Nevada Revocable Living Trust – Client Intake Questionnaire

Nevada Revocable Living Trust – Client Intake Questionnaire

Professional plain-English client intake questionnaire for DPS of Northern Nevada. Complete the pages that apply to you; some pages appear only if your answers require them.
NRS 240A Disclosure — Please Read Carefully
I, DEBORAH BARNHART, DOING BUSINESS AS DPS OF NORTHERN NEVADA, AM NOT AN ATTORNEY IN THE STATE OF NEVADA. I AM NOT AUTHORIZED TO GIVE LEGAL ADVICE OR LEGAL REPRESENTATION. I MAY NOT ACCEPT FEES FOR GIVING LEGAL ADVICE OR LEGAL REPRESENTATION.
Trustor / Settlor 1 – About You
Full legal name

First NameMiddle NameLast Name
Other names used
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Email address
example@example.com
Mailing address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Physical / residence address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
County of residence
U.S. citizen
Marital status
Trustor / Settlor 2 – Spouse / Partner
Full Legal Name

First NameMiddle NameLast Name
Other Names Used
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
U.S. Citizen?
Preferred Trust Arrangement
Additional Background Information
Children and Family
Number of living children
Living children list
Are there any deceased children who left children (grandchildren)?
If yes, provide details for deceased children and their children
Does any child or beneficiary have special needs or receive government benefits such as SSI or Medicaid?
If yes, describe the special needs or benefits
Is any child intentionally excluded from this trust plan?
If yes, explain the reason
Additional child or family details
Names of any grandchildren to include in planning notes
Are all living children listed above?
If no, provide the missing child's details
Trustees
Initial trustee(s) default to self/yourselves?
First successor trustee name

First NameMiddle NameLast Name
First successor trustee relationship to you
First successor trustee phone
Please enter a valid phone number.Format: (000) 000-0000.
First successor trustee address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Second successor trustee name

First NameMiddle NameLast Name
Second successor trustee relationship to you
Second successor trustee phone
Please enter a valid phone number.Format: (000) 000-0000.
Second successor trustee address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
If more than one successor trustee serves together, how must they act?
Must successor trustees post bond?
Should successor trustees be compensated?
Distribution After Death
How should the trust be distributed after both trustors pass away?

Other
Beneficiary list
If a beneficiary dies before the trustors, who should receive that share?

Other
If other, explain the alternate distribution for a deceased beneficiary's share
Describe any specific gifts of items, property, or cash amounts to any person
Pets care provisions
Charity name
Charitable gift type
Charitable gift amount or percentage
Should beneficiaries receive outright at a certain age?
Age for outright distribution
If using staggered ages, describe the distribution schedule
If you want a different distribution plan, explain
Additional instructions for distribution after death
Assets to Fund the Trust
Real Property to Fund the Trust
Bank and Credit Union Accounts
Investment and Brokerage Accounts
Retirement Accounts
Life Insurance Policies
Vehicles, Boats, Trailers, and RVs
Business Interests
Mining Claims, Water Rights, or Other Nevada-Specific Property
Other Valuable Personal Property (Jewelry, Firearms, Collections, etc.)
Approximate Total Estate Value
Do you own property in other states?
Details of Property in Other States
Estimated Number of Real Properties
Estimated Number of Bank or Credit Union Accounts
Estimated Number of Investment or Brokerage Accounts
Estimated Number of Retirement Accounts
Estimated Number of Other Valuable Personal Property Items
Additional Documents Requested
Which additional documents would you like prepared?
Executor name for the pour-over will

First NameMiddle NameLast Name
Alternate executor name for the pour-over will

First NameMiddle NameLast Name
Agent name for the durable financial power of attorney

First NameMiddle NameLast Name
Alternate agent name for the durable financial power of attorney

First NameMiddle NameLast Name
Health care agent name for the Nevada advance directive / health care power of attorney

First NameMiddle NameLast Name
Alternate health care agent name for the Nevada advance directive / health care power of attorney

First NameMiddle NameLast Name
List any real property deeds to be prepared or recorded
List any bank or account funding details needed for the funding instruction letter
Additional instructions or special document requests
Other Considerations
Is anyone expected to contest the trust?
Details about a possible contest
Do you have concerns about long-term care or Medicaid planning?
Details about long-term care or Medicaid concerns
Would you like asset protection from creditors?
Details about asset protection concerns
Do you own a business?
Business details
Are there any pending lawsuits, bankruptcy, or divorce matters?
Details about any pending legal matters
Notes or questions for DPS
Acknowledgment and Signature
Acknowledgment
Trustor 1 e-Signature
Trustor 2 e-Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Nevada Revocable Living Trust – Client Intake Questionnaire

NRS 240A Disclosure — Please Read Carefully

Trustor / Settlor 1 – About You

Trustor / Settlor 2 – Spouse / Partner

Children and Family

Trustees

Distribution After Death

Assets to Fund the Trust

Additional Documents Requested

Other Considerations

Acknowledgment and Signature