LAW OFFICES OF ROZSA GYENE

📋 Welcome to the Estate Planning Questionnaire
Please complete this secure form to begin creating your personalized estate planning documents. You will be asked to provide information about yourself, your family, and your wishes regarding guardianship, trustees, healthcare decisions, and more.

📄 What You Will Receive:
A custom estate planning package including: Revocable Living Trust, Last Will and Testament, Durable Power of Attorney, Advance Health Care Directive, HIPAA Authorization, Personal Property Memorandum, and Certification of Trust.

👥 Single or Joint Plan:
At the end of the form, you will be asked to select one of the following:
Single Estate Plan – For individuals ($575)
Joint Estate Plan – For married couples or domestic partners ($675)
Your selection will determine the correct documents and direct you to the appropriate payment page.

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  • 📞 Questions? Call us at (818) 291-6217

Estate Planning Questionnaire

Client Information

First Name
MIddle Name
‍
Last Name
‍
Gender
Date of Birth
U.S. Citizen?
Client Address
Phone Number
Email Address

Spouse Information

Spouse First Name
Spouse MIddle Name
Spouse Last Name
Gender
Spouse Date of Birth
Spouse U.S. Citizen?
Spouse Phone Number
Spouse Email

Children Information

Full Name
Date of Birth
Gender
Add Another Child

Successor Trustee

💡 What is a Successor Trustee?
A Successor Trustee is the person who will take over managing your trust if you become unable to do so. This includes paying bills, handling your assets, and eventually distributing them to your beneficiaries.
Full Name of Successor Trustee
Successor Trustee Address
Successor Trustee Phone Number
Add Another Successor Trustee

Beneficiary Information

💡 Who is a Beneficiary?
A Beneficiary is someone who will receive your assets after your death. You can name one or more people, organizations, or charities, and you may also specify what each should receive.
Beneficiary Full Name
Beneficiary Relationship
Beneficiary Share
Add Another Beneficiary

Specific Gifts

🎁 What is a Specific Gift?
A Specific Gift is a particular item or amount of money that you want to leave to a specific person or organization, such as a home, car, or set dollar amount. These gifts are distributed before the rest of your estate.
Full name of Specific Beneficiary
Gift Description
Add Another Specific Gift

Executors Information

📝 What is an Executor?
An Executor named in your Pour-Over Will is responsible for handling any remaining assets not already placed in your trust at the time of your death. Their job is to ensure those assets are transferred ("poured over") into your Revocable Living Trust.
Executor Full Name
Executor Address
Executor Phone Number
Add Another Executor

Durable Power of Attorney

📄 What is a Durable Power of Attorney?
A Durable Power of Attorney allows the person you appoint (your "agent") to manage your financial and legal affairs if you become incapacitated. This can include accessing bank accounts, paying bills, and transferring property into your trust.
Durable Power of Attorney
Durable Power of Attorney Address
Durapble Power of Attorney Phone Number
Add Another Power of Attorney

Health Care Agents

❤️ What is a Health Care Agent?
A Health Care Agent is someone you trust to make medical decisions for you if you are unable to communicate or make decisions yourself. They follow your wishes and ensure you receive the kind of care you want.
Health Care Agents
Health Care Agent Address
Health Care Agent Phone Number
Add Another Health Care Agent

Organ Donation Selection

🫀 What is Organ Donation?
You can choose to donate your organs after death to help others. If you say "Yes," you can specify if you want your organs used for:
  • Transplantation
  • Medical research
  • Any purpose
If you select "No," no organ donation will be made on your behalf.

Guardian Information

👨‍👩‍👧 Guardian for Minor Children
If you have children under 18, you can name someone you trust to care for them if something happens to you. This person will be legally responsible for their upbringing, education, and well-being. You may also name an alternate guardian in case your first choice is unable to serve.
Guardian Name
Guardian Phone Number
Guardian Address
Add Another Guardian
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