Special Needs Trust Questionnaire

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

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

Grantor Full Legal Name(Required)

Birth Date(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Phone Number(Required)

Grantor #2 (if applicable)

Grantor #2 Full Legal Name(Required)

Grantor #2 Birth Date(Required)

Grantor #2 Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Grantor #2 Best Phone Number(Required)

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

Full Legal Name(Required)

Birth Date(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Telephone Number(Required)

Relationship to Grantor(Required)

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(Required)

Relationship to Beneficiary(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Phone Number(Required)

Add an Alternate Trustee

Yes

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This person takes on the responsibilities of the Trustee, in the event the Trustee is incapable of serving.

Alternate Trustee Full Legal Name(Required)

Alternate Trustee Relationship to Beneficiary(Required)

Alternate Trustee Full Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Alternate Trustee Best Phone Number(Required)

Hidden

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Disability & Trust Information

Disability Caseworker Full Name(Required)

Disability Caseworker Phone Number(Required)

What is the Disability?(Required)

ex.: Diagnosis, difficulties, etc.

What is the amount to be put into the Trust?(Required)

Where was the money derived from?(Required)

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

What benefits does the disabled person receive, and in what amount? (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?)(Required)

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

How did you hear about us?(Required)

End of Special Needs Trust Questionnaire

Enter your email to complete this form.(Required)

Thank you for completing the Special Needs Trust Questionnaire. If you don't receive confirmation in your email, please check your junk mail.

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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.

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

Grantor #2 (if applicable)

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

Trustee Information

Section Break

Section Break

Disability & Trust Information

End of Special Needs Trust Questionnaire

Contact us now

For a Private Consultation

SPECIAL NEEDS

Estate Planning

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