Questionnaire Two · Asset Protection by Design

The Asset Protection by Design Questionnaire

This is the complete design questionnaire for your plan — the same one we use to begin drafting. We cannot begin drafting until this questionnaire and the Document Checklist are complete. A complete form usually saves several rounds of follow-up emails.

Before you begin: Married couples: answer for both of you — each spouse should review the whole form. Write every name exactly as it appears on a passport, driver’s license, or Social Security card, including middle names. For every person you list, say how they are related to each of you (for example, “John’s daughter; Mary’s stepdaughter”). Unsure about something? Write “unsure” or “not decided” rather than leaving it blank — we will go over it with you. Do not enter Social Security numbers or account numbers; we collect those by phone or through the secure client portal.

Part 1 · About You and Your Spouse

Single clients: use the Client 1 column only.

Client 1Client 2 (spouse / partner)

Full legal name (as on ID) *

Full legal name (as on ID)

Other names used (maiden, prior married, nicknames, name on property titles)

Other names used

Date of birth

U.S. citizen?

Home address, county, ZIP *

Mailing address, if different

Other residences (state, months per year)

Florida resident since

Cell phone *

Cell phone

Email *

Preferred contact method

Occupation / retired from

Military service (branch, dates)

Currently receiving Medicare, Medicaid, SSI or SSDI?

Part 2 · Marriage and Prior Marriages

Current marital status

Date and place of current marriage

Prenuptial or postnuptial agreement? (send a copy with your documents)

Client 1 prior marriages (spouse’s name, how it ended, year)

Client 2 prior marriages (spouse’s name, how it ended, year)

Any obligations under a divorce decree (alimony, life insurance, property)?

Part 3 · Children, Grandchildren and Other Family

List every child of either of you, living or deceased, including stepchildren, adopted children, and children you do not intend to include. Leaving someone off the list can cause problems later, even if you mean to exclude them.

Child 1

Full legal name

Date of birth

Child of

Address, phone, email

Married? Spouse’s name

Living?

Receives SSI, SSDI, Medicaid, SNAP or other benefits, or has a disability?

Include as beneficiary?

Grandchildren, and children of any deceased child (name, DOB, parent’s name, contact, benefits or disability, include as beneficiary?)

Family members you intend to leave out — name anyone you are intentionally not including and, if you wish, why. We will make the exclusion clear in your documents.

Your parents: are either of your parents living? Do you expect to inherit from a parent or anyone else? (details in Part 7)

Part 4 · Beneficiaries and Shares

Who should receive your estate after you (or both of you) are gone? Shares must total 100%.

Beneficiary 1

Full legal name

Relationship to Client 1

Relationship to Client 2

Share (%)

Outright, or held in trust?

If a beneficiary dies before you, should their share go to (a) their children, (b) the other beneficiaries in proportion, or (c) someone else? Answer per beneficiary if different.

Any specific gifts (cash amount, item or property to a named person)?

Any gifts to charity (name, amount or %)?

Should anything you inherit or already own separately (for example, from a parent) go to different people than your joint assets?

If yes, explain

Should a surviving spouse be able to change who inherits after the first death?

If the surviving spouse remarries, should the plan protect the inheritance from the new spouse?

If everyone named above dies before you, who should inherit?

Part 5 · Fiduciaries — The People Who Act for You

Name a first, second and third choice for each role. For each person, give their full legal name, relationship to each of you, city and state, phone and email. Note any condition, for example “only while married to my son.” Florida note: a personal representative who lives outside Florida can serve only if related to you in certain ways (for example, a child, parent, sibling, niece or nephew, or the spouse of one of those). A stepchild or friend living out of state may not qualify — tell us where each person lives.

Successor trustee — manages your trust when neither of you can

Client 1: 1st / 2nd / 3rd choice

Client 2: 1st / 2nd / 3rd choice

Personal representative (executor) — handles anything that goes through probate

Client 1: 1st / 2nd / 3rd choice

Client 2: 1st / 2nd / 3rd choice

Agent under durable power of attorney — handles finances outside the trust if you are incapacitated

Client 1: 1st / 2nd / 3rd choice

Client 2: 1st / 2nd / 3rd choice

Health care surrogate — makes medical decisions if you cannot

Client 1: 1st / 2nd / 3rd choice

Client 2: 1st / 2nd / 3rd choice

Final disposition designee — carries out your funeral and burial or cremation wishes

Client 1

Client 2

Guardian of minor children or dependents — cares for minors if both parents are gone

1st / 2nd / 3rd choice (or N/A)

Trustee of any trust for a beneficiary (for example, a disabled beneficiary)

Choices, and which beneficiary

Trust protector (optional) — can fix problems or replace a trustee later without court

Client 1

Client 2

Contact details for each person named above (full legal name · relationship to Client 1 / Client 2 · city and state · phone · email)

Part 6 · Assets, Debts and Income

Approximate values are fine. For “owner,” write exactly how the asset is titled (for example, “John A. Smith and Mary B. Smith, husband and wife”).

Real estate

Property 1

Property address

Owner(s), exactly as titled

Homestead?

Approx. value

In another state?

Mortgage? Lender and balance

Bank, brokerage and investment accounts

List each: institution · type (checking, savings, CD, brokerage) · owner(s) · approx. balance · payable-on-death or transfer-on-death beneficiary, if any

Retirement accounts, pensions and annuities

List each: plan or company · type (IRA, 401(k), 403(b), pension, annuity) · owner · approx. value or monthly amount · primary beneficiary · contingent beneficiary · pension survivor option elected

Life insurance and long-term care insurance

List each: company · type · insured · owner · death benefit · beneficiaries

Other assets

Vehicles (owner, approx. value)

Business interests (owner, approx. value, notes)

Valuables — jewelry, art, collections

Digital assets and online accounts

Money owed to you

Safe deposit box (bank, location)

Debts (other than mortgages above)

List each: creditor · type · approx. balance

Monthly income

Client 1Client 2

Social Security

Pension

Retirement account withdrawals

Employment or business

Other

Gifts in the last five years: have either of you given away money or property worth more than $500 to any one person in a year? List the date, recipient and amount.

Part 7 · Expected Inheritances and Family Trusts

Tell us about any trust or estate you are named in, now or in the future — for example, a parent’s trust. Please send the complete trust agreement, including every amendment and schedule, not a summary.

Whose trust or estate? Your relationship to them

Name and date of the trust or will, and dates of any amendments

Your share (% or amount); who else shares

Approximate value

Are you a trustee, co-trustee or successor trustee?

Is that person’s attorney or this firm handling their plan?

What should happen to this inheritance under your own plan?

If you want changes made to someone else’s trust or will, that person must hire us separately and sign the documents themselves. It cannot be done under your engagement.

Part 8 · Goals and Concerns

Check all that apply and add comments at the end.

Avoid probate Keep things simple; fewer trusts and trustees Beneficiaries inherit outright (no ongoing trust) Protect a beneficiary’s share from divorce, creditors or poor spending Protect a disabled beneficiary’s government benefits Provide for a surviving spouse for life, then pass to children Protect the inheritance if the surviving spouse remarries Keep inherited or separate money apart from joint assets Access to your money during your lifetime is essential Minimize taxes

Plan for long-term care and Medicaid eligibility?

Care preferences: if you need care in the future, what would you prefer?

Comments on your goals, and anything else we should know: family tensions, a beneficiary with special needs or addiction, a pending lawsuit, plans to move, a business, pets?

Part 9 · Health Care and End-of-Life Wishes

Client 1Client 2

If terminally ill, in an end-stage condition or permanently unconscious, withhold life-prolonging procedures?

Artificial nutrition and hydration in those conditions

Do-not-resuscitate order in those conditions

Organ and tissue donation

Preferred place for end-of-life care

Religious or personal wishes for your care

Who may receive your medical information (HIPAA) besides your surrogate?

Part 10 · Final Disposition

Client 1Client 2

Burial, cremation, or other?

If cremated, what should happen to the ashes, and who decides?

Burial place or cemetery plot owned?

Religious service, memorial, or no service?

Prepaid funeral or burial contract? (provider, contract number)

Any other instructions

Personal belongings: do you want specific items (jewelry, cars, art, keepsakes) to go to specific people?

Part 11 · Existing Documents and Advisors

For each existing document, give the date and the attorney who prepared it, for each of you.

Will (Client 1 / Client 2: date and attorney)

Revocable trust

Durable power of attorney

Health care surrogate / living will

Other (prenup, business agreements)

Your advisors — name, phone and email, and whether we may contact them.

Financial advisor

Accountant / tax preparer

Insurance agent

Other attorney

Acknowledgment We confirm that the information in this form is complete and accurate to the best of our knowledge. We understand that Turk Law Group will draft our documents based on this form and the documents we provide; that the flat fee covers the plan described in our engagement agreement, and major changes to beneficiaries, fiduciaries or plan structure after drafting begins may require an additional fee; and that work on another person’s documents, such as a parent’s trust, requires a separate engagement with that person. *

Client 1 — type your full name to sign *

Client 2 — type your full name to sign

Date

Next step: gather your documents using the Document Checklist. Your answers are sent securely and confidentially to attorney Evan W. Turk. Submitting this questionnaire does not create an attorney-client relationship; that relationship is formed only by a signed engagement agreement. Please do not include Social Security numbers or account numbers. Privacy policy.