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	APPENDIX II ESTATE PLANNING QUESTIONNAIRE Date:___________________ A. Personal and Family Data 1. Full Name Name Variations/Nicknames Social Security Number • Date and place of birth: • Date began residence in California: • Are you a United States citizen ? ___Yes ___No 2. Residence Address: __________________________________________________ Telephone No.: (____) __________________Facsimile No.: (_____) _______________ 3. Occupation: Employer Name: Address/Telephone: _______________________________________________ (____) ____________________ 4. Prior Marriages: ____Yes ____No If yes, list name(s) of prior spouse and date of termination of marriage: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ 5. Children: Name Birthdate Name of Other Parent ____________________________ ________________ ____________________________ ____________________________ ________________ ____________________________ ____________________________ ________________ ____________________________ ____________________________ ________________ ____________________________ 6. Deceased children (if any): ____________________________ ________________ Date of Death: _________________ ____________________________ ________________ Date of Death: _________________ 7. Grandchildren: ____________________________ ________________ Parent: _______________________ ____________________________ ________________ Parent: _______________________ ____________________________ ________________ Parent: _______________________ ____________________________ ________________ Parent: _______________________ ____________________________ ________________ Parent: _______________________ 8. Living parents: ___________________________________________________ ___________________________________________________ 9. Living brothers and sisters: _______________________________________ _______________________________________ _______________________________________ _______________________________________ 10. Military service (give branch and dates of service): ________________________________________________________ 11. Location of safe deposit box and important papers: ________________________________________________________ 15. Prior Wills/Codicils? (If yes, give dates and provide copies): ________________________________________________________ ________________________________________________________ 17. Have you created a trust or trusts? (If yes, give dates, describe trust agreement or declaration and provide copies): ________________________________________________________ ________________________________________________________ B. Income 1. Salary or other earned income: _______________________________________ 2. Other income: ___________________________________________________ ___________________________________________________ C. Assets * * Please provide us with copies of your deeds and current property tax statements for real property, deeds of trust for any notes payable to you that are secured by real property, and ownership documents concerning other assets. Approx. Present Value 1. Real property (include address): __________________________________________ $ _____________ __________________________________________ _____________ __________________________________________ _____________ 2. Cash Accounts (include institution name and branch location): __________________________________________ $ _____________ __________________________________________ _____________ __________________________________________ _____________ __________________________________________ _____________ 3. Brokerage Accounts (excluding retirement accounts): __________________________________________ $ _____________ __________________________________________ _____________ __________________________________________ _____________ __________________________________________ _____________ 3. Stocks, bonds and other securities held outright by you: __________________________________________ $ _____________ __________________________________________ _____________ __________________________________________ _____________ __________________________________________ _____________ 4. Tangible personal property (jewelry, household furnishings, cars, etc.): __________________________________________ $ _____________ __________________________________________ _____________ __________________________________________ _____________ __________________________________________ _____________ 5. Business interests (partnerships, proprietorships, controlled corporations, etc.): Approx. Buy-Out Name Present Value Agreement ____________________________________________ $ _____________ ___Yes ___No ____________________________________________ _____________ ___Yes ___No ____________________________________________ _____________ ___Yes ___No ____________________________________________ _____________ ___Yes ___No 6. Debts owed to client by others: Debtor Amount Due Date __________________________________________ $ _____________ __________ __________________________________________ _____________ __________ __________________________________________ _____________ __________ 7. Life Insurance: Total coverage of all policies $ _____________________ Term Insurance Death Company Insured Owner Beneficiary Benefit _______________ ________________ ________________ ___________ ____________ _______________ ________________ ________________ ___________ ____________ _______________ ________________ ________________ ___________ ____________ Permanent Life Insurance (whole life, universal, variable, etc.) Death Present Company Insured Owner Beneficiary Benefit Value _____________ _______________ _________________ ____________ ________ ________ _____________ _______________ _________________ ____________ ________ ________ _____________ _______________ _________________ ____________ ________ ________ 8. Death or other benefits from all qualified retirement plans, Keoghs, IRAs or annuities: Present Death Company Type Beneficiary Value Benefit ________________ __________________ _________________ ______________ ________ ________________ __________________ _________________ ______________ ________ ________________ __________________ _________________ ______________ ________ ________________ __________________ _________________ ______________ ________ 9. Other assets (including copyrights, patents, mineral rights, etc.): Type of Asset Approx. Present Value __________________________________________ $ _____________ __________________________________________ _____________ __________________________________________ _____________ __________________________________________ _____________ D. Other Interests or Expectancies 1. Beneficial interests in trusts (provide copies of trust documents): Power of Present Creator of Trust Trustee Interest Appointment Value _____________________________________________________________________$________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. Expected inheritances or gifts (from parents or others): ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 3. Holder of any Power of Appointment): ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ E. Liabilities 1. Mortgages on real property: Property Address Outstanding Obligation _____________________________________ $ ________________________ _____________________________________ _____________________________________ 2. Notes, loans, spousal/child support obligations and judgments (include amount and to whom owed) Description of Obligation Outstanding Obligation _________________________________ $ _________________ _________________________________ _________________________________ _________________________________ F. Gifts Made to Others: 1. Have you made any gifts in excess of $10,000.00? ____ No ____ Yes If yes, give description and amount of gift, to whom given and date of gift: Gift To Whom Given Amount or Value _______________________ __________________ _________________ _______________________ __________________ _________________ _______________________ __________________ _________________ _______________________ __________________ _________________ 2. If any gift tax returns were filed for any gifts made by you, provide copies. G. Certain Will and/or Trust Provisions 1. Executor of Will: A person's estate is probated to transfer the decedent's assets in accordance with the decedent's Will. If certain assets are not transferred into the living trust, then it may be necessary to probate that portion of your estate. The "pour-over" Will is intended to serve that purpose. An Executor is the person named in a Will to represent the decedent's estate before the Probate Court. It is customary to have the surviving spouse act as the Executor of the decedent's estate. However, should the first person selected decline or otherwise be unable to act as the Executor, it will be necessary to have at least two alternates named in place of that person. 1st choice __________________________________________________ Successor __________________________________________________ 2nd successor __________________________________________________ Will bond be required: Yes _____ No _____ 2. Selection of Trustees: A Trustee is the individual or entity responsible for administering and distributing the trust assets according to the terms of the trust instrument. It is necessary to name who will become the Trustee if you are unable to serve. 1st choice __________________________________________________ Successor __________________________________________________ 2nd successor __________________________________________________ Will bond be required: Yes _____ No _____ 3. Guardians for minor children: If you have minor children, you will need to select a person or persons who will act as the Guardian(s) of the person and/or estate of your children. If you choose a husband and wife as Co-Guardians, you should consider what you would happen if one of the Co-Guardians cannot serve (ex., death, divorce, resignation or incapacity). 1st choice __________________________________________________ Successor __________________________________________________ 2nd successor __________________________________________________ Will bond be required: Yes _____ No _____ 4. State briefly how you wish your property to be disposed of upon your death: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 5. Describe any unique distributions on your death: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 6. Durable Powers of Attorney: There are two additional documents which we prepare as part of the estate plan. For estate planning purposes, the Durable General Power of Attorney should come into effect upon your incapacity (unless you have some other reason for creating an existing power of attorney) and provides the appointed agent with the authority to manage your financial affairs, other than those related to the authority provided to you as the Trustee of your Trust, without the complexity and expense of court supervision. The remaining document which we can prepare, the Durable Power of Attorney for Health Care, provides your designated agent with the ability to make decisions regarding your health care, including the use or termination of life support systems, when you are unable to make such decisions. When combined with a living trust, these documents will allow you to fully avoid the need for a conservatorship should you become incapacitated. If either of these documents are desired, please complete the Durable Power of Attorney Questionnaire that accompanies this form. Signature: _____________________________________