R. Zebulon Law

Your Name:

First Name
Last Name
Middle Initial
Date of Birth

                        SS#:

Home Address:

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
FAX
E-mail

Your Work (Employer):  

Self Employed:

Yes
No

Employer Address Same as Above:

Yes
No

Employer Address:

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail

Where do you want correspondence and documents sent?

Home
Work

FAMILY INFORMATION

Children:

 Name                                            Sex             Are you both the parents?    If no, child of you      Date of Birth                 SS#                          Living in City/State

                                                                                                                                  or your spouse   

    M F          Y    N                Y    S                

    M F          Y    N                Y    S                  

    M F          Y    N                Y    S                

    M F          Y    N                Y    S                

    M F          Y    N                Y    S                

If any of your children are deceased, check here:  

If, yes, did they leave any surviving issue?

Yes
No

Any children born out of wedlock?

Yes
No

Please provide any other relevant family information?

WILL INFORMATION. If we are preparing a will(s) for you, please complete the following:

1.    EXECUTOR-Who do you want to handle the estate upon your death?

[NOTE: if you have a living trust, the successor trustee handles the trust, while the executor handles the estate (i.e., assets outside of the Trust). The executor pays estate taxes, settles creditor claims and makes sure proper guardians are appointed. The first choice is usually the spouse].

Your choices for Executor:

First Choice:      

Second Choice: 

Third Choice:    

2.        GUARDIANS (Note - you would normally fill out this section only if you have minor children or other dependents).-

2.1    Who do you want to serve as guardian of the person of any minor children (this is the person who the child would actually live with):

 Your choices for Guardian of the Person:

First Choice:      

Second Choice: 

Third Choice:    

2.2     GUARDIAN OF THE ESTATE -  Who do you want to serve as guardian of the estate of any minor children (this is the person who you would be responsible for overseeing the child's financial needs.) [NOTE: The guardian of the estate is often the same as the guardian of the person, but does not have to be the same]:

Your choices for Guardian of the Estate:

First Choice:      

Second Choice: 

Third Choice:    

3.    Do you have any other special provisions? (For example, special assets such as jewelry or gun collection to pass to particular children; the exclusion of a child from the will, etc.)

TRUST INFORMATION.  If we are preparing a living (or family) trust for you, please complete the following:

1.    TRUSTEES. Who do you want to handle the Trust upon your death?

[NOTE: This could be the most important person involved with your family assets after your death].

First Choice:      SS#Phone#

Second Choice: SS#Phone#

Third Choice:     SS#Phone#

(We will not include any alternate trustees if you do not select any.)

Please consider the following as you select the Trustee:

A.     Any children over age 18 can be successor trustee, as well as other family members and friends. A common first choice is a child or children if they are already grown.

B.    If your children are minors, the trustee should be able to work with the guardian of the estate of the children.

C.    You can also select several persons to serve at the same time as a "board" of trustees. You might consider this if you want your children involved with the estate, but would rather have an experienced advisor assisting them.

D.    If you do not specify otherwise, the first choice will serve as sole trustee until resignation or death, at which point second  choice serves as sole trustee, etc. Please let us know if you want  more than one Successor Trustee serving at the same time.

E.    Please give due consideration for having a corporate Trustee serve as trustee. In our experience, the major banks and trust companies serving as Trustee have done very well for the Trust on behalf of the beneficiaries. The downside is that the company will charge a fee, generally ranging from 1 to 2% of the Trust's assets per year. The Corporate Trustee may not need to serve until your death (or the death of both spouses), which would keep fees from starting until such time.

2.    QUESTION REGARD THE TRUSTEE.

A.     If there is more than 1 successor trustee serving at the same time, do you want actions to be taken by majority vote or by unanimous vote?          (Automatically Unanimous if not checked)

Majority
Unanimous

B.     Upon your death, do you want your children to have the power to remove and replace the trustee? (Automatically NO if not checked)

Yes
No

C.     If yes, do you want to limit the ablity of your children to replace the trust so that the replacement trustee can only be a recognized trust company or bank (so your children don't appoint friends, etc. to act as trustee)? (Automatically YES if not checked)

Yes
No   

3. DISTRIBUTION OF TRUST ESTATE:

After the last spouse's death, at what age(s) do you want your children to get distributions of the balance of the trust estate?

  Age        Percentage         Example Common Request   

                             Age 30   1/3

                             Age 35   1/3

                              Age 40  1/3

 

[NOTE: If your children are already sufficiently mature, you should consider distributing the estate promptly, leaving a portion of the estate remaining in trust to pay estate taxes, which often takes 12-24 months].

OTHER DISPOSITIVE PROVISIONS:

 

OTHER INFORMATION. PLEASE COMPLETE THE FOLLOWING:

Do you have any existing Wills or Trusts, etc.?

Yes
No

Are you a U.S. citizen?

Yes
No

If not, what is your status?

Have you ever made gifts of over $12,000 in 1 year to 1 person?

Yes
No

Have you ever filed a gift tax return?

Yes
No

Do you have assets in other states or countries?

Yes
No

Are you currently being sued or threatened with a lawsuit?

Yes
No

[NOTE: If you answered yes, to any of the above, we will require additional information].

OTHER ESTATE PLANNING QUESTIONS:

A.     After the death of the first spouse, how much of the trust do you want the surviving spouse to have control over (including the power to dispose of)?

A. Give survivor control over all the trust
B. Give survivor control over their 1/2 only
C. Give survivor control over as little as possible

            [NOTE: if you check B above, one-half (1/2) of the trust becomes irrevocable after the death of the first spouse, and if you check Column C above, the entire trust becomes irrevocable at the first death].

B.    After the death of the first spouse, do you want to give the surviving spouse unrestricted ability to withdraw small amounts of principal from the trust estate (known as the "five" and five" power)? [NOTE: The surviving spouse typically has access to the trust's income, and generally has restricted access to principal of the entire trust for health, education, maintenance, and support).

            Our form assumes "YES".            Yes     No

C.    Do you want children to be able to put a distribution of their inheritance in their Will in case they die after the last spouse, but before they actually get the money?

            Our form assumes "YES".            Yes     No     

D.    Do any of your children or grandchildren have any special living, medical, or educational needs?

           Our form assumes "NO".            Yes     No

E.    Do you want your grandchildren to be provided a special distribution upon your death?

         Yes     No      

        If so, what?   

POWER OF ATTORNEY INFORMATION. Please complete the following in connection with a Power of Attorney or a Power of Attorney for Health Care

POWER OF ATTORNEY FOR FINANCIAL MATTERS:

A.    Who do you want to sign legal documents on your behalf should you become incapacitated?

[This person is called your "Agent"]

Your First Choice:

    Name:    SS#:     Phone#:

   Second Choice:

    Name:    SS#:    Phone#:

B.    If you have more than one agent, do you want decisions to be unanimous, or otherwise?

        Unanimous     

        [Otherwise]:       

[NOTE: The following questions mainly apply when someone other than a spouse has power of attorney.]

C.    Do you want to authorize the agent to be able to enter into transactions between himself/herself and the incapacitated person's estate (self-dealing)?                Yes     No     (NOTE: Our form assumes "YES")

D.    Do you want the agent to make regular reports to family members?

        Yes     No     (NOTE: Our form assumes "NO")

E.    Do you want to give the agent the ability to commingle assets with their own?

        Yes     No   (NOTE: Our form assumes "YES")

F.    Do you want to authorize the agent to transmute the property from community to separate and vice-verse?

        Yes     No   (NOTE: Our form assumes "YES")

G.     Do you want your agent to serve with or without compensation?

        With    Without (NOTE: Our form assumes "WITHOUT")

H.    If your agent is provided compensation, do you want the compensation to be reasonable, hourly or paid as a percentage of assets under management?        Reasonable        Hourly      Percentage    %

POWER OF ATTORNEY FOR HEALTH CARE:

A.    Who do you want to make medical decisions on your behalf should you become incapacitated?

    Your First Choice:

        Name:     SS#:        Phone#:            

    Second Choice:

         Name:     SS#:        Phone#:    

B.    Do you wish your funeral to be arranged as either a burial or cremation?

        Burial    Cremation 

C.    If you have more than one agent, do you want decisions to be unanimous, or otherwise?

        Unanimous     

        [Otherwise]:       

ASSET INFORMATION. Please complete the following:

Approximate GROSS Value of Your Entire Estate (include death benefits on life insurance owned by you and the value of gifts made within the last three (3) years: $

Approximate NET Value (after debts) of Your Entire Estate: $

FINANCIAL INFORMATION. Please complete the following:

Be as specific as possible with regard to account names.

Account balances will vary, please list the approximate balance of each account.

Where necessary, attach addition schedules.

AMOUNTS IN BANKS, SAVING & LOANS AND CREDIT UNIONS                                                                                                  

(Do not include IRAs or other retirement accounts)                                                                                                                                 

Checking, CD's, Savings, Money Market, etc. If CD, list maturity date:

NAME OF INSTITUTION        TYPE OF ACCOUNT & MATURITY DATE       ACCOUNT NUMBER

1.                                

2.                                

3.                                

4.                                

5.                                

6.                                     

7.                                

8.                                

MUTUAL FUNDS AND/OR BROKERAGE ACCOUNTS

(Do not include IRA or other retirement accounts)

NAME OF FIRM OR FUND             ACCOUNT NUMBER

1.                      

2.                      

3.                      

4.                      

5.                      

6.                          

INDIVIDUAL STOCKS AND BONDS (No Brokerage Accounts)

NAME OF STOCK/BOND              NUMBER OF SHARES                                     APPROX. VALUE

1.                                                                                   $

2.                                                                                   $

3.                                                                                   $

4.                                                                                   $

5.                                                                                   $

6.                                                                                   $

                                                                                                             TOTAL VALUE $

IRA ACCOUNTS AND OTHER RETIREMENT PLANS

NAME WHERE ACCOUNT IS   TYPE OF ACCOUNT AND ACCOUNT#  CURRENT BENEFICIARY  APPROX. BALANCE

 1.                           $ 

2.                            $ 

3.                            $ 

4.                            $ 

WHEN DO YOU RETIRE?                                                                                TOTAL VALUE $

CLOSELY-HELD BUSINESSES                                                                                                                                                              

  (i.e., closely-held companies where you should actually have the Certificates of Bonds)

NAME OF STOCK/BOND              NUMBER OF SHARES                                     APPROX. VALUE

1.                                                                                   $

2.                                                                                   $

3.                                                                                   $

4.                                                                                   $

5.                                                                                   $

6.                                                                                   $

                                                                                                             TOTAL VALUE $

ANNUITIES                                                                                                                                                                                                                                                         (Not as Part of a Retirement Plan)

INSURANCE COMPANY NAME                ANNUITANT                TOTAL VALUE

 1.                             $     

 2.                             $  

 3.                             $   

 4.                             $        

REAL ESTATE

[REMINDER: Please bring the GRANT DEED and a recent PROPERTY TAX BILL for each property]

Property Address                           Original Cost      Current Value    Debt or Mortgage    Net Value

 1.  $  $    $      $  

                                                                                                    Assessor's Parcel Number*

 2.  $  $    $      $  

                                                                                                    Assessor's Parcel Number*

 3.  $  $    $      $  

                                                                                                    Assessor's Parcel Number*

 4.  $  $    $      $  

                                                                                                    Assessor's Parcel Number*

                                                                                                        TOTAL NET VALUE  $

*The Assessor's Parcel Number can be found on the Property Tax Bill.

PROMISSORY NOTES & TRUST DEEDS

[Where someone is paying you on a note]

[Reminder: If secured, please bring the original or a copy of the recorded Trust Deed.]

NAME OF DEBTOR            SECURED BY TD?    DUE DATE      BALANCE

                                                    YES        NO

1.                                       $

2.                                       $

3.                                       $

LIMITED OR GENERAL PARTNERSHIPS

NAME OF PARTNERSHIP                    LIMITED OR GENERAL        APPROXIMATE VALUE

 1.                                     $     

 2.                                     $  

 3.                                     $   

LIFE INSURANCE

NAME OF COMPANY & BROKER      POLICY#      INSURED PERSON    CURRENT BENEFICIARY

1.                          

2.                          

3.                          

4.                          

OTHER ASSETS

1.    Are you expecting any large inheritances soon? Yes        No

        If yes, approximate amount:  $  

2. If you own a business, its name:

    Is it a corporation? Yes        No

    Percentage owned by you %

    Total Value of Business $   

3.    Any other assets not yet mentioned?