Duran Firm Client Information Worksheet

Client *
Full Legal Name
Street Address *
Street Address
City, State, Zip *
City, State, Zip
e-Mail *
e-Mail Address
Phone Number *
Best Phone Number
U.S. Citizen *

Yes No
Are you the beneficiary, trustee (singly or jointly), or creator of a trust? *

Yes No
If you answered "Yes" to the previous question, please provide basic details about the trust.

Financial Fiduciaries (Agents, Guardians, Executors, and Trustees)

A fiduciary is someone who accepts the responsibility for taking care of the property of another person for the benefit of that person. Your estate plan will include the appointment of financial fiduciaries.

Qualities to look for in fiduciaries:
1. responsible, business-like adults;
2. never been convicted of a felony;
3. preferably have their own money so they are not tempted to dip into yours;
4. at least one agent should be relatively young so that you don't outlive all of your fiduciaries;
5. usually spouse is primary;
6. other beneficiaries are often alternates.
These people will fill the following roles in your estate plan:

Agent: the person responsible for taking care of your property while you are still alive pursuant to a Power of Attorney.

Guardian: the person responsible for taking care of your property while you are still alive pursuant to a court appointment.

Executor: the person who will be responsible for probating your Will, paying your last debts, filing tax returns, and distributing the assets of the estate to your beneficiaries.

Trustee: the person who will be responsible for the long-term management of any property left in trusts for your beneficiaries.
Primary Financial Fiduciary: *
Name
Phone Number
Best Phone Number; Disregard if Spouse
Mailing Address (Optional)
Street, City, State, Zip; Disregard if Spouse
First Alt. Financial Fiduciary
Name
Phone Number
Best Phone Number
Mailing Address (Optional)
Street, City, State, Zip
Second Alt. Financial Fiduciary
Name
Phone Number
Best Phone Number
Mailing Address (Optional)
Street, City, State, Zip
Professional Trustee

For some people, the thought of leaving a $5 million trust under the supervison of a brother-in-law that likes to dabble in the market causes some concern. For larger estates, the Duran Firm recommends that clients consider having a professional trustee oversee the long-term management of trusts left to their children.
Professional Trustee?

Yes, we would like a referral to meet with a professional trustee recommended by the Duran Firm. No, we have complete faith in the ability and trustworthiness of our selections above.

Last Will and Testament
Please describe who will receive your property at your death. Please remember that "pay on death", "transfer on death", and other similar beneficiary designations on your accounts take priority over the terms of your Will.
Are you going to leave everything to your spouse and then your children, share and share alike? *

Yes No
If “No”, then in your own words please describe how you wish to distribute the remaining property under your will:
If your planned distribution strays too far away from a "natural distribution" of spouse, then descendants, extra attorney's fees may be required.

Medical or Health Care Agents in case of your Incapacity

Please designate medical agents who will be responsible for making personal and medical decisions for you in the event you are unable to do so. These persons will be named as your Agents in a Medical Power of Attorney and will be named as the Guardians of your Person in a Designation of Guardian form.
Primary Health Care Agent:
Name
Phone Number
Best Phone Number
Mailing Address (Optional)
Street, City, State, Zip
First Alt. Health Care Agent
Name
Phone Number
Best Phone Number
Mailing Address (Optional)
Street, City, State, Zip
Second Alt. Health Care Agent
Name
Phone Number
Best Phone Number
Mailing Address (Optional)
Street, City, State, Zip
Please list any special instructions limiting the decision making authority of your agent:

Living Will –

Your wishes in case of permanent or terminal medical incapacity will be expressed in your Living Will, also referred to as a Directive to Physicians.
When death is expected within six months, no matter what.

If, in the judgment of my physician, I am suffering with a terminal condition from which I am expected to die within six months, even with available life-sustaining treatment provided in accordance with prevailing standards of medical care:
CHOOSE ONE *

I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible (ALLOWS FOR HOSPICE AND PAIN MANAGEMENT CARE ONLY); OR I request that I be kept alive in this terminal condition using available life-sustaining treatment. (DOES NOT APPLY TO HOSPICE CARE.)
When death can be delayed indefinitely; example = feeding tube.

If, in the judgment of my physician, I am suffering with an irreversible condition so that I cannot care for myself or make decisions for myself and am expected to die without life-sustaining treatment (such as a feeding tube) provided in accordance with prevailing standards of care:
CHOOSE ONE *

I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible (ALLOWS FOR HOSPICE AND PAIN MANAGEMENT CARE ONLY); OR I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
Additional requests: (After discussing with your physician, you may wish to consider listing particular treatments in this space that you do or do not want in specific circumstances, such as artificial nutrition and fluids, intravenous antibiotics, etc. Be sure to state whether you do or do not want the particular treatment.)

What is the estimated value of your gross taxable estate (including but not limited to real estate, cash, financial accounts, businesses, life insurance policies, revocable trusts, personal property assets, and ALL OTHER PROPERTY THAT TRANSFERS ON YOUR DEATH): *
Value
SIGNED AND ACCEPTED ON: *

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