email: ____________________________________________________________

USMail (for post office delivery): ______________________________

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phone (if we have questions)(home or cell, please indicate which):
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2. Exact name(s) (of individual, or of both husband and wife):
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3. Are you married? Yes __________________    No ________________

Is this a first or second marriage for you? (and your spouse)?

H’s marriage # __________________ W’s marriage # ________________

5. Do you have children? Please note if any children are by a prior marriage by either spouse.

Mutual children (names and ages): ___________________________________________

H’s children by prior relationship (names and ages): _____________________________

W’s children by prior relationship (names and ages): ____________________________

6. For any adult children, would you be interested in powers of attorney for them?

Yes _________________ No _________________

7. Do you think your estate is more or less than $1,000,000?

More _________________ Less _________________ Approximate value _________________

An estate is all your assets, including the equity in your home, life insurance on your life, pension and IRA accounts, and joint tenancy property.

8. Do you have any additional concerns about your estate planning? Such as: Disabled beneficiaries? Who will be the fiduciaries? Asset Protection for beneficiaries? Please INCLUDE THOSE CONCERNS IN THE BODY OF YOUR EMAIL, OR ADD THEM HERE.

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