Special Needs Trust Questionnaire

Sussan, Greenwald & Wesler > Special Needs Trust Questionnaire

Filling out this short questionnaire will provide us with the information we need to draft your special/supplemental needs trust documents.

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Grantor Information. The Grantor is the person providing the funds for the trust.

Grantor Full Legal Name

Social Security Number

Birthdate

Full Mailing Address

Best Phone Number

Grantor #2 (if applicable)

Grantor #2 Full Legal Name

Grantor #2 Social Security Number

Grantor #2 Birthdate

Grantor #2 Full Mailing Address

Grantor #2 Best Phone Number

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Trustee Information

(for the Special Needs Trust) the Trustee is an individual responsible for handling trust assets for the disabled child/person, if both parents are deceased:

Trustee Full Legal Name

Relationship to Beneficiary

Best Phone Number

Full Mailing Address

Add Alternate Trustee Information (If the Trustee dies or is unable to serve):

Alternate Trustee Full Legal Name

Alternate Trustee Relationship to Beneficiary

Alternate Trustee Best Phone Number

Alternate Trustee Full Mailing Address

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Disability & Trust Information

Disability Caseworker Full Name

Disability Caseworker Phone Number

What is the Disability?

What is the amount to be put into the Trust?

Where was the money derived from?

Income Information: What benefits does the disability person receive and how much? (e.g. Medicaid, SSI, Disability, etc.

Name of Remote Contingent (Name of the person who will receive the funds in the event that the beneficiary passes?)

Does the Beneficiary have siblings? If yes, please provide full legal name(s) and birthdate(s).

How did you hear about us?

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Beneficiary Information. The Beneficiary is the person directly benefiting from the trust.

Full Legal Name

Social Security Number

Birthdate

Full Mailing Address

Best Telephone Number

Relationship to Grantor

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End of Special Needs Trust Questionnaire

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Special Needs Trust Questionnaire

Grantor Information. The Grantor is the person providing the funds for the trust.

Trustee Information

Disability & Trust Information

Beneficiary Information. The Beneficiary is the person directly benefiting from the trust.

End of Special Needs Trust Questionnaire

Summary

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