How Did You Hear About Ridout Barron? ______

Estates Questionnaire

Updated: October 20, 2018

Page 1 of 11

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ESTATES QUESTIONNAIRE

The following questionnaire will provide us with information that we will use to draft a Will that will reflect your decisions regarding the distribution of your estate and regarding the people who will be responsible for dealing with your estate. Please note that if you and your spouse have identical, mirror image instructions you need only fill out one form.

How did you hear about Ridout Barron? ______

I.FAMILY INFORMATION

Personal Information

Full Name:Spouse Name:

______

List any other names you and/or your spouse are/have been known by including previous surname(s)

______

Date of Birth ____/____/______Date of Birth ____/____/______

DD/MM/YYYYDD/MM/YYYY

Place of BirthPlace of Birth

Town/City______Town/City______

Province ______Province ______

Country ______Country ______

Citizenship ______Citizenship ______

Present AddressPresent Address

______

______

______

Home Phone ______Home Phone No ______

Bus. Phone ______Bus. Phone ______

Cell Phone ______Cell Phone ______

E-Mail ______E-Mail ______

Occupation ______Occupation ______

Employer ______Employer ______

Employer’s Address ______Employer’s Address ______

______

Marriage Information

Marital Status ______Marital Status ______

Date and Place of Marriage ______

______

Previous Marriages  Yes  NoPrevious Marriages  Yes  No

*If yes, name of previous spouse(s) and date of death/divorce/separation

______

______

______

Obligation pursuant to previous marriage (e.g. spousal and child maintenance):

______

______

______

If you are single, separated or divorced

(a)Are you planning on marrying in the near future? Yes  No

If yes, to whom ______

(b)Are you cohabiting with anyone? Yes  No

If yes, with whom: ______

For how long?______years

Do you have a Cohabitation Agreement with this person?YesNo

Children

-Number of children ______(please include stepchildren)

-Are all of the following children from your present marriage?  Yes  No

-If no, indicate with the appropriate letter beside each child:

P - from previous marriage (husband/wife)

A - adopted

O - born outside of present marriage

1._____ Name ______DOB _____ /_____/______

MM DD YYYY

Address ______Marital Status ______

Grandchildren (Names / Ages)______

______

______

2._____ Name ______DOB _____ /_____/______

MM DD YYYY

Address ______Marital Status ______

Grandchildren (Names / Ages)______

______

______

3._____ Name ______DOB _____ /_____/______

MM DD YYYY

Address ______Marital Status ______

Grandchildren (Names / Ages)______

______

______

4._____ Name ______DOB _____ /_____/______

MM DD YYYY

Address ______Marital Status ______

Grandchildren (Names / Ages)______

______

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5._____ Name ______DOB _____ /_____/______

MM DD YYYY

Address ______Marital Status ______

Grandchildren (Names / Ages)______

______

______

6._____ Name ______DOB _____ /_____/______

MM DD YYYY

Address ______Marital Status ______

Grandchildren (Names / Ages)______

______

______

-Are there any stepchildren, adopted children or illegitimate children of either spouse?

 Yes  No

-Are any of your grandchildren adopted or illegitimate?  Yes  No

-If yes to any of the above question, please provide details.

______

______

______

Are any of the children or grandchildren mentally or physically incapacitated?

 Yes  NoIf yes, please explain.

______

______

Are you responsible for any dependent adults who are mentally or physically incapable of handling their own affairs?  Yes  No If yes, please explain.

______

______

______

Have any of your children predeceased you?  Yes  No

If yes, please give the name and date of death of the deceased child and the names of their children, if any:

______

______

______

Do you act in the role of parent to any of your grandchildren or great-grandchildren? If so, name them and state whether they live with you and are financially dependent on you?

______

______

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II.EXECUTOR(S)

An executor (or an Executrix in the case of a female) is the person named in the Will who will administer your estate. The Executor’s powers begin immediately upon your death. Fundamentally, the Executor is responsible for gathering in your assets and distributing them according to the terms of your Will, and for paying your legally enforceable debts. The Executor should be someone you trust absolutely.

You may designate one or two or more Executors to act together in administering your estate. As well, an alternate Executor or Executors should also be named in the Will to protect your estate should the initial Executor or Executors be unable or unwilling to act. To avoid the possibility of an Executor or Executors being unwilling to act you should consult with the person you will be naming as Executor and Alternate Executor before executing your Will.

Name of Executor /Executrix ______

Relationship to you______

Address______City______
Prov______PC______

Occupation ______Tel______

Has the named Executor/Executrix been consulted?  Yes  No

Name alternate Executor /Executrix ______

Relationship to you______

Address______City______
Prov______PC______

Occupation ______Tel______

Has the alternate Executor/Executrix been consulted?  Yes  No

III.DISPOSITION OF ESTATE

You may dispose of your estate to individuals or organizations in amounts or percentages as you see fit.

1.All to your spouse  Yes  No N/A Other ______

______

2.If spouse predeceases me ______

-equally to all children? Yes  No N/A

-different percentages to particular children?  Yes  No

Details ______

______

If no children and spouse predeceases me:

-entire estate to one other person? YesNo

If yes, provide name, address and relationship to you.

______

-equal shares of estate to other persons? YesNo

If yes, provide names, addresses and relationship to you. of each person

______

-% shares to persons as specified: ______

-other (eg, Charity)______

3.At what age are your children to receive their share of your estate? You can gift their share to them all at once or in stages:

- entire estate at (e.g. 18) ______years of age;

OR,

 ____% at _____ years, ____% at _____ years, and the rest at age ______years.

 other ______

In the typical Will, the Trustee (who is the Executor) has the power to encroach on the child’s trust funds from time to time for the child’s education, support, health and maintenance, and usually does so in consultation with the named Guardian.

4.If one child dies before you do, or before attaining the age at which he is entitled to his or her share, who will receive that share or the amount thereof remaining?

- The children of the deceased child (your grandchildren)? YesNo

- The surviving children only? Yes No

 - other ______

5.If my children and spouse all predecease me:

- entire estate to one other person? YesNo

If yes, provide name, address and relationship to you.

______

 - equal shares of estate to other specified persons? YesNo

If yes, provide names, addresses and relationship to you. of each person

______

-% shares to persons as specified Yes No

If yes, provide names, percentages, addresses and relationshipto you.of each person

______

______

-other ______

 - if one beneficiary predeceases me:

 other surviving beneficiaries share equally  Yes  No

 predeceased beneficiary’s share to (e.g. children, charity,etc.)_____

______

6.Specific Gifts, Bequests or Legacies: List the items or amounts. (We suggest that you do not list an item unless it is extremely valuable or of great sentimental value, the reason being that if an item is lost or stolen, or otherwise disposed of, a codicil or new Will will have to be drawn up to alter the will.). If you would like to make a list separate from your formal Will that you can change from time to time, state this here and we will make reference to a “Memorandum” in your Will and provide you with a sample Memorandum of Gifts document that you can draft on your own.

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Attach a separate page if necessary.

IV.GUARDIANS

In choosing a Guardian or Guardians for your children, you should keep in mind the age of the intended Guardian. For example, your parents may not be an appropriate choice for the role of Guardian due to their ages. As well, you choice of Guardian should be someone you trust absolutely.

Your Will should provide for an Alternate Guardian or Guardians in case the intended Guardians are not able or not willing to act, or in the event of their untimely death. As well, to avoid the possibility of the named Guardian(s) or Alternate Guardian(s) being unwilling to act, you should consult with the person(s) you will be naming before executing your Will.

Name of Guardian(s) ______

Relationship to you______

Address______City______
Prov______PC______

Occupation ______Tel______

Has the named Guardian been consulted?  Yes  No

Name of alternate Guardian(s) ______

Relationship to you______

Address______City______
Prov______PC______

Occupation ______Tel______

Has the alternate Guardian(s) been consulted?  Yes  No

V.FUNERAL AND BURIAL INSTRUCTIONS

The named Executor of your estate is the person who is responsible for your funeral arrangements. If you have a special interest in how you would like to see this matter handled (e.g. donation of body or parts thereof, cremation or burial, etc.), a clause can be inserted into your Will to reflect this. As well, we recommend that you ensure that your named Executor(s) are aware of all of the details your funeral/burial wishes. Please describe any special wishes you may have in this regard.

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ENDURING POWER OF ATTORNEY (EPA)

The EPA is a legal document which allows you to select a person (called an “Attorney”)who you trust to manage your financial matters in the event of your incapacity (mental or physical). The Attorney’s powers can begin immediately or upon the happening of a specified event (e.g. you are deemed by a physician to be mentally unable to manage your own financial affairs). Typically, we state that the written declaration of two physicians will be required. The EPA may be revoked by you in writing at any time while you have mental capacity and it ends upon your death or the death of the Attorney. You may designate two or more Attorneys to act on your behalf and it is prudent to appoint an alternate Attorney should your first choice be unable or unwilling to act.

Name of Attorney(s) ______

Relationship to you______

Address______City______
Prov______PC______

Occupation ______Tel______

Has the named Attorney(s) been consulted?  Yes  No

Name alternate Attorney(s) ______

Relationship to you______

Address______City______
Prov______PC______

Occupation ______Tel______

Has the alternate Attorney(s) been consulted?  Yes  No

PERSONAL DIRECTIVE (PD)

The PD is a legal document which allows you to make certain health care decisions in advance of your mental incapacity. Through the PD you may select a person (called an “Agent”) who you trust to manage your personal health care matters in the event of your incapacity. Also, through a PD you may provide information about your personal beliefs and values regarding these personal health matters to guide your Agent. The PD may be revoked in writing at any time that you have mental capacity. You may designate two or more Agents to act on your behalf and it is prudent to appoint an alternate Agent should your first choice be unable or unwilling to act.

Name of Agent(s) ______

Relationship to you______

Address______City______
Prov______PC______

Occupation ______Tel______

Has the named Agent(s) been consulted?  Yes  No

Name alternate Agent(s) ______

Relationship to you______

Address______City______
Prov______PC______

Occupation ______Tel______

Has the alternate Agent(s) been consulted?  Yes  No

Would you like a Living Will to be included in your PD? This is the statement that you do not wish to have extraordinary measures used where there is no hope of recovery.______

TERMS AND CONDITIONS

(THE FINE PRINT)

We agree to represent your interests in the matter of preparing your estate documents, including the preparation of your Last Will and Testament, Enduring General Power of Attorney and/or your Personal Directive, including consultations with you in this regard, seeking your instructions on all aspects of the preparation of your documents, and attending to the proper execution of your documents and providing all legal advice with regard to same. In particular, we wish to confirm our agreement with you, regarding our fees and other matters that are relevant to the terms of this engagement.

FEES:

Will – single simple Will -$450.00

Will - simple Wills for a couple - $750.00

Will – complex Will$to be discussed

Enduring General Power of Attorney(2 originals)-$150.00

Personal Directive(2 originals)-$150.00

DISBURSEMENTS:

Disbursements are out-of-pocket expenses and other costs incurred by the firm on behalf of the client and are billed in addition to legal fees. Generally speaking, in the preparation of estate documents disbursements are minimal (e.g., photocopying charges, long distance charges, fax charges, and file opening fees)..

GOODS AND SERVICES TAX:

All legal services rendered are subject to G.S.T.. Some disbursements and other charges that we incur on your behalf are subject to G.S.T. and some are not. Any G.S.T. charged will be indicated separately on our statement of account.

BILLING:

Generally speaking, original documents will not be released to clients until accounts are paid in full.

Accounts are payableby VISA, Mastercard, personal cheque made out to RIDOUT BARRON orin cash on the date the account is rendered and if an account remains outstanding after 30 days, interest will be charged on the outstanding balance at the rate of 1.5% per month. There is a fee of $25 for all NSF cheques.

CONFIRMATION:

We would appreciate your confirming the terms of our retainer by signing, dating and then returning to the writer the enclosed copy of this correspondence along with the completed questionnaire. The firm of Ridout Barron appreciates the opportunity to act as your counsel in these matters. In the event that you require further information regarding the terms of this engagement or at any time have any concerns regarding the conduct of this matter, please contact Jacqueline Barron at (403)541-5600.

ACKNOWLEDGED AND ACCEPTED:

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SignatureDate

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SignatureDate