PARTIAL
ESTATE PLANNING CHOICES WORKSHEET
(PRELIMINARY CHOICES)
free living trust dvd upon completion & faxing
DATE OF FORM: 5/1/07
Your Name:
Spouse's Name:
Address:
City:
Telephone: (Optional)
County: Los Angeles Other:
Number of Children of Current Marriage: one (1) two (2) three (3) four (4) other:
Number of Children of Previous Marriage(s): ______________
NAMES OF CHILDREN:
H/W/B ______________________________________________
H/W/B ______________________________________________
H/W/B ______________________________________________
H/W/B ______________________________________________
CHOICES FOR GUARDIAN
OF YOUR MINOR CHILDREN
GOOD CHOICES ARE:
PARENTS (IF NOT TOO OLD)
CHILDREN (IF NOT TOO YOUNG)
BROTHERS & SISTERS
FRIENDS
[70] YOUR FIRST CHOICE FOR GUARDIAN:
[71] RELATIONSHIP TO YOU:
friend / mother/father / son/daughter / brother/sister / / in law
**[72] OPEN
[73] RELATIONSHIP TO SPOUSE:
friend / mother/father / son/daughter / brother/sister / /in law
[74] YOUR SECOND CHOICE FOR GUARDIAN:
[75] RELATIONSHIP TO YOU:
friend / mother/father / son/daughter / brother/sister / / in law
**[76] open
[77] RELATIONSHIP TO SPOUSE:
friend / mother/father / son/daughter / brother/sister / /in law
[78] YOUR THIRD CHOICE FOR GUARDIAN:
[79] RELATIONSHIP TO YOU:
friend / mother/father / son/daughter / brother/sister / / in law
**[80] open
[81] RELATIONSHIP TO SPOUSE:
friend / mother/father / son/daughter / brother/sister / /in law
DURABLE POWER OF ATTORNEY -
HEALTH CARE POWER OF ATTORNEY
(THIS PERSON MAKES HEALTH DECISIONS FOR YOU)
GOOD CHOICES ARE:
PARENTS (IF NOT TOO OLD)
CHILDREN (IF NOT TOO YOUNG)
BROTHERS & SISTERS
FRIENDS
[122] YOUR FIRST CHOICE FOR HEALTH CARE:
[123]
RELATIONSHIP TO YOU:friend /mother /father /son /daughter /brother /sister / / in law
[124] SPOUSE'S FIRST CHOICE:
[125] RELATIONSHIP TO SPOUSE:
friend/mother/father /son/daughter /brother /sister / /in law
[126] YOUR SECOND CHOICE FOR HEALTH CARE:
[127] RELATIONSHIP TO YOU:
friend /mother /father /son /daughter /brother /sister / / in law
[128] SPOUSE'S SECOND CHOICE:
[129] RELATIONSHIP TO SPOUSE:
friend/mother/father /son/daughter /brother /sister / /in law
[130] YOUR THIRD CHOICE FOR HEALTH CARE:
131] RELATIONSHIP TO YOU:
friend /mother /father /son /daughter /brother /sister / / in law
[132] SPOUSE'S THIRD CHOICE:
[133] RELATIONSHIP TO SPOUSE:
friend/mother/father /son/daughter /brother /sister / /in law
DISTRIBUTION PATTERN
(WHO GETS WHAT)
1. SPECIFIC ITEMS TO SPECIFIC PERSONS: (MONEY, ETC.)
2. ALL OTHER ASSETS GO TO:
____ SIMPLE: - ALL TO CHILDREN IN EQUAL SHARES
____ OTHER:
FREE VIDEOTAPE:
ONCE YOU HAVE PRINTED AND FILLED OUT THIS FORM (AS MUCH AS POSSIBLE),
FAX THE FORM TO BILL'S OFFICE AT
(818) 244-9996
WE WILL SEND YOU A FREE ESTATE PLANNING VIDEOTAPE, ALONG WITH A COUPON FOR A FREE INITIAL CONSULTATION.