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RFG DOCUMENT LIVING TRUST APPLICATION CENTER INC.
Date:____________ Signing Date:_____________________ Price:____________ ASSISTANT:____________________ Name of Living Trust:________________________________________________________________________________
Name of Husband:________________________________________________ D.O.B._____________________________
Also Known as: ________________________________________________
Cell Phone: _____________________________SSN:_______________________________Citizen/Resident: C □ R □
Name of Wife:___________________________________________________ D.O.B.____________________________
Maiden Name:___________________________________________________
Cell Phone: _____________________________SSN:_______________________________Citizen/Resident: C □ R □
Marital Status: Married □ Together but not Legally Married □ Widow(er) □ Divorced □ Single □
□Home/ □Mailing address:____________________________________________________________________________
Name of NOTARY? RFG □ Leonor □ Indiana □ Other □ ______________________________________
Will there Be Distribution of Assets upon the First Death? YES □ NO □
If so, which assets shall be distributed? Real Estate □ Financial Accounts □ Personal Property □ All □
Have you made cemetery or funeral plans? If so, where:_____________________________________________________
__________________________________________________________________________________________________
Husband: Any special wishes for funeral Services? No □ Yes:________________________________________________
__________________________________________________________________________________________________
Wife: Any special wishes for funeral services? No □ Yes:____________________________________________________
__________________________________________________________________________________________________
HUSBAND: (A) Would you like to cremated or buried? □ Cremated □ Buried (B) Are you an organ donor? □ YES □NO
(C) Do you accept a blood transfusion? □ YES □ NO (D) Do you accept life support? □ YES □NO
How Long/Notes? ___________________________________________________________________________________
WIFE: (A) Would you like to cremated or buried? □ Cremated □ Buried (B) Are you an organ donor? □ YES □NO
(C) Do you accept a blood transfusion? □ YES □ NO (D) Do you accept life support? □ YES □NO
(E) Would you like to return to your home country? □ YES □ NO How Long?/Notes_____________________________
__________________________________________________________________________________________________
COMPLETED BY:
11-12-21 2,080 Maricela
Zoila E Jordan De Hernandez 7-24-1956Jordan Salazar
818-912-1692 619-86-0582
19130 Hart Street Reseda Ca 91335
Holy Cross Culver City
5834 West Slauson Avenue Culver City Ca 90230
Jordan LT
Mariachii during tha barial and piano in the cemetery. No black attire
RFG DOCUMENT LIVING TRUST APPLICATION CENTER INC.
How many children inside the marriage?_______________________
How many children outside the marriage for the Husband?_________
How many children outside the marriage for the Wife? _________
NAME:________________________________________________________________%_______________________
D.O.B._____________________________________
Minor: YES □ NO □ Disabled? YES □ NO □ Male □ Female □ BOTH □ HIS □ HERS □
NAME:________________________________________________________________%_______________________
D.O.B._____________________________________
Minor: YES □ NO □ Disabled? YES □ NO □ Male □ Female □ BOTH □ HIS □ HERS □
NAME:________________________________________________________________%_______________________
D.O.B._____________________________________
Minor: YES □ NO □ Disabled? YES □ NO □ Male □ Female □ BOTH □ HIS □ HERS □
NAME:________________________________________________________________%_______________________
D.O.B._____________________________________
Minor: YES □ NO □ Disabled? YES □ NO □ Male □ Female □ BOTH □ HIS □ HERS □
MORE CHILDREN: Disinherit Children Below? YES □ NO □
_________________________________________________ DOB:___________________________
_________________________________________________ DOB:___________________________
_________________________________________________ DOB: ___________________________
_________________________________________________ DOB: ___________________________
_________________________________________________ DOB: ___________________________
_________________________________________________ DOB: ___________________________
Dina Consuelo Menendez
7-2-1981
Magdalena Hernandez 8-23-1987
Eli Hernandez6-29-1995
Rosario Stefani Hernandez
8-31-1985
Margarita Hernandez 6-2-1984José Alberto Hernandez Jordan 1-13-1989
Dennis Samuel Hernandez 12-13-1991
Marilyn Hernandez 6-25-1998
RFG DOCUMENT LIVING TRUST APPLICATION CENTER INC.
WHO WILL BE THE SUCCESSOR TRUSTEE?:_______________________________________________________
__________ NAME:_______________________________________________________________________________
Relationship._____________________________________Cell:_____________________________________________
Address:_________________________________________________________________________________________
________________________________________________________________________________________________
Male □ Female □ Successor Trustee □ Health Care Agent □ Power of Attorney Agent □ All □
__________ NAME:_______________________________________________________________________________
Relationship._____________________________________Cell:_____________________________________________
Address:_________________________________________________________________________________________
________________________________________________________________________________________________
Male □ Female □ Successor Trustee □ Health Care Agent □ Power of Attorney Agent □ All □
__________ NAME:_______________________________________________________________________________
Relationship._____________________________________Cell:_____________________________________________
Address:_________________________________________________________________________________________
________________________________________________________________________________________________
Male □ Female □ Successor Trustee □ Health Care Agent □ Power of Attorney Agent □ All □
WHO WILL BE THE GUARDIAN OF MINOR OR DISABLED CHILD?
NAME:_______________________________________________________________________________
Relationship._____________________________________Cell:_____________________________________________
Address:_________________________________________________________________________________________
________________________________________________________________________________________________
1st
2nd
Lives at home
daughter
Lives at home
Juan Antonio Borjas 4-15-1964
818-770-9546
12728 Rajah St Sylmar Ca 91342
Dina Consuelo Menendez
Magdalena Hernandezdaughter
818.251.6285
818-818-0697
Magdalena y Dina y Juan
Brother in Law
RFG DOCUMENT LIVING TRUST APPLICATION CENTER INC.
ASSETS:
1. If any of the beneficiaries were to pass away then their share shall go to?
Surviving Beneficiary(ies) □ or The Children of Deceased Beneficiary □
Special Instructions for Assets :______________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________
Real Estate:
A)_____________________________________________________________________________________
B) _____________________________________________________________________________________
Personal property:_________________________________________________________________________
BANK:________________________________ ACCT #:_________________________________________
BANK:________________________________ ACCT #:_________________________________________
BANK:________________________________ ACCT #:_________________________________________
401K:_____________________________________ ACCT #:______________________________________________
401K:_____________________________________ ACCT #:______________________________________________
LIFE INSURANCE:_____________________________________ POLICY #:________________________________
LIFE INSURANCE:_____________________________________ POLICY #:________________________________
OTHER ASSETS: ________________________________________________________________________________
_______________________________________________________________________________________________
19130 Hart Street Reseda Ca 91335
Bank of America 3251 2131 0260
RFG DOCUMENT LIVING TRUST APPLICATION CENTER INC.
POTENTIAL CLIENTS:
Name: _________________________________________________ Phone # ___________________________
Name:_________________________________________________ Phone # ___________________________
Name:_________________________________________________ Phone # ___________________________
RFG DOCUMENT LIVING TRUST APPLICATION CENTER INC.
NOTES/SPECIAL INSTRUCTIONS:_______________________________________________________________
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RFG DOCUMENT Correct Information CENTER INC. Waiver:
By signing the line below the designated agent to said Living Trust file is agreeing to the following responsibility.
� 1. Any and all information referring to the Living Trust file has been confirmed and accepted by the clients.
� 2. All details and questions of the Living Trust file have been gone over one by one, see below for some examples of what should be confirmed: the order of the successor trustees, cremated/buried, percentages to beneficiaries, special instructions and much more.
� 3. If any proof of information has been provided it has been added into the file, any and all id’s, bank statements, insurance policies and more.
� 4. No other special need to be added, all special instructions provided by the clients have been typed into the application.
� 5. If another party or parties are on title along with the client (i.e. child, sibling, parent or anyone else) then the client was made aware that the additional party or parties must come and sign the title documents.
If at fault of the agent, a fee of $75 may be charged to the agent for any corrections, changes, additions or anything else that may need to be fixed in the Living Trust
Agent Signature:____________________________________________ Supervisor Signature:________________________________________ Name of Living Trust:________________________________________ Name of Client(s):___________________________________________
FIDEICOMISO / LIVING TRUST Fecha: ___________ Quien lo Refirió?: __________________ RFG Rep.: ________________
Nombre: _______________ Apellido: _______________ DOB: _________Casado: Si __No__
Nombre de Cónyuge: __________________ Apellido: _________________ DOB: __________
Telefono: El_____________ Ella: __________Email: _________________ Tiene Facebook: Si__ No_
Domicilio: ____________________________________Ciudad____________________ CA Zip Postal ____________
Recibe: Me-dical ____ Medicare____ Por que le gustaría hacer el Fideicomiso?: ___________
¿Cómo está su salud? ¿Buena ___ Regular ___ Mala ___ Alguna operación programada pronto? Sí __ No ____
¿De qué país es?: _______________ Estado: _______________ Ciudad o pueblo: ___________________
¿Cuántos hijos tiene?: _____ ¿A cuántos quiere heredar?: ____ Hijos de Otro Matrimonio____ Algun hijo con discapacidad: Si___ No__Nombre y edad: ______ Recibe Medi-cal o ayuda del seguro social? Sí __ No__
¿Tiene hijos menores de edad?: Si___ No__ Edades: 1____ 2____ 3____ 4____
¿Algun hijo o familiar que necesite cuidados en la casa debido a una discapacidad? Sí___ No__ ¿Cuantas casas tiene?: _______________ ¿La casa está a nombre de quién?: _______________ ¿Tiene un lugar en el cementerio o seguro de Gastos finales? Si: ____ No: _____ ¿Tiene Hipoteca?: Si __No: __Balance de la Deuda: $ _______ Tiene Seguro de vida? Sí _ No_
¿Tiene planes de retiro, pensión o 401K? Si: __ No: __ Balance: $ _______________
¿Maneja usted o su esposa? Si: ___ No: ____ Tiene seguro de carro o Casa? Sí __ No __ USTED DEBE CUIDAR LO QUE LE COSTO ACUMULAR TODA SU VIDA. ES MUY IMPORTANTE QUE SE CUIDE DEL MEDICAL Y DE LAS DEMANDAS, TAMBIEN NO DEJAR PROBLEMAS DE HERENCIA. POR FAVOR HACER UNA CITA EN NUESTRAS OFICINA, LA CONSULTA ES GRATIS.
Necesita traer ID y seguro social. Los Nombres, fechas de nacimiento de todos sus hijos. Nombres, domicilio y teléfono de los albaceas sucesores (quienes van a encargarse del fideicomiso y de repartir bienes cuando usted ya no este. Lista de todos los bienes y con qué institución las tiene y numero de póliza o cuenta. Cita Para el Día: _____________ Hora: _____ Enviar carta y recordatorio de cita: Si: ___ No: ____
Notas: 3 Razones por que lo DEBE hacer: _______________________________________________
*Usar Preguntas: ¿Por qué? ¿Como? ¿Cuando? ______________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Page 1 of 2 Requested By: davidde, Printed: 11/15/2021 10:55 AMDoc: CALOSA:2011 00985808~06037
Page 2 of 2 Requested By: davidde, Printed: 11/15/2021 10:55 AMDoc: CALOSA:2011 00985808~06037
