Insert your information in this section. If you are married or have a significant other enter that person's personal information below yours.
Insert your full legal name.
This is the email address to which we will email this Questionnaire to when you click on the Submit button at the end of the Questionnaire.
Check the box for each type of phone number you will give us below. You must give us at least one phone number which should be the primary number we will call to reach you.
What are the names of your ex-spouses, the dates on which you were divorced and the reason for each divorce.
Insert your spouse's or significant other's information in this section. This Questionnaire will use the term "Partner" to mean the spouse or significant other of the person described above.
Check the box for each type of phone number you will give us below.
Enter the following information about each child: (i) legal name, (ii) birth date or date of death, (iii) phone, (iv) email, (v) mailing address, (vi) does this child have special needs (vii) marital status, (viii) spouse's name if married, (ix) number of children (your grandchildren), (x) legal names of children..
Enter the following information about each of your Partner's children who are not your children: (i) legal name, (ii) birth date or date of death, (iii) phone, (iv) email, (v) mailing address, (vi) does this child have special needs (vii) marital status, (viii) spouse's name if married, (ix) number of children (your grandchildren), (x) legal names of children.
Some common concerns are listed below. Please select your top five concerns. If you have a concern about something not on the list, add it below. If you have more than five concerns, check as many as you want to discuss at your initial meeting.
Enter any additional concerns you have.
Do not be concerned if you do not understand a question. The purpose of the following questions is to provide a preliminary inventory of issues that may affect your planning. At our meeting we will discuss the relevance based on your responses.
If you answer yes to a question that involves supporting documents, please give us a copy of those documents.
What is the difference between the total value of all of your assets minus the total value of all of your debts?
Check each type of income you receive.
Following are questions regarding several matters that will be relevant upon your death. This information will become part of your estate plan and provide your family with directions regarding your desires.
Check all that apply.
Explain any additional organ donation desires you have.
If you have advisors who may have information about you that we need to design your estate plan please check the box next to your advisor that we can contact if necessary.
This is the end. If you have finished entering your information click on the Submit button below. When you submit this Questionnaire our system will send an email message to the address you first entered at the top of the Questionnaire with copies to Dyer Bregman & Ferris, PLLC, estate planning attorneys Richard Keyt, Mark Bregman and Richard C. Keyt and their legal assistant Anya Bregman.