Special Needs Trust | Bryant Elder Law

SPECIAL NEEDS TRUST WORKSHEET

Step 1 of 3

Information provided is held in complete confidence, and is used for the sole purpose of analyzing estate planning needs and designing estate planning documents. Preparation of this worksheet is not mandatory prior to the initial appointment with us, but if we are able to review the completed worksheet prior to your appointment, more information and value will be received during the 30-minute complimentary initial consultation.

Date

Referred By

Creator of the Trust: Who are you?

Full legal name as written on government issued ID:

First Middle Last

Preferred Name

Name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Home Phone Number

Cell Phone Number

Social Security Number

Beneficiary of the Trust: Who is this trust created for?

Full legal name as written on government issued ID:

First Middle Last

Preferred Name

Name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Home Phone Number

Cell Phone Number

Trustees

Who do you want to be in charge of this Trust? (List people in order of preference.)

Full legal name as written on government issued ID:

First Middle Last

Full legal name as written on government issued ID:

First Middle Last

Full legal name as written on government issued ID:

First Middle Last

Do you have any deceased children? If so, what is his/her name?

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SPECIAL NEEDS TRUST WORKSHEET

Creator of the Trust: Who are you?

Beneficiary of the Trust: Who is this trust created for?

Trustees

Distribution Scheme

If no, then please fill out the chart below:

Beneficiary (Full legal name issued by government ID)

Percentage %

Medical Condition

San Jose Office

San Mateo Office