be named as the first person in charge of distributing your assets as stated above upon your death?

1. __________________________________

This person shall serve first unless they die before you or decline to act

2. __________________________________

This person shall serve second if the person in number 1. is unable or declines to act

3. __________________________________

If you have a third person in mind if numbers 1 & 2 are unavailable, please list them here

If you were to become physically incapacitated I need to know how you would like your doctors to proceed. The person you place in charge of carrying out your requests selected below will ensure that your wishes are kept. Please answer the following questions and if you have any concerns about your answers, call me and I will clarify.

INSTRUCTIONS FOR HEALTH CARE

If you fill out this part of the form, you may strike any wording you do not want.

(2.1) END-OF-LIFE DECISIONS: I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choice I have marked below:

( ) (a) Choice Not To Prolong Life I do not want my life to be prolonged if (1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or (3) the likely risks and burdens of treatment would outweigh the expected benefits,

If the extension of my life would result in a mere biological existence, devoid of cognitive function, with no reasonable hope for normal functioning, then I do not desire any form of life sustaining procedures, including nutrition and hydration unless necessary for my comfort or alleviation of pain or, if life sustaining treatment has been instituted, I desire that it be withdrawn. It is my desire that my agent consider relief from suffering, preservation or restoration of functioning, and the quality as well as extent of the life being preserved when decisions are made concerning life sustaining care, treatment, services, and procedures. In making the decision to withhold or remove treatment, my agent should ask the question: "Is the proposed treatment an aid to recovery or merely a prolongation of inevitable death?" What is "reasonable," what is "an aid to recovery," and what is "merely a prolongation of inevitable death" shall be determined by my agent after consulting with my attending physicians.

OR

( ) (b) Choice To Prolong Life I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.

(2.2) RELIEF FROM PAIN: I direct that treatment for alleviation of pain or discomfort be provided at all times, even if it hastens my death.

(2.3) OTHER WISHES: (If you do not agree with any of the optional choices above and wish to write your own, or if you wish to add to the instructions you have given above, you may do so here.) I direct that:

Please provide any specific instructions here such as a “celebration of life to be held at”:_____________________________________________________________________

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You will be naming up to three individuals to act in your place should you be incapacitated and unable to make decisions for yourself and to carry out your wishes as you have selected above. You can select the same order of people to handle your medical as you selected for your assets or you may change the order according to who you believe is strongest in this area.

Who would you like to place in charge of your medical?

1. __________________________________

This person shall serve first unless they die before you or decline to act

2. __________________________________

This person shall serve second if the person in number 1. is unable or declines to act

3. __________________________________

If you have a third person in mind if numbers 1 & 2 are unavailable please list them here

Disposition of Remains: My agent shall have the authority to arrange for the following disposition of my remains: I direct that:

( ) My body be cremated.

( ) My body to be buried.

( ) I have previously made arrangements through:

Name of mortuary or facility: _________________________

_________________________

_________________________

Background History

Have you ever been married before: ( ) yes or ( ) no

If yes, how did this marriage end: ( ) divorce; ( ) death; ( ) nullity

If any of the three previous options were chosen, please provide the date of death or date of judgment for divorce or nullity. ________________________________________________________________________

________________________________________________________________________

Do you have any children that have passed away? ____________

If yes, did your child who passed away leave behind any children of their own? ________

If yes, what are their names, ages and birth dates? ______________________________

______________________________________________________________________

______________________________________________________________________.

Any other marriages? ____. If Yes, please complete the below information.

If yes, how did this marriage end: ( ) divorce; ( ) death; ( ) nullity

Do you currently have children? If so, please provide their names and date of birth in the following space.

________________________________________________________________________

________________________________________________________________________

Do you have any step children? If so, do you want them to inherit in the same manner as if you had adopted them as your own children? _______________ If yes, please be sure to include them in this questionnaire under applicable categories.

Please list any additional information you would like me to know.

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