Estate Planning & Elder Law Questionnaire
Personal Information
Full Legal Name
Date of Birth
Current Address
Street Address
City, State and Zip Code
Phone Number
Email Address
Marital Status
Single
Married
Divorced
Widowed
Asset Information
Real Estate Assets
Primary Residence (Description/Address)
Current Value
Joint w/spouse?
Yes
No
Additional Property (Description/Address)
Current Value
Joint w/spouse?
Yes
No
Financial Assets
Checking Accounts (Description)
Current Value
Joint w/spouse?
Yes
No
Savings Accounts (Description)
Current Value
Joint w/spouse?
Yes
No
Investment Accounts (Description)
Current Value
Joint w/spouse?
Yes
No
Retirement Accounts Description
Current Value
Spouse's Retirement Description
Current Value
Life Insurance Description
Current Value
Spouse's Life Insurance Description
Current Value
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