CLIENT PROFILE for the use of our associated CPA and Law Firms Regular printable short profile (Headquarters) Florida Office 1860 82nd Avenue Suite 206 Vero Beach FL 32966 Toll Free: (800) 922-1771 Tel: (772) 770-6680 Fax: (866) 533-4804 Nevada Office 500 N Rainbow Boulevard Suite 300 Las Vegas NV 89107 Toll Free: (800) 922-1771 Fax: (866) 533-4808 California Office 5757 W Century Boulevard Suite 700 Los Angeles CA 90045 Toll Free: (800) 922-1771 Fax: (866) 533-4808 Please forward to our Office Headquarters 1860 82nd Avenue Suite 206, Vero Beach FL 32966 Tel (800) 922-1771, Fax (866) 533-4804 Email CapsLLC@earthlink.net Representative name Representative affiliation Basic Asset Protection Plan - complete profile plus Section 1 Simple Living Trust - single person complete profile plus Sections 2, 3 and 4 AB Trust Package - complete profile plus Sections 2, 3 and 4 US Asset Protection & Estate Planning Foundation - complete profile plus Sections 1 - 4 Life Partners Trust Package - complete profile for each partner plus Sections 2, 3 and 4 Ultra Trust – profile and Sections 2, 3 and 4 CLIENT PROFILE Client Name SS# DOB Spouse/Partner Name SS# DOB Home Address City County State Zip Home Telephone Business Telephone *1 Email *1 Are we authorized to contact you at this number? Yes No Date of Marriage Prior Marriage *2 *2 If yes, please provide details: Client   Spouse/Partner Date of marriage   Date of divorce   Name of prior spouse   Are both spouses/partners citizens of the United States? Yes No *3 *3 If no, of what country are they a citizen? Section 1 - Asset Protection 1.1 Selected name for (Family) Limited Partnership 1.2 Should that name not be available please list options Option A   Option B  1.3 Selected name for Limited Liability Company 1.4 Should that name not be available please list options Option A   Option B  Who will be the Managing Member of the Limited Liability Company? Section 2 - Estate Plan 2.1 Executor of Will (normally each for each other)    Yes    No Executor for Client Executor Address Successor Executor for Client Successor Executor Address Executor for Spouse/Partner Executor Address Successor Executor for Spouse/Partner Successor Executor Address Guardians of minor children Guardian Address 2.2 Durable Power of Attorney   Health (normally each for each other)    Yes    No Agent for Client Agent Address Successor Agent for Client Successor Agent Address Agent for Spouse/Partner Agent Address Successor Agent for Spouse/Partner Successor Agent Address Assets (normally each for each other)    Yes    No Agent for Client Agent Address Successor Agent for Client Successor Agent Address Agent for Spouse/Partner Agent Address Successor Agent for Spouse/Partner Successor Agent Address 2.3 Trust Name of Grantor(s) Name of Trustee(s) Trustee Address Successor Trustee(s) Successor Trustee Address 2.4 Beneficiaries (use additional sheets if required) Names of Beneficiaries DOB or SS# Relationship % of Estate Note: Where the named person does not reside with client please furnish contact information Section 3 - Previous Planning 3.1 Client Spouse/Partner Durable Power of Attorney (Health) Durable Power of Attorney (Assets) Living Will (year prepared ________) Will (year prepared ________) Revocable Living AB Trust Limited Partnership(s) (Family) Insurance Trust Foreign Security Trust Non US Grantor Trust Charitable Remainder Trust Children's Trust Charitable Lead Trust Pension Limited Partnership Limited Liability Company(s) Corporation(s) (International) Corporations(s) (Domestic) US Grantor International Trust Other (please list on separate paper) Section 4 - Financial Information 4.1 Include: Name of institution and Account numbers for assets, Legal description and parcel number for land, VIN numbers for vehicles, boats etc. 4.2 Please attach a financial statement, if available, if not please complete. Account numbers, legal land descriptions and parcel numbers expedite the transfers into the trust. Assets Client's Separate Spouse/Partner's Separate Joint or Community Property Cash or cash equivalents Residence Second residence Real property for investment income Investment securities Stock in closely held corporation(s) Insurance, cash surrender value Sole Proprietorship(s) General Partnership(s) Limited Partnership investment(s) Limited Liability Company investment(s) Note(s) receivable Vested interest in Pension and/or Profit Sharing Plan(s) * Individual retirement account(s) * Automobiles Collectibles Other assets Total Assets Liabilities Mortgage(s) on residence(s) Mortgage(s) on investment income real property Secured notes payable Unsecured notes payable Other unsecured liabilities Total liabilities * Note: Normally these cannot be transferred directly into a trust and retain tax deferral status, but the trust can be the successor beneficiary. 4.3 a) Are any of the principals involved in any current litigation? Yes* No b) Do any of the principals currently have any judgments or outstanding liens? Yes * No * Provide details Additional Information (Note: Please reference question) I (we) understand that the information found on the profile that has been completed is the information that will be used to complete my (our) documents. Should I (we) decide that we want to change those instructions our transaction will be subjected to a change fee whose hourly rate will be not less than $150.00 per hour. To ensure the security of your information, we ask that you type the code (displayed below) in the text box. This code is an image that cannot be read by web robots and prevents them from gaining access to your information.