How to get Started Download questionnaire form here Enter answers to questions here Step 1 of 3 33% CLIENT INFORMATION[Strictly Confidential] We Need Your Deed and Exhibit ASpouse 1 Legal NameOther Names used by HusbandAddressCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweEmailTelephone (Home)Telephone (Work)Telephone (Cell)Date of Birth Social Security NoUS citizen? YesNoIf no, what nationalityBusiness/EmploymentSpouse 2 Legal NameOther Names used by WifeDate of Birth Social Security NoBusiness/EmploymentUS citizen?YesNoIf no, what nationalityPrior Marriages?HusbandYesNoIf yes, name of prior spouseHow Terminated?DeathDivorceDate WifeYesNoIf yes, name of prior spouseHow Terminated?DeathDivorceDate CHILDREN OF THIS MARRIAGENoneCHILDREN OF THIS MARRIAGEAge/DOB Number of grandchildrenRange of AgesCHILDREN FROM PRIOR MARRIAGEWIFE/HUSBANDAGE SelectWifeHusband Treat all children as if they were the children of this marriage?YesNoAny deceased children? YesNoIf yes, nameIf yes, survived by issue?Any adopted children?YesNoIf yes, nameDo any of your beneficiaries’ have a learning disability, special educational, medical or physical needs?YesNoDo either of you expect to inherit substantial assets ($100,000 +)?YesNoDo you have any existing trusts?YesNoShould the surviving spouse have the power to control the distribution of the entire estate after the first death?YesNoThe name of the person(s) other than the surviving spouse that you want to be the decision maker concerning your financial estate upon your death The name of the person(s) that you want to raise a child that is under 18, if both spouses die (if applicable) The name of the person(s) other than the surviving spouse that you want to make any major medical decisions on your behalf In general, state how you want your estate distributed among your beneficiaries after the death of both of you?State any specific concerns (not already mentioned) that you have regarding the distribution of your estateReal Estate OwnedYesNoExhibit A Legal DescriptionBe sure to attach a grant deed and exhibit A BURIAL WISHESHUSBANDAt my death, I wish to becrematedburiedIf cremation, I would like my ashes disposed as followsIf buried, I would like my remains interred as followsI have already made arrangements atWIFEAt my death, I wish to becrematedburiedIf cremation, I would like my ashes disposed as followsIf buried, I would like my remains interred as followsI have already made arrangements at ESTIMATED* VALUE OF ESTATEREAL ESTATE(fair market value, less loans) Attach Grant Deed and Exhibit A HUSBAND'S SEP. PROP.WIFE'S SEP. PROP.COMMUNITY PROPERTYSECURITIES(stocks, bonds, mutual funds)HUSBAND'S SEP. PROP.WIFE'S SEP. PROP.COMMUNITY PROPERTYCASH TYPE ASSETS(cash, annuities, notes due you)HUSBAND'S SEP. PROP.WIFE'S SEP. PROP.COMMUNITY PROPERTYBUSINESS INTERESTS(sole proprietorship, partnerships, closely held corporation, etc.) HUSBAND'S SEP. PROP.WIFE'S SEP. PROP.COMMUNITY PROPERTYRETIREMENT PLANS(IRA, 401k, etc. †)HUSBAND'S SEP. PROP.WIFE'S SEP. PROP.COMMUNITY PROPERTYVEHICLES(autos, R.V., boat)HUSBAND'S SEP. PROP.WIFE'S SEP. PROP.COMMUNITY PROPERTYPERSONAL PROPERTY(jewelry, furniture, antiques)HUSBAND'S SEP. PROP.WIFE'S SEP. PROP.COMMUNITY PROPERTYTOTALHUSBAND'S SEP. PROP.WIFE'S SEP. PROP.COMMUNITY PROPERTY * Use best guess; this can be a “ballpark” estimate. † Do not show benefits which will terminate at death (e.g., pension, social security, etc.). Value of Life Insurance policies will be listed separately on the next page. WAIVER OF POTENTIAL CONFLICT OF INTEREST We have each read the foregoing material and understand that there are potential conflicts of interest between myself and my spouse in the matters about which we are consulting you. If either of us desire to have separate counsel or desire you not to be involved at all, that spouse shall notify you. We each hereby consent to having you represent both of us in the drafting of our estate planning documents and we each hereby waive any potential or actual conflicts of interest. We understand that since you will be representing both of us on the same matter, as between ourselves and you, there are no confidential communications. Dated:
