BFCal Estate Planning Data Form

Legacy Plan Worksheet

Please fill in as completely as possible. All information provided is held instruct confidence by The Baptist Foundation of California and its representatives. Please use full legal names, including middle names for children. Please provide approximate values for assets and liabilities and fill in to the fullest extent you can.
Tips for Filling the Worksheet
- Take a look at our PDF worksheet to get an idea of what information you will need to fill out the worksheet. To avoid mistakes, you may want to pre-complete a hard copy of the form to use as a “practice” draft for submitting your form on-line.
- Allow approximately 20-30 minutes to complete the on-line form and submit it to us. If you are unable to complete the form and submit the completed data at this time, you will not be able to save your information and must restart the on-line submission process. You are encouraged to wait until you have the time and opportunity to complete and submit all information in one sitting.
  If you are married and are submitting a joint form, please consult with your spouse before submitting to ensure its accuracy.
- Though estimates are helpful, you should always try be thorough and accurate when submitting your data form. This will help the attorney customize an estate plan that is best for you and your family.
- Your data is not stored when completing the form, so always remember to hit the "Submit" button at the end of the form. Once you submit, you will be able to save your data information.
- After you submit your worksheet, please be on the lookout for a confirmation email from us. If you do not receive one, kindly give us a call at the number below.
If you have any questions, please do not hesitate to give us a call at 909-738-4000, and we would be glad to help you.

About You
Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
US Citizen

YesNo
Address

Line 1

Line 2

CityState

ZIP Code
Primary Phone number
Mobile Phone
Primary Email
example@example.com
Secondary Email
example@example.com
Occupation

About Your Church
Church
Church Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Pastor

First NameLast Name
Did you attend The Baptist Foundation of California Estate Planning Seminar?

YesNo
Date of Seminar

MonthDayYear
Date
Seminar Presenter

Jonathan JarboeCourtney CoatesErnest Ong
If yes, please provide the date and name of Seminar Presenter

Previous Wills and Trusts
Do you have a Will or Trust?

YesNo
If you answered yes, please attach a photocopy of Will or Trust (if convenient)

Cancelof

About Your Spouse
Are you currently married?

YesNo
Marriage Date

MonthDayYear
Date
Spouse Name

First NameMiddle NameLast Name
Spouse Date of Birth

MonthDayYear
Spouse Mobile Phone
Spouse Email
example@example.com
(Spouse) US Citizen

YesNo
Prior Marriage (Check if Applicable)

DivorcedWidowed

Children Information

You can list up to 5 children, please let us know if you have more than 5 children.
Child 1

First NameLast Name
Whose Children?
Sex
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Email
example@example.com
Child 2

First NameLast Name
Whose Children?
Sex
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Email
example@example.com
Child 3

First NameLast Name
Whose Children?
Sex
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Email
example@example.com
Child 4

First NameLast Name
Whose Children?
Sex
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Email
example@example.com
Child 5

First NameLast Name
Whose Children?
Sex
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Email
example@example.com

Naming a Guardian

If you have minor children, a guardian should be named in your Will. Nominate the person you wish to take care of your children until they turn age 18. You may wish to name a different person as Guardian of the Person, who will have custody and raise the children and as Guardian of the Estate, who will manage the child’s assets absent their placement in a trust.
1st Guardian Name

First NameLast Name
Relationship with 1st Guardian
1st Guardian Phone Number
1st Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1st Guardian Email
example@example.com
2nd Guardian Name

First NameLast Name
Relationship with 2nd Guardian
2nd Guardian Phone Number
2nd Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2nd Guardian Email
example@example.com
3rd Guardian Name

First NameLast Name
Relationship with 3rd Guardian
3rd Guardian Phone Number
3rd Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3rd Guardian Email
example@example.com

NAMING A TRUSTEE OR EXECUTOR

The trustee and executor will have control over all assets and make discretionary decisions regarding the handling and distribution of the assets. An executor must be named and an alternate should be named. An executor should be one who knows your affairs and is competent to handle financial matters. Usually a husband will name his wife and the wife will name her husband. If this is the case, write “spouse” in the place of name under the 1st choice. The alternates may be anyone over the age of 18 or if you desire a Christian professional administrator, you may name The Baptist Foundation of California.
Is 1st Trustee/Executor Spouse?

YesNo
1st Trustee/Executor Name

First NameLast Name
Relationship with 1st Trustee/Executor
1st Trustee/Executor Phone Number
1st Trustee/Executor Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1st Trustee/Executor Email
example@example.com
2nd Trustee/Executor Name

First NameLast Name
Relationship with 2nd Trustee/Executor
2nd Trustee/Executor Phone Number
2nd Trustee/Executor Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2nd Trustee/Executor Email
example@example.com
3rd Trustee/Executor Name

First NameLast Name
Relationship with 3rd Trustee/Executor
3rd Trustee/Executor Phone Number
3rd Trustee/Executor Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3rd Trustee/Executor Email
example@example.com

SELECTION OF AGENTS UPON INCAPACITY
1. Financial Decisions: Powers of Attorney.

Names, addresses, phone numbers and emails under Power of Attorney (you may list co-agents):
Is 1st POA Spouse?

YesNo
1st POA Name

First NameLast Name
Relationship with 1st POA
1st POA Phone Number
1st POA Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1st POA Email
example@example.com
2nd POA Name

First NameLast Name
Relationship with 2nd POA
2nd POA Phone Number
2nd POA Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2nd POA Email
example@example.com
3rd POA Name

First NameLast Name
Relationship with 3rd POA
3rd POA Phone Number
3rd POA Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3rd POA Email
example@example.com
2. Medical Decisions: Agent for Healthcare Directive.

Names, addresses, phone numbers and emails under Advance Healthcare Directive (you may list co-agents):
Is 1st Agent Spouse?

YesNo
1st Agent Name

First NameLast Name
Relationship with 1st Agent
1st Agent Phone Number
1st Agent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1st Agent Email
example@example.com
2nd Agent Name

First NameLast Name
Relationship with 2nd Agent
2nd Agent Phone Number
2nd Agent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2nd Agent Email
example@example.com
3rd Agent Name

First NameLast Name
Relationship with 3rd Agent
3rd Agent Phone Number
3rd Agent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3rd Agent Email
example@example.com

Medical Record Release Authorization

Please provide the following information below.
What is your primary healthcare provider?
Example: Kaiser Permanente of Southern California
Name of Primary Care Physician

First NameLast Name
Address of Primary Care Physician

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Care Physician's Email
example@example.com
Primary Care Physician's Phone Number
Please enter a valid phone number.
Preferred Healthcare Facility
Address of Preferred Healthcare Facility

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Preferred Healthcare Facility
Please enter a valid phone number.
Additional Names

Please provide additional names of individuals you would like the hospital and the physicians to release records to. You do not have to include individuals you have named in your Advance Healthcare Directive.

1st Authorized Recipient of Medical Information
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

2nd Authorized Recipient of Medical Information
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

3rd Authorized Recipient of Medical Information
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

	Your Sole & Separate	Spouse’s Sole & Separate	Jt, Tenancy/ Community Property
Current Value

	Your Sole & Separate	Spouse’s Sole & Separate	Jt, Tenancy/ Community Property
Current Value

	Your Sole & Separate	Spouse’s Sole & Separate	Jt, Tenancy/ Community Property
Current Value

CASH AND OTHER ASSETS

Please use approximate values. It is not necessary to list account numbers. (Retirement assets are to be listed in the next page)

	Cash (List financial institution name and address and checking/savings CDs/etc. as well as approximate value)	Your Sole & Separate	Spouse’s Sole & Separete	Jt. Tenancy/ Community Property
1
2
3
4
5

Total: Your Sole & Separate
Total: Spouse's Sole & Separate
Total: Jt, Tenancy/ Community Property

	Stocks, Bonds and Mutual Funds Other than Retirement Account (e.g. 401K, 403b, IRA) (List company name and address, current value, tax/cost basis)	Your Sole & Separate	Spouse’s Sole & Separete	Jt. Tenancy/ Community Property
1
2
3
4
5

Total: Your Sole & Separate
Total: Spouse's Sole & Separate
Total: Jt, Tenancy/ Community Property

	Business Interest Sole Proprietor, Jt. Venture, L.L.C., L.P., G.P., P.C., S. or C. Corp., etc (List company name, address and business type):	Your Sole & Separate	Spouse’s Sole & Separete	Jt. Tenancy/ Community Property
1
2
3
4
5

Total: Your Sole & Separate
Total: Spouse's Sole & Separate
Total: Jt, Tenancy/ Community Property

	Your Sole & Separate	Sole & Separete	Jt. Tenancy/ Community Property
Personal Property Vehicles, furniture, antiques, art, jewelry, collections, electronics, etc.
Business Interest Mortgages, trust deeds, notes, etc.
Miscellaneous

Total: Your Sole & Separate
Total: Spouse's Sole & Separate
Total: Jt, Tenancy/ Community Property
Total: Your Sole & Separate
Total: Spouse's Sole & Separate
Total: Jt, Tenancy/ Community Property

RETIREMENT ASSETS

Your retirement Plan, IRA and/or Tax Sheltered Annuities (eg 401k, 403b, IRA)(Do not include pensions which carry no death benefits)

	Company Type	Beneficiary	Current Account Value
1
2
3
4
5

Retirement Assets Total

Your Spouse’s Individual Retirement Accounts and/or Tax Sheltered Annuities

	Company Type	Beneficiary	Current Account Value
1
2
3
4
5

Spouse's Retirement Assets Total

LIFE INSURANCE POLICIES

Your Life Insurance

	Insured	Company	Type of Policy	Beneficiary	Death Benefit
1
2
3
4
5

Your Spouse's Life Insurance

	Insured	Company	Type of Policy	Beneficiary	Death Benefit
1
2
3
4
5

Your Life Insurance Total
Your Spouse's Life Insurance Total

LIABILITIES

Estimate Balances Owed

Mortgages

	Your Sole & Separate	Sole & Separete	Jt. Tenancy/ Community Property
Home Address
Other Properties

Loans (If you have more than one, please give totals)

	Your Sole & Separate	Sole & Separete	Jt. Tenancy/ Community Property
Automobile
Bank
Installment Contracts
Life Insurance

Charge Accounts

	Your Sole & Separate	Sole & Separete	Jt. Tenancy/ Community Property
Totals

Other Debts

	Your Sole & Separate	Sole & Separete	Jt. Tenancy/ Community Property
Totals

Total: Your Sole & Separate
Total: Spouse's Sole & Separate
Total: Jt, Tenancy/ Community Property

YOUR TOTAL TAXABLE ESTATE:

Totals from each section will auto-populate and calculate to give your Taxable Estate.
Real Estate: Your Sole & Separate
Real Estate: Spouse's Sole & Separate
Real Estate: Jt. Tenancy/Community Property
Cash and Other Assets: Your Sole & Separate
Cash and Other Assets: Spouse's Sole & Separate
Cash and Other Assets: Jt. Tenancy/Community Property
Retirement Assets (yours and spouse combined)
Life Insurance Policies (yours and spouse combined)
Liabilities: Your Sole & Separate
Liabilities: Spouse's Sole & Separate
Liabilities: Jt. Tenancy/Community Property
TOTAL TAXABLE ESTATE

Real Estate, Cash and Other Assets, Retirement Assets, and Life Insurance Policies totaled then Liabilities are subtracted
Taxable Estate

Non-Charitable Beneficiaries / Individuals
Beneficiary:   First Name   Last Name   Percent of Estate
Beneficiary:   First Name   Last Name   Percent of Estate
Beneficiary:   First Name   Last Name   Percent of Estate
Beneficiary:   First Name   Last Name   Percent of Estate
Charitable Beneficiaries

Tell us what charitable causes you would like your estate to support.
Your Local Church: Percent of Estate
The Baptist Foundation of California:   Percent of Estate
California Baptist University:   Percent of Estate
Gateway Seminary:   Percent of Estate
Write In A Charity   Percent of Estate
Write In A Charity   Percent of Estate
What is a charitable organization you would like to give to?*

Local ChurchThe Baptist Foundation of CaliforniaCalifornia Baptist UniversityGateway SeminaryOther
Percent of Total Estate Accounted For

Important Information

You will engage one of The Baptist Foundation of California's attorneys separately to complete your estate plan. The Baptist Foundation of California is not a law firm. In most cases, the attorneys’ fee for legal representation is a discounted flat fee in the amount of $750, and is conditioned upon your expressed interest in charitable giving to support the Great Commission in partnership with the Baptist Foundation of California. You will be asked to specifically identify those charitable donations at the time of your initial attorney-client meeting. The attorneys’ fee is a flat fee earned upon payment and is not subject to refund. If you are not interested in charitable giving and partnering with the Baptist Foundation of California, we may not accept a discounted fee but, instead, refer you to another law firm that will prepare your estate plan at a higher market rate to be negotiated separately. You are always free to engage any attorney of your choosing to prepare your estate planning documents.
I/We acknowledge that we have read the above policies.*

Agree

Signature

I/We acknowledge that the information provided in this form is accurate and complete. I/We understand The Baptist Foundation of California and any attorney(s) working on my estate plan will rely upon the information provided in this form.
Signature*

Clear
Date*

MonthDayYear
Date
Spouse Signature (If Applicable)

Clear
Date

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Legacy Plan Worksheet

Tips for Filling the Worksheet

About You

About Your Church

Previous Wills and Trusts

About Your Spouse

Children Information

Naming a Guardian

NAMING A TRUSTEE OR EXECUTOR

SELECTION OF AGENTS UPON INCAPACITY

1. Financial Decisions: Powers of Attorney.

2. Medical Decisions: Agent for Healthcare Directive.

Medical Record Release Authorization

Additional Names

REAL ESTATE

CASH AND OTHER ASSETS

RETIREMENT ASSETS

LIFE INSURANCE POLICIES

LIABILITIES

YOUR TOTAL TAXABLE ESTATE:

TOTAL TAXABLE ESTATE

Non-Charitable Beneficiaries / Individuals

Charitable Beneficiaries

Important Information

Signature