Living Trust Information Form (Short Form) Page 7
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9Desires regarding life-sustaining treatment:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Desires regarding funeral/burial:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Spouse states:
[ ]
I DO authorize my Agent to make Anatomical Gifts [ ] I DO NOT authorize my Agent to make Anatomical Gifts
Desires regarding life-sustaining treatment:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Desires regarding funeral/burial:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
DO YOU NEED A SPECIAL NEEDS TRUST FOR A DISABLED CHILD? Yes ____ No ____
General Information regarding the special need child
First, Middle & Last Name of child:
_____________________________________________________________________
Address where child lives:
_____________________________________________________________________
City, State, Zip code:
_____________________________________________________________________
Is child employed? Yes ____ No ____
Name of employer:
_________________________________________________________
Address, City, State, Zip: _________________________________________________________
SSN: __________________________
Date of Birth: _____/_____/_____
Is the special needs child married? Yes ____ No ____
Name of spouse: ________________________________________________________
Does the special needs child have any children of his/her own? Yes ____ No ____
Name of first child:
__________________________________________
Name of second child:
__________________________________________
Does the special needs child receive governmental benefits? Yes ____ No ____
Will the Trustee be allowed discretion to sprinkle payments from the trust among the spouse of the special needs child (if
child is married) and any living children of the special needs child?
If Yes,
____
Income only
____
Income and Principal
What standard should the Trustee use when making payments:
____
Ascertainable standard (health, education, support, maintenance)
____
Broad standard (comfort, welfare, happiness)
____
Broad standard, but use ascertainable standard for distributions where the Trustee is also a Beneficiary
Note: Sprinkling beneficiaries should not become sole-trustee
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