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Date MM / DD / YYYY
Name

Please indicate how your name should read and any middle initial. This is how it will look in the trust/will
(Married couples only need to fill out one form, not two)
Spouse Name
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Phone Number ### - ### - ####
Marital status
Married Single Divorced Widowed
US Citizen
Yes No
Children
How do you want to leave your assets?
All to my spouse then to my children equally All to my children equally All to other heirs

Please indicate who inherits your assets
Distributions to Kids/Heirs
Hold in trust for needs then all at age 25 Hold in trust for needs then 50% at 25, rest at age 30 Hold in trust for needs then 1/3 at 25, 1/3 at age 30 , rest at age 35 Flexible protective trust against divorce and creditors (recommended for adults)

All trusts must end, please indicate when yours should be distributed
Who do you want to inherit (if not children)
Name of Successor Trustee (person who manages $)
Name of Second Successor Trustee (backup person who manages $)
Name of Guardian (If kids are under age 18)
Name of Second Guardian (If kids are under age 18)
Name of agent for health care decisions
Name of second agent for health care decisions
Assets

Please list all the stuff that you own
Life Insurance Polices

Please indicate amount of policy and who is owner
Retirement Plans (IRA/401k/403b/Deferred Comp or any other retirement plan)
Regular Non-IRA assets (stocks, bank accounts, brokerage acccounts etc)

Please indicate approximate valaue and who is account owner
Real Estate

Indicate whether real estate is joint and approximate value
Specific Bequests (People or charities to whom you want to leave $)

This is optional. Please indicate the names of anyone you want to leave $ to and the amount
Do Not Fill This Out

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Assets