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Estate Planning
&
Elder Law Questionnaire
Estate Planning & Elder Law Questionnaire
This Questionnaire gathers information that is necessary for our analysis of your estate planning and elder law needs.
Personal Information
Full Name
*
First
Middle
Last
Suffix
Preferred Name
Preferred
If you prefer to be called something other than your full name, please list it here
Gender
*
Gender
Male
Female
Other
Date of Birth
*
MM slash DD slash YYYY
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mobile Number
*
Email
*
Employer
Employer
Do you have children?
*
Children
Yes
No
If you have children, you can tell us about them on the next page.
Marital Status
*
Status
Married
Single
Widow/Widower
If you are married after a previous spouse's death, select Married.
Anniversary
*
MM slash DD slash YYYY
Does your spouse have children?
*
Children
Yes
No
If your spouse has children, you can tell us about them on the next page.
Are your children and your spouse's children the same?
*
Gender
Yes
No
You can tell us about the children on an upcoming page.
Spouse's Personal Information
Please tell us about your spouse.
Spouse Name
*
First
Middle
Last
Suffix
Please complete this even if your spouse is deceased
Spouse's Preferred Name
Preferred
If your spouse prefers to be called something other than their full name, please list it here
Spouse's Gender
*
Gender
Male
Female
Other
Spouse Date of Birth
*
MM slash DD slash YYYY
If you are married after your previous spouse's death, list the information for your current spouse.
Spouse's Address
Same As Previous Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Spouse's Mobile Number
*
Spouse's Employer
Spouse's Profession/Field/Employment
Family (Children) Information
It helps us when we understand your family structure. This section allows you to tell us about your children and their family.
How many children in the family?
*
1
2
3
4
5
6
7
8
Please tell us the number of children in your/your spouse's family. For each child, whether your child, your spouse's child, or a child of both, we've created spots where you can tell us about them. Their information is important to the planning we do.
Child 1: Full Name
*
First
Middle
Last
Suffix
Preferred Name
Preferred
Child 1: Date of Birth
*
MM slash DD slash YYYY
Whose Child?
*
His, Hers, or Ours
His
Hers
Both of ours
Does Child 1 Live With You?
*
Child 1
Yes
No
Child 1: Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Child 2: Full Name
*
First
Middle
Last
Suffix
Child 2: Preferred Name
Preferred
Child 2: Date of Birth
*
MM slash DD slash YYYY
Whose Child?
*
His, Hers, or Ours
His
Hers
Both of ours
Does Child 2 Live With You?
*
Child 2
Yes
No
Child 2: Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Family (Children) Information: Continued
Child 3: Full Name
*
First
Middle
Last
Suffix
Child 3: Preferred Name
Preferred
Child 3: Date of Birth
*
MM slash DD slash YYYY
Whose Child?
*
His, Hers, or Ours
His
Hers
Both of ours
Does Child 3 Live With You?
*
Child 3
Yes
No
Child 3: Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.
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