THE LAW OFFICES OF

R. GRACE RODRIGUEZ

21000 Devonshire Street, Suite 111, Chatsworth, California 91311

(818) 734-7223 ~ www.LORGR.com ~ Fax: (818) 338-5821

Thank you for choosing the Law Offices of R. Grace Rodriguez to prepare your estate plan. We are sending you the Individual Estate Planning Questionnaire. Please note, that if you have a spouse who will be creating the Estate Planning documents with you, please make sure we have a separate email for your spouse so we can send them a separate questionnaire to collect their responses.

At this point Attorney Rodriguez has gone over the basic design of how to formulate your estate plan. However, in order to put in all of the specifics and for us to prepare all of your estate planning documents we need all of the information requested below. If you do not understand what is being requested, please do not hesitate to give us a call. The accuracy of this questionnaire determines the correctness of your documents.

Once we have your completed questionnaire, it should take proximately two weeks to have everything in order ready once everything has been received Once your documents are complete, Attorney Rodriguez will meet with you to go over any questions or changes you may have.

Thank you again for this opportunity to serve you and your friends and family.

Contact information: #28 - YOU/YOUR Information

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

#20 - Please identify which pronoun YOU prefer to use?

#21 - Are you married?

Yes, opposite-sex couple.

Yes, same-sex couple.

No, but engaged.

No, but a widow or widower.

No, I have never been married.

No. I am divorced.

ABOUT YOUR FAMILY

In this section we want to learn about any children you have both living and tragically some which may be deceased. We want to know about all of the children you have.. Also if you have any grand children that you wish to directly give a gift to once you have passed away.

#62 - Do You have any children, living or deceased?

Living ChildrenDeceased ChildrenNeither of us have any children.

#72 - State the full name (maiden last name), give the date of birth and identify your child's present gender identification. e.g. if you are Jones and your daughter got married to Smith, you would write it like this: Jonnie Art Smith (Jones), 4/8/1974, Female

#84 - Regrettably we must ask about any children who have pre-deceased you. If you could please state which parent, their Name, Gender, Date of Death and whether or not they had any children list how many they had.

Specifics About your Trust

The next questions are directed more specifically at your Trust and what you would like to have happened when you pass away. What you would like to have happen with your Trust assets.

#97 - What do you want to call the Trust? You are free to name the trust anything you want. But remember that the longer the name you choose, the longer it takes to do things when you have to put the full name of the trust. Some examples include: The Smith Family Trust, The John Doe and Jane Doe 2021 Trust, You could also use names that don't have your last name in it like The 1234 Main Street Trust. You can also be creative and invent names like Our Legacy Trust. Put what you would like it to be called below, and if there are any issues with that name, I will let you know.

What is the Complete Address of Your Primary Residence?

Do you own the home where you live?

Yes

Do you own any other real estate?

Yes

Will all your heirs/children be treated equally?

In this section we begin to discuss what will happen when you pass away. Generally if you have children most parents want to treat each child equally. This is the trust we will commonly prepare to distribute everything to everyone equally. If this is not your desire or you have special concerns, or have children with special needs, or any other issues or concerns. Please let the office know as you are likely to need a trust which is more complex than the one we are offering you. Special Needs Trusts, and restrictive behaviors trusts are more complex and will require additional work. Please let the office know this.

Treat all of my heirs/children equally when I am gone.

Yes

Do you have any adult children which could benefit from a special needs trust, or suffer from any limitations in their ability to manage money? Such limitations could include physical, mental or emotional disabilities or mental health issues such as addiction or diagnosis.

Yes

#147 - Will you be giving any specific gifts of any of the following:

Club Memberships - Do you have an club memberships or time shares you wish to leave to anyone.Any Special Instructions You would like?Money - is there any money you would like the Trustee to distribute upon your death.Stock - Do you have a brokerage account you would l ike to leave to someone?Loan Forgiveness - Does anyone owe you money that you plan to forgive upon your death?

I have the following Assets: (Please Check All that Apply) - If you have over $11.5 Million in assets please contact the office as we have a more detailed questionnaire you need to be filling out.

I own a business that I am the sole proprietor.I am the sole Managing member of an LLCI am an Officer/Director of a CorporationI have a brokerage accountI have a 401K/403BI own a Time-ShareI have been given an inheritance that I can give away upon my death. In other words did a family member leave you property that you were to use during your lifetime, and then once you passed away it was to then go to someone else who is not your children?I have shares of stock in a non-publicly traded company.

#148 - If you are making a gift of money - who will you be giving money to?

CharityEmployeeIndividual

#151 - Provide the name of each recipient and amount of money you wish to give. Please state whether the money should be given to that person directly or should it be kept in the trust to be given to that person over a period of time. Also if that person does not survive you, please state whether the gift should go to that person's children or should the gift just be cancelled or given to someone else.

#163 - GIFT TO CHARITY: Please give the name address and amount of any gifts to a charity you wish to make. Please advise whether you wish to have the gift be for a general purpose or a specific purpose.

#172 - GIFT TO Employee(s): Please state which Company employees will receive the gift. How many years will the employee had to have been working to qualify for the gift. Identify if all employees are getting the gift. Also specify whether you are giving a specific amount to each employee, or are you basing in on a percentage of their compensation or will it be based upon amount per year of service.

#191 - GIFT OF STOCKS: Please state the name, Gender, and corporation name and the number of shares you will be giving to said person.

#196 - LOAN FORGIVENESS - It is recommended that regardless whether there are loans owed to you by your children, that you make a statement that all loans are forgiven. If a child owes you money then please indicate if you will insist upon repayment at the time of your death. List the name of the person and the amount they owe.

#202 - Is there anything else you would like to make sure happens when you pass away. Please write it down here.

#206 - Do you want to provide money or a trust for your pets to be taken care of?

Yes

#224 - GRANDCHILDREN - Are there any gifts you wish to give to grand children after you pass away? Note that all gifts to your children will be passed on to their children if they do not survive you. This is a separate gift.

Yes

#308 - Once you have passed on, are all of your children to be treated equally?

Yes

Please tell me how you think you would like all of your assets distributed once you have passed on.

Who Will Be In Charge of the Trust When You are Not.

The day comes when you may not feel well enough to take care of your trust or make decisions on your own. In this section we will explore who will be in charge of the Trust when you are not. Below you will tell us who you wish to be in charge of your Trust when you cannot be. It is important that you name someone that you feel confident will carry out your instructions exactly as you have set forth in your Trust. You will want to choose someone you trust who follows instructions very well in order to have the best result. Also note, that you don't have to choose just one person. You can have more than one. If you choose more than one person, please let us know if they have to all agree on the decisions that are made, or can it be a simple majority. For example if you have three children and you name them all as successor trustees, 2 out of the three agree on a course of action, then that will be the course of action. You will have one year of changes you can make to your Trust that comes with your Estate Planning Services with our law firm. So if you are having a hard time deciding, we suggest go with your instincts first.

Also one other recommendation: If you have adult children who all are pretty rational and have stable lives, you may wish to simply name all of your children together to serve as your first successor trustees to serve as a group. In the event, one or more are unavailable the remainder can continue to serve.

#702 - Please tell me the full name, address and telephone number of whom you wish to serve as your first successor trustee(s)?

#703 - If your first choice cannot serve or is unable to serve, who would be your 2nd choice(s) of Trustee(s):

YOUR Health Care Directives

In this section we will ask YOU some questions about what YOU want to happen if YOU should ever find yourself in a position where YOU cannot answer questions for your doctor and someone else has to make medical decisions for you.

#1166 - In the event that your Agent/Co-Agents are unable to serve or refuse to serve, who would you like to name as an alternate? Again, you have the right to name more than one person to act as an alternate. Please state their NAME, ADDRES, PHONE NUMBER, and GENDER.

#1157 - In the event YOU became incapacitated and could not make your own medical decisions, who do you want to make all those decisions for you?

#1176 - Do you give your agents the power and authority to consent to withholding or withdrawal of life-sustaining treatment? Remember this is a very very serious question. Please make sure the Agent is someone you trust and who has the fortitude to end your life if it is your wishes that your life be ended.

Yes

#1177 - Do YOU want to include a provision that if YOU are unable to communicate instructions and wishes, your agent is required to first consult with members of your family?

Yes

#1178 - Do YOU wish to nominate a Conservator? The State of California will appoint a Conservator for you and it may not be your SPOUSE if you fail to nominate someone. In the event you need long term care, it is best you nominate one here.

Yes

#1197 - Do YOU wish to Donate any Organs upon your death?

Yes

#1181 - Do you want a provision listing the following Prohibited Actions. "My Agent shall not have the power to cause any experimental drug (as defined in Section 111515 of the Health and Safety Code) to be prescribed for or administered to me, or to authorize or consent to any of the following on my behalf: (1) commitment to or placement in a mental health treatment facility; (2) convulsive treatment (as defined in Section 5325 of the Welfare and Institutions Code); (3) psychosurgery (as defined in Section 5325 of the Welfare and Institutions Code); or (4) sterilization."

Yes

#1200 - Do YOU want to designate a primary physician?

Yes