ESTATE PLANNING CLIENT QUESTIONNAIRE

Please answer as many of the questions below. If you do not know the answer to a question, leave it blank. We will review your Client Questionnaire in detail during your telephone consultation.

You will receive an e-mail of your Client Questionnaire after you press SUBMIT at the end.

Thank you,

Kevin J. Perkins, Esq., LL.M. Tax,
Sr. Managing Attorney
Office: (949) 251-8877 | Fax: (949) 748-8530
Email: Kevin@perkinsestateplanning.com | www.perkinsestateplanning.com

Contact Information

Salutation

First name

Last name

Email*

Company name

Phone number

Phone Type

Primary Address

Street address

Country/Region

City

State/Region

Postal code

Address Type

Your Information

Please tell us what items you would like to update on your trust?

Date of Birth

Month/Day/Year

Occupation

Other Name(s) Used by You:

Are you a US Citizen?

Yes

Spouse or Partner Information

Relationship

Spouse or Partner's Full Name

Spouse or Partner's Date of Birth

Name

Mother

Father

DOB

Month/Day/Year

Male or Female

Male

Female

Additional information or special circumstances about your child or children that you would like to discuss during your consultation:

Grandchildren

List of Grandchildren

(NAME, BIRTHDAY, MOTHER, FATHER, LEGAL GUARDIAN, OTHER)

List of deceased children (if any)

(NAME, BIRTHDAY, MOTHER, FATHER, LEGAL GUARDIAN, OTHER)

General Information

Do you wish to disinherit any of your children, grandchildren, or any other close relative?

Yes

Do you have an existing Marital Property Agreement?

Yes

Do either of you expect to inherit substantial assets?

Yes

Do you own a Corporation, LLC, LC, etc?

Yes

Business Details (if applicable)

Name, state, etc

Business Purpose (if applicable)

Fiduciaries
Generally your spouse or partner would be first, then trusted family members, friends or professional Fiduciary services.

Successor Trustee and Executor(s)

First Choice

Second Choice

Third Choice

Personal Guardian of Child and Child's Estate

First Choice

Second Choice

Third Choice

Durable Power of Attorney for Asset Management
(Financial Power of Attorney)

Your Initial Attorney Of Fact

Your Successor Attorney Of Fact

Partner's Initial Attorney Of Fact

Partner's Successor Initial Attorney Of Fact

Durable Power of Attorney for Healthcare

(Advanced Healthcare Directive)

Your Initial Attorney Of Fact

Your Successor Attorney Of Fact

(AHD) Partner's Initial Attorney Of Fact

(AHD) Partner's Successor Attorney Of Fact

Existing Estate Plan

Yes

Date Existing Estate Plan Signed

Month/Day/Year

Revocable Living Trust Information

Name of Revocable Trust

Date Revocable Trust Was Created

Month/Day/Year

First Trustee(s): SETTLOR(S)

(Generally Spouse or Partner)

First Successor Trustee(s)

Second Successor Trustee(s)

PERKINS LAW FIRM, APC - TRUST PROTECTOR

Yes

I would like to discuss this during my consultation

Name

Interest %

First Donor Special Gifts

Please list any items of Personal or Real Property that you would like to give to a specific person or charity. List the donee of each Special Gift.

Second Donor Special Gifts

Please list any items of Personal or Real Property that you would like to give to a specific person or charity. List the donee of each Special Gift.

Special Drafting Instructions

Provide a brief description of any special circumstances that you would like to discuss during your Telephone Consultation.

End of Life Decisions

You

Choose to Prolong Your Own Life I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.

Choose Not Prolong Your Own 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.

Spouse or Partner

Spouse or Partner Chooses to Prolong Life Spouse or Partner wants life to be prolonged as long as possible within the limits of generally accepted health care standards

Spouse or Partner chooses NOT to Prolong Life Spouse or Partner does not want life prolonged if (1) Spouse or Partner has an incurable and irreversible condition that will result in death within a relatively short time, (2) becomes unconscious and, to a reasonable degree of medical certainty, will not regain consciousness, or (3) the likely risks and burdens of treatment would outweigh the expected benefits.

Organ Donation

(Anatomical Gifting)

Are you an Organ Donor?

Yes

Is your Spouse or Partner an Organ Doner

Yes

Estimated Value of Estate

Your Cash Assets

(cash, annuities, notes due you)

Your Business Interests

(Partnerships, Corps, LLCs, etc.)

Your Retirement Plans

(IRA, 401k, etc.)

Spouse or Partner’s Retirement Plans

(IRA, 401k, etc.)

Other property

TOTAL: Estimated Value of Estate

Life Insurance

Your Life Insurance Death Benefit

(Be specific if the insurance is Term or Whole Life)

Spouse or Partner Life Insurance Death Benefit

(Be specific if the insurance is Term or Whole Life)

Spouse or Partner Whole Life Cash Value

List the insured and the cash value of the insurance.

Related Planning Issues That You Would Like To Discuss During Your Telephone Consultation

Charitable Gifting and Philanthropy

CRAT: Charitable Remainder Annuity Trust | CRUT: Charitable Remainder Unitrust

GRIT: Grantor Retained Interest Trusts | GRAT: Grantor Retained Annuity Trusts

PERKINS LAW FIRM CLIENT QUESTIONNAIRE

If you have completed the form, please click SUBMIT.

You will receive an e-mail of your Client Questionnaire.

On the day of your consultation, please be in front of your computer or mobile device. Your Attorney will be calling you. We look forward to being of service.

Thank you.

Kevin J. Perkins, Esq., LL.M. Tax
Office: (949) 251-8877 | Fax: (949) 748-8530
Email: Kevin@perkinslawfirm.com | www.perkinslawfirm.com

Business, Real Estate, Estate Planning, & Tax Attorney
Charitable Planning & High Net Worth Tax Planning

Locations: Beverly Hills, Newport Beach, Irvine

Mailing Address:

Perkins Law Firm, APC

2618 San Miguel Drive, #103,

Newport Beach, California 92660

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Perkins Law Firm | Client Questionnaire | (949) 251-8877 | www.perkinslawfirm.com

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Mobile phone number

ESTATE PLANNING CLIENT QUESTIONNAIRE

Contact Information

Primary Address

Your Information

Spouse or Partner Information

Children / Descendant Information

Child 1:

Child 2:

Child 3:

Child 4:

Child 5:

Grandchildren

General Information

FiduciariesGenerally your spouse or partner would be first, then trusted family members, friends or professional Fiduciary services.

Successor Trustee and Executor(s)

Personal Guardian of Child and Child's Estate

Durable Power of Attorney for Asset Management(Financial Power of Attorney)

Durable Power of Attorney for Healthcare

Revocable Living Trust Information

Beneficiaries

Trust Beneficiary 1

Trust Beneficiary 2

Trust Beneficiary 3

Trust Beneficiary 4

Trust Beneficiary 5

Trust Beneficiary 6

End of Life Decisions

You

Spouse or Partner

Organ Donation

Estimated Value of Estate

Life Insurance

Related Planning Issues That You Would Like To Discuss During Your Telephone Consultation

Charitable Gifting and Philanthropy

PERKINS LAW FIRM CLIENT QUESTIONNAIRE

CONFIDENTIALITY STATEMENT

Fiduciaries
Generally your spouse or partner would be first, then trusted family members, friends or professional Fiduciary services.

Durable Power of Attorney for Asset Management
(Financial Power of Attorney)