Estate Planning Questionnaire

Date

Full Legal Name

Preferred First or “Nick” Name

Age

DOB

Citizen?
Yes No

Spouse’s Full Legal Name

Preferred First or “Nick” Name

Age

DOB

Citizen?
Yes No

Address

City

State

Zip

Employer/Retired?

Your Work #

Spouse’s Employer/Retired?

Spouse’s Work #

Best E-mail Address

Your Cell #

Home #

Spouse’s Cell #

Referral Source How did you hear about us? Credit union, family member, newspaper, postcard, seminar, friend, legal plan… please designate (example: Bellco): Children
Below, list full names (and married names, if applicable) of all your children.
If a child is the product of your present marriage, put a “P” in the “Comments” blank.
If a child is the product of husband’s former marriage, put an “H” in the “Comments” blank
If a child is the product of wife’s former marriage, put a “W” in the “Comments” blank. If you have particular concerns you would like to discuss about a child, put an “O” in his or her “Comments” blank.

Name(s) of child(ren)	Age	Single (S) or Married (M)	# of Children	Comments

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