The Law Offices of Eric J. Gold | Calabasas, Santa Monica, Burbank Attorneys

Contact Information

This initial section provides basic demographic and classification information.

First Name *

Required

Middle Name

Last Name *

Required

Email *

Required

Phone *

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Date of birth *

Required

Street Address *

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City *

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State *

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Country *

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Postal Code *

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Preferred Office Location *

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Residence County *

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Gender Identification

US Citizen *

Yes No

Required

Marital Status *

Required

Spouse or Significant Other's Information

Spouse Legal Name *

Required

Spouse Middle Name

Spouse Email *

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Spouse Mobile Phone *

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Spouse Birthday *

Required

Spouse Gender

Spouse US Citizen *

Yes No

Required

Spouse Portal Access *

Yes No

Required

Family Details and Information

Do you have children? *

Yes No

Required

Your children — add each child below (up to 8).

Do either of you have children from another relationship? *

Yes No

Please provide name, gender, DOB, % allocation, and parent (you / spouse) for each

Do you have any deceased children? *

Yes No

Required

Please provide name and DOB for each deceased child.

Distribution Related Questions

Do you or any of your beneficiaries have a learning disability, special educational, medical or physical need? *

Yes No

Required

Please describe.

Do you have any relatives (other than a spouse or children) who depend on you for all or part of their support? *

Yes No

Required

Please describe.

Do you believe any of your beneficiaries have problems with spouses, drugs, alcohol or handling money? *

Yes No

Required

Please describe.

Do you wish to disinherit any of your children, grandchildren or any other close relative or person? If so, please provide their name and the nature of the relationship, such as son, cousin, granddaughter, etc. *

Yes No

Required

Please describe.

If a named beneficiary dies before you, do you want the assets to go to that beneficiary's issue (children)? *

Yes No

Required

Do you want assets passing to your beneficiaries to be held in trust until specific age or ages? Please select the option that best meets your desire. *

Required

General distribution wishes.

Specific concerns about distribution.

Miscellaneous Questions

Do either of you expect to inherit substantial assets ($100,000+)? *

Yes No

Required

Do either of you have an existing Last Will and Testament? *

Yes No

Required

Do either of you have an existing Trust (either revocable or irrevocable)? *

Yes No

Required

Do either of you have an existing General Power of Attorney? *

Yes No

Required

Do either of you currently hold any assets in joint tenancy with another person? *

Yes No

Required

Do either of you hold an interest (ownership) in a closely-held business, s-corporation, LLC, farm, ranch, etc.? *

Yes No

Required

If either of you do hold an interest, please provide the legal name of the business and describe what the business does.

Agents for your Estate Plan

Roles for Your Estate Plan

Successor Trustee — represents the Trust if you are both unable or unwilling to serve. You both share these people.

Executor — the nominated executor(s) for your Last Will and Testament.

Financial Power of Attorney — the nominated Agent for your financial Power of Attorney.

Guardian for Minor Children — the nominated guardian for your child or children.

Health Care Agent — the nominated Agent for your Advance Health Care Directive.

Add each person once, then check the role(s) they will serve. One person can serve in several roles, but each role can be held by only one person — and all 5 roles must be assigned before you submit.

Successor Trustee

Primary Successor Trustee — Full Name *

Required

Primary Successor Trustee — Relationship *

Required

Primary Successor Trustee — Phone *

Required

Primary Successor Trustee — Email *

Required

Backup Successor Trustee — Full Name

Backup Successor Trustee — Relationship

Backup Successor Trustee — Phone

Backup Successor Trustee — Email

Should the Successor Trustee be eligible for compensation? *

Yes No

Required

Executor for Your Will

Same Executor For Both Spouses? *

Yes No

Required

Executor — Full Name *

Required

Executor — Relationship *

Required

Executor — Phone *

Required

Executor — Email *

Required

Spouse's Executor — Full Name

Spouse's Executor — Relationship

Spouse's Executor — Phone

Spouse's Executor — Email

Agent for Financial Power of Attorney

Same Financial POA Agent For Both Spouses? *

Yes No

Required

Financial POA Agent — Full Name *

Required

Financial POA Agent — Relationship *

Required

Financial POA Agent — Phone *

Required

Financial POA Agent — Email *

Required

Spouse's Financial POA Agent — Full Name

Spouse's Financial POA Agent — Relationship

Spouse's Financial POA Agent — Phone

Spouse's Financial POA Agent — Email

Nominated Guardian for Minor Children

Primary Guardian — Full Name *

Required

Primary Guardian — Relationship *

Required

Primary Guardian — Phone *

Required

Primary Guardian — Email *

Required

Backup Guardian — Full Name

Backup Guardian — Relationship

Backup Guardian — Phone

Backup Guardian — Email

Medical Decision Maker

Same Medical Decision Maker For Both Spouses? *

Yes No

Required

Medical Decision Maker — Full Name *

Required

Medical Decision Maker — Relationship *

Required

Medical Decision Maker — Phone *

Required

Medical Decision Maker — Email *

Required

Spouse's Medical Decision Maker — Full Name

Spouse's Medical Decision Maker — Relationship

Spouse's Medical Decision Maker — Phone

Spouse's Medical Decision Maker — Email

End-of-Life Decision Making

Which statement best states your wishes about prolonging life? *

CHOICE NOT TO PROLONG LIFE. I do not want my life to be prolonged if (1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or (3) the likely risks and burdens of treatment would outweigh the expected benefits. CHOICE TO PROLONG LIFE. I want my life prolonged as long as possible within the limits of generally accepted health care standards. Undecided

Required

Should your health care agent have authority for anatomical gifts? *

Yes No

Required

Should your agent have authority to authorize autopsy? *

Yes No

Required

Disposition of remains preference *

Required

Any specific requests for disposal?

Do you have pre-need funeral arrangements?

Yes No

If yes, please describe

Your Spouse or Significant Other's Wishes

Which statement best states your spouse or significant other's wishes about prolonging life? *

CHOICE NOT TO PROLONG LIFE. I do not want my life to be prolonged if (1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or (3) the likely risks and burdens of treatment would outweigh the expected benefits. CHOICE TO PROLONG LIFE. I want my life prolonged as long as possible within the limits of generally accepted health care standards. Undecided

Required

Should your spouse's health care agent have authority for anatomical gifts? *

Yes No

Required

Should your spouse's agent have authority to authorize autopsy? *

Yes No

Required

Your spouse's disposition of remains preference *

Required

Any specific requests for disposal?

Does your spouse have pre-need funeral arrangements?

Yes No

If yes, please describe.

Estimated Value of Estate

Do you own real estate? *

Yes No

Required

List each property you own (up to 6).

Do you own securities (stocks, bonds, etc.)? *

Yes No

Required

Estimated value of securities

Estimated value of cash-type assets *

Required

Estimated value of retirement plans *

Required

Describe valuable personal property (jewelry, antiques, art) *

Required

Community / Separate Property

Do you and your spouse / partner have separate property interests? *

Yes No

Required

If yes, do you want to maintain these interests as separate?

Should all assets be considered community assets?

Yes No

Confirmations

I confirm I am fluent in English. *

Required

I confirm this form is complete and accurate to the best of my knowledge. *

Required

Submission

Electronic Signature (type your full legal name) *

Required

Spouse / Partner Electronic Signature (type full legal name) *

Required

Today's Date *

Automatically set to today's date.

Required

Estate Planning Questionnaire

Contact Information

Spouse or Significant Other's Information

Family Details and Information

Distribution Related Questions

Miscellaneous Questions

Agents for your Estate Plan

End-of-Life Decision Making

Estimated Value of Estate

Submission

Address

Satellite Offices

Phone

Fax

Email