*Name:

*Address:

*City:

*State:
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*Zip:

*E-mail address:

*Home Phone:

Business Phone:

Cellular or Pager:

Facsimile:

What does this matter involve?
Choose One Probate of an Estate Administration of an Estate Estate Planning

Probate/Administration of an Estate

Name of the decedent:

Date of death:

Residence at the time of death:

Your relationship to the decedent:

Did the decedent leave a will?
Yes  No  Unknown 

If yes, do you have a copy of the will?
Yes  No 

Are you named as the executor or administrator in the will?
Yes  No 

If no, who is named?

What was the marital status of the decedent?
Choose One Single Married Divorced Separated Widowed

If married or separated, please provide the name and address of the spouse:

Did the decedent have any children?
Yes  No  Unknown 

If yes, list their names and addresses. If no, please list the names and addresses of the decedents closest known relatives:

Is there anyone not listed above (including charitable organizations) who is named as a beneficiary of the will, if any?
Yes  No  Unknown 

If yes, list their names and addresses:

Please describe any concerns you have about this estate:

Describe what you would like to happen to resolve your concerns (your preferred outcome):

Have other attorneys worked on this matter?
Yes  No 

If yes, provide names, addresses, and a brief description of their involvement:

Estate Planning

What is your marital status?
Choose One Single Married Divorced Separated Widowed

Please list the names and addresses of your children, if any:

Please list the names and addresses of anyone else (including charitable organizations) you wish to provide for in your estate plan:

Do you now have a will?
Yes  No 

Life insurance?
Yes  No 

Retirement plan?
Yes  No 

Do you own a business?
Yes  No 

If yes, provide the business name, address, and phone:

If you own a business, how is the business organized (if known)?
Choose One Sole Proprietorship Partnership Limited Liability Company or Partnership Professional Corporation S Corporation C Corporation Other

What is your approximate net worth:

Describe your concerns regarding your estate:

Describe what you would like to happen with your estate (your preferred outcome):

Have other attorneys worked on this matter?
Yes  No 

If yes, provide names, addresses, and a brief description of their involvement:

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