By Victoria Carroll,2014-07-10 15:30
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     Estate Planning Service

    Decker and Associates, Inc. is pleased to offer this client service. D&A has assembled estate planning attorneys

    who understand our firm’s desire for an integrated financial, investment and estate plan. The fees for the

    service are listed on page 9 of this form. Please note, the information requested in this form is designed to

    assist your estate planning attorney in creating an appropriate estate plan for you, and it will likely be the case

    that some of your answers will not be incorporated into your estate plan.

    Preliminary Information

    Please Use WORD to complete this form. If Not Applicable, note NA. Today’s Date Your Information

    Last Name First Name Middle Name Suffix (Jr., Sr., etc.) Citizen of Date of Birth (M/D/YYYY) Social Security Number

If Married, Spouse’s Information

    Last Name First Name Middle Name Suffix (Jr., Sr., etc.) Citizen of Date of Birth (M/D/YYYY) Social Security Number Home Address City State Zip Code County Duration of Residence in State Home Phone Home E-mail Address Mail Documents to Home Address - Employer Position

    Address City State Zip Code

    Your Business E-mail Address

    Phone Fax Cell Phone

    Spouse’s Employer Position

    Address City State Zip Code

    Business E-mail Address

    Phone Fax Cell Phone


    Full Name Date of Marital # of Parents if not clients

    Birth Status children

    Single Date

    Single Date

    Single Date

    Single Date

    Single Date Estate Planning Form Page 1 of 15 (07/10/10)

If you have more than 5 children, please enter information on the additional children below.

Is any beneficiary receiving government benefits? YES If YES, who

    Is any beneficiary physically impaired or mentally handicapped? YES If YES, who

    Have any of your children died leaving heirs? YES If YES, who

    If ―YES,‖ complicated provisions may need to be added to your documents, the cost of which will be

    discussed with you and with your agreement, billed to you on an hourly basis.

    Marriage date (M/D/YYYY) If this is not your only marriage and you have children, please indicate the parent of each child:

    Financial Statement

    ASSETS & LIABILITIES Ownership U.S. Value Foreign Debt

    Value C=Community Property H = Husband’s Separate Property W=Wife’s Separate Property

     C Cash & Savings

    C Life Insurance on You

    C Life Insurance on Spouse

    C Installment Notes

    C Stocks

    C Stock Options

    C Bonds

    C Mutual Funds

    C Investment Real Estate

    C Business Interest

    C Your Retirement Plans

    C Spouse Retirement Plans

    C Primary Residence

    C Secondary Residence

    C Automobiles

    C Furniture & Contents

    C Jewelry & Collectibles

    C Other Assets

    Separate Property Your Potential Inheritance

    Separate Property Spouse Potential Inheritance

    C Credit Card & Consumer Debt

    C Student Loans Estate Planning Form Page 2 of 15 (07/10/10)

    C Other Debt

     $ 0.00 $ 0.00 $ 0.00 TOTAL ESTATE

    Do you own stock options granted by an employer? YES Employer Does your spouse own stock options granted by employer? YES Employer If any of your assets are located outside of your state of residence, indicate below where those assets are

    located? ---

    Fiduciary Appointments

    NOTE: If your fiduciary will be your spouse, note ―Spouse.‖ If you want more than one person to serve together

    as co-fiduciaries, list them both. Please indicate the relationship of all appointments, for example, brother,

    mother, friend, etc.


    Will SELF SPOUSE st1 Executor

    Relationship nd2 Executor

    Relationship rd3 Executor


    TESTAMENTARY TRUSTS FAMILY, MARITAL, & CHILDREN’S TRUST If your trustees are the same as your executors, do NOT complete

    Testamentary Trust SELF SPOUSE st1 Trustee

    Relationship nd2 Trustee

    Relationship rd3 Trustee


    REVOCABLE LIVING TRUST to avoid probate

    Do you want a revocable living trust to minimize the expense of probate? YES. If YES,

    you (and your spouse) will be co-trustees and then your successor executors are the successor trustees.

    GUARDIAN, named in your will for your children less than age 18

    Please name only one person as a guardian or as a successor guardian, not a married couple. You do not have

    to name the child’s parent as a guardian since that is automatic.

    Guardian NAME RELATIONSHIP Estate Planning Form Page 3 of 15 (07/10/10)

    st1 Guardian nd2 Guardian rd3 Guardian

    Would you want your guardian’s child(ren) to be an income beneficiary of the trust for higher education needs only until the age of 25? YES Any Comments?


    (including permission to travel)

Because you travel, it is recommended you name a close friend or neighbor who could make health care

    decisions for your children in your absence. This document may also permit the agent to serve as a temporary

    care provider until your wills can be admitted to probate and the permanent guardian is appointed by the court.



    Successor Agent



    In the event you, your spouse, children and grandchildren or other named beneficiaries should die without

    leaving any descendants your estate will automatically pass to your heirs (which generally means ―next-of-kin‖)

    as determined by your State’s law. For married couples, as a general rule, property that was included in your

    estate will pass to your heirs, and the property included in the surviving spouse’s estate will pass to his or her


    Is it acceptable to you to allow the property to pass to heirs? YES If ―NO‖, you can modify this distribution scheme if you want with the understanding that a complicated

    distribution scheme will be billed to you on an hourly basis.

    Change the default language as follows

    Do you wish to leave funds to anyone other than your spouse or children? YES If YES, then complete:

    Beneficiary Percent of estate %

    Beneficiary Percent of estate %

    Beneficiary Percent of estate %

    Beneficiary Percent of estate % Estate Planning Form Page 4 of 15 (07/10/10)


    This document authorizes your agent to conduct your financial affairs while you are alive but are mentally or

    physically incapable of making decisions

DPOA - Financial SELF Effective Immediately SPOUSE Effective Immediately

    st1 Agent

    Relationship nd2 Agent

    Relationship rd3 Agent



    This document authorizes your agent to make health care decisions on your behalf if you are alive but are

    mentally or physically incapable of making decisions. Only one person can serve as your agent at a time.


    st1 Agent



    City, State, Country

    Phone Number nd2 Agent



    City, State, Country

    Phone Number rd3 Agent



    City, State, Country

    Phone Number

    LIVING WILL, DIRECTIVE TO PHYSICIAN This document is your declaration that you would want to withhold life support measures if you have a terminal

    illness or injury. In some states it is incorporated into the Medical Durable Power of Attorney.

     Self Withhold life support Do NOT withhold life support

     Spouse Withhold life support Do NOT withhold life support Estate Planning Form Page 5 of 15 (07/10/10)


NOTE: Any deviation from the options listed below may result in additional attorney fees. For example, if you

    want Child A to receive 25% of your estate and Child B 75%, or Child C to be sole trustee at age 25 and Child D

    at 35, an extra fee would apply. The fee for special drafting language will be discussed with you in advance of

    the drafting and billed at $300/hour.

For married persons only

    Upon the death of the first spouse, the trust will divide into one or more subtrusts to preserve the estate tax

    exemption of the first spouse to die. If you were to die first, what rights would you want your spouse to have in

    your share of the trust? Spouse is to received ---

     No income Needed income All income

     No principal Needed principal

    When the surviving spouse dies, your share of the trust property will automatically pass in accordance with your

    distribution scheme. However, you can give the surviving spouse the power to override this distribution scheme

    by giving your surviving spouse a ―power of appointment.‖ Do you want the survivor of you to have this power?

     No power of appointment

     Yes, the surviving spouse can give the trust property to any of my descendants

     Yes, the surviving spouse can give the trust property to any of my descendants, my family members

    and/or to any charity or charities.

For children and grandchildren

    After the surviving spouse dies, do you want to make any specific gifts of cash or real property? Please list.

Beneficiary Gift

    Beneficiary Gift

    Beneficiary Gift

    Beneficiary Gift

After the surviving spouse dies, do you want the assets managed as a single trust (pooled) for the benefit of all

    of your children until the youngest child attains a specified age, after which the trust assets would be divided?

     YES , have the trust managed as a single trust until my youngest child is age (typically 25, 30, 35)

     NO, divide the trust upon the death of my spouse

Would you like your child or grandchild to be a co-trustee with the fiduciary previously named or a sole trustee

    of his own trust?

     Co-trustee at age (typically age 25) and sole trustee at age (typically 30 or 35)

     Sole trustee at age or

     Sole trustee immediately upon creation of child’s trust

     Never a trustee of his or her trust

Do you want your assets to be distributed to your child with a

     Terminal Trust, the trust terminates during the lifetime of your child, ending when the child is age Estate Planning Form Page 6 of 15 (07/10/10)

    (not past age 35 if you want trusts for a longer period of time, please select Generation Skipping below), or

     Generation Skipping Descendants Trust, the trust continues for your child’s life. Your child could be

    the trustee. Your child could receive the trust income and can use the principal for his health, education,

    maintenance and support. During your child’s life, the assets within the trust are normally protected from

    creditors, bankruptcy and divorce. When your child dies the remaining assets are passed, free of estate tax,

    to your grandchildren and the trust would then remain for the maximum time permitted by State law

If your child has no descendants, his or her inheritance will automatically pass to your other children (or to their

    children). However, you can give your children the power to override this distribution scheme by giving them a

    ―power of appointment.‖ Do you want your children to have this power?

     No power of appointment

     Yes, they can give their trust property to any of my descendants

     Yes, they can give their trust property to anyone related to them by blood, marriage, adoption, and/or to

    any charity or charities.


    NOTE: If you request an ILIT and you and your spouse have a joint life insurance policy, neither may serve as

    a trustee. If only one spouse has coverage, then the other spouse may be a trustee. Therefore, if you want your

    spouse to be the trustee, you may only have one ILIT. If you want someone other than a spouse to be the

    trustee, you may have 2 separate ILITs.


    st1 Trustee

    Relationship nd2 Trustee

    Relationship rd3 Trustee



    NOTE: If you create a trust for your children or grandchildren, you should not serve as the trustee. These trusts

    are generally used for educational funding or for transferring your wealth.

Do you intend to have

     one trust for all children and/or grandchildren or

     a trust for each child and his or her descendents or

     a separate trust for each child and each grandchild?

    If grandchildren are included, please list the names and dates of birth of your grandchildren. Estate Planning Form Page 7 of 15 (07/10/10)

    Investment Trust One Trust A Trust for each child & his or her


    st1 Trustee

    Relationship nd2 Trustee

    Relationship rd3 Trustee



1. If co-trustees are named, how many signatures are required for property transfers?

     One signature All trustees’ signatures 2. If there are three or more co-trustees, should decisions be made by --

     Majority rule Unanimous rule

    3. Should trustees provide an accounting of the trust funds to beneficiaries

     Annually Upon termination of the trust or change of trustees

     Upon request Never

    4. Any comments or questions? Estate Planning Form Page 8 of 15 (07/10/10)

    Fees & Agreements

    Decker & Associates, Inc. (D&A) has made special arrangements with a law firm, so clients may obtain estate

    documents at a cost substantially reduced from the normal legal fees charged for such services.

    The law firm has agreed to provide each individual and his/her spouse, if applicable, with the following

    documents at the stated fee. The fee paid to the law firm includes the preparation of the applicable documents,

    as well as two thirty-minute meetings (unless noted otherwise in the document description) with the client(s).

    The purpose of the first meeting is to review your preliminary information and develop an estate plan. The

    second meeting will be held to sign your documents.

    The fee for administration, paid to Decker & Associates, Inc. includes review of this form during a one hour

    session. Additional time spent with Decker & Associates, Inc is charged at $250/ hour.

    If you have requested special planning provisions, additional attorney time will be required to complete your

    documents. By signing this agreement, you agree that any additional time required to draft your special requests

    will be billed to you at $300.00/hour. The attorney will contact you prior to drafting any special planning

    provisions to discuss any additional fees.

    The law firm has agreed to provide you with legal services only. Decker & Associates, Inc. has agreed to

    provide you with administrative services associated with compiling and validating the preliminary information to

    prepare your documents. The planning options and associated costs are valid for the next 90 days. If you

    have an old form, please contact D&A for revised pricing.

    Documents Legal Admin. Total Mark Options

    Fee Fee Fee Chosen

    $500 $425 $995 A. SIMPLE ESTATE DOCUMENTS Prepare simple wills, trust and guardians for minor-age children, statutory durable powers of attorney

    (POA), medical power of attorney (POA), beneficiary arrangements

    and living wills. Fee includes two attorney meetings totaling 30

    minutes and one hour of counseling with D&A.


    guardian appointments and medical POA. Two-hour meeting with D&A

    and 15 minute meeting with attorney included with fee.

    $1,000 $475 $1,475 C-1. TAX PLANNED DOCUMENTS WITH or WITHOUT

    GENERATION SKIPPING Prepare wills with family trust and

    marital trust (for married persons), generation skipping trust

    provisions, statutory durable POA, medical POA, beneficiary

    arrangements and living wills plus one hour attorney meeting and

    document binder. Fee includes one hour of counseling with D&A.



    GENERATION SKIPPING Prepare wills with family trust, qualified

    domestic marital trust, with generation skipping descendants trusts

    statutory durable POA, medical POA, beneficiary arrangements and

    living wills plus one hour attorney meeting and document binder. Fee

    includes one hour of counseling with D&A.

    $1,350 $550 $1,900 D. REVOCABLE LIVING TRUST TO AVOID PROBATE Prepare pour-over wills and revocable living trust with family and marital trusts (or qualified domestic trust for married non-U.S. citizens) and generation skipping descendants trusts, statutory durable POA,

    medical POA and living wills. Fee includes transfer of one deed, filing

    fee, attorney meeting, and document binder. Client may request transfer of additional deeds at $90.00 per deed. Fee includes one hour

    counseling with D&A.


    INVESTMENT TRUST FOR DESCENDANTS Prepare irrevocable generation skipping trust, withdrawal letters, and memorandum

    explaining operation and administration of trust plus attorney meeting

    and 30 minutes of counseling with D&A. Estate Planning Form Page 9 of 15 (07/10/10)

Multi-Party Representation for Married Couples: There is an important ethical matter that must be dealt with

    at the commencement of this representation of you in connection with your estate planning. Each of you is advised of the hazards of multi-party representation by one attorney or by one planner. The interest of one spouse may not be promoted to the disadvantage of the other spouse. An attorney and the planner may act as the common representative for more than one person in a common enterprise or endeavor for so long as the common interests do not differ or potentially differ. Both of you are advised to obtain the services of independent legal counsel to insure that your legal interests are best protected. You are clients of both the law firm and Decker & Associates, Inc. and as long as your interests are not in conflict, these firms may ethically continue to represent both of you. This engagement document will confirm that you have been advised that during the course of estate planning work conflicts may arise between you with respect to the ownership of your property and its desired disposition during your lifetime and at your deaths. You have disclosed no facts that might give rise to a conflict, however, such a possibility always exists. If any conflict, which could affect your estate planning, does arise, you have an obligation to so advise these firms.

    Complete and Free Disclosure: In addition to informing these firms of any conflict which arises between you,

    you have each agreed that there will be complete and free disclosure and exchanges of all information given to these firms in the course of this representation. Such information shall not be confidential as between you. In order to adequately advise you, you will need to provide information concerning your financial resources and business and family matters, You must provide full disclosure of all such information as the type of documents which are prepared for you depend in large part on the assets you state that you own. Of course, such information is held in strictest confidence. You also agree to discuss any issues that may arise with respect to the preparation and execution of any documents in good faith and your conduct at all times will be fair and open with one another and with Decker & Associates, Inc. and the law firm.

    Future Events: Estate planning documents may be complex to read and understand. It will be your affirmative

    duty to comprehensively review documents prepared for you before execution, and to ask for an explanation of any provisions you do not understand. Any changes made to your documents after they are executed will be billed to you on an hourly basis. You may decide that the types of documents or provisions in the documents you want to execute are different from ones requested on this form. Decker & Associates, Inc. and the law firm shall not be responsible for any consequences resulting from such a change. Similarly, changes will likely occur in tax, property, probate and other laws, which could impact your estate, plan. Unfortunately, it is not possible to review the file of each client to determine the impact of court cases, rulings and other changes in the law. Furthermore, changes will likely occur in your own family, in your marital status and in your finances, any of which could impact your estate plan. Hence, you should have your plan reviewed regularly, and you acknowledge that the law firm and Decker & Associates, Inc. have no duty to review your documents or estate plan unless you request them to do so and agree to pay a reasonable fee for such review.

    The law firm has agreed in this contract to provide you with legal services only. You have been advised of the advantages and disadvantages, if any, of having the legal documents listed on page one of this document prepared, and the law firm has agreed to prepare such documents at a stated fee. The attorneys at the law firm are not financial planners, investment advisors, insurance agents or money managers. Decker & Associates, Inc. has agreed in this contract to provide you with administrative services only to facilitate the drafting of these documents. You are free to invest your money and property in any way you see fit, and neither the law firm, nor Decker & Associates, Inc. make representations or warranties as to the financial products which may be purchased by you as a part of your overall estate plan. You are urged to research as best you can the financial strength and viability of any company whose products you purchase.

    I understand that Decker & Associates, Inc. is not a law firm and none of its employees are lawyers. The fee I am paying to Decker & Associates, Inc. is an administrative fee to compensate them for their help in compiling some of the information that will be used by the law firm in preparing my estate planning documents. Estate Planning Form Page 10 of 15 (07/10/10)

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