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General
Information
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| 1.
Your Full Name: |
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| 2a.
Your Home Address: |
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| 2b.
Your Email Address: |
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| 3.
Date of Birth: |
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| 4a.
Your Home Telephone Number: |
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| 4b.
Your Business Telephone Number: |
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| 4c.
Prefer to be called |
Home
Business
N/A
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| 5a.
Are you a citizen of the United States? |
Yes
No
N/A
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| 5b.
If yes, what is your Social Security Number? |
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| 5c.
If no, from what country are you a citizen? |
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| 6a.
Are you a legal resident of the State of Maryland or District
of Columbia? |
Yes
No
N/A
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6b.
If not, in what state do you legally reside ?
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| (Your
legal residence is usually where you vote, or pay taxes,
or the state where you live for more than half of the year) |
| 7.
Are you married? |
Yes
No
N/A
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8. If
married, complete the following for your spouse:
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8a. Your spouse's Full Name:
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| 8b.
Is your spouse a citizen of the United States? |
Yes
No
N/A
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| 8c.
Your spouse's age or Date of Birth: |
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| 8d.
Your spouse's Social Security Number: |
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9.
If your are presently not married:
9a. Were
you never married?
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Yes
No
N/A
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| 9b.
Previously married? |
Yes
No
N/A
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9c.
If married previously, indicate:
9c(i) Name of Prior Spouse
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| 9c(ii)
Did prior marriage end in divorce? |
Yes
No
N/A
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| 9c(iii)
Did prior marriage ended with the death of your spouse?
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Yes
No
N/A
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| 9c(iv)
Date of death or divorce: |
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9c(v)
Are there any children as a result of this prior marriage?
If yes, include children in #14 on this Questionnaire: |
Yes
No
N/A
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| 10.
If your spouse was previously married, indicate how that
previous marriage ended: |
Death
Divorce
N/A
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| 10(i)
Date of death or divorce: |
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| 11.
Are you and your current spouse living together? |
Yes
No
N/A
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| 12.
Have you ever executed a prenuptial agreement or a separation
agreement? |
Yes
No
N/A
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| 13.
Do you have any children from your current marriage or from
a prior marriage or relationship? |
Yes
No
N/A
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14.
Give each of your children's names, addresses, date of
birth, and social security number:
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| 14a(i).
Child's Name |
14b(i).
Child's Name |
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| 14a(ii).
Address |
14b(ii).
Address |
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| 14a(iii).
Date of Birth |
14b(iii).
Date of Birth |
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| 14a(iv).
Social Security Number |
14b(iv).
Social Security Number |
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| 14c(i).
Child's Name |
14d(i).
Child's Name |
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| Address |
Address |
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| Date
of Birth |
Date
of Birth |
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| Social
Security Number |
Social
Security Number |
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| 15.
Does your spouse have any children from a prior marriage
or relationship? |
Yes
No
N/A
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| 16.
Give each of your spouse's children's names, addresses,
date of birth, and social security number: |
| 16a(i).
Spouse's Child's Name |
16b(i).
Spouse's Child's Name |
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| 16a(ii).
Address |
16b(ii).
Address |
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| 16a(iii).
Date of Birth |
16b(iii).
Date of Birth |
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| 16a(iv).
Social Security Number |
16b(iv).
Social Security Number |
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| 16c(i).
Spouse's Child's Name |
16d(i).
Spouse's Child's Name |
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| 16c(ii).
Address |
16d(ii).
Address |
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| 16c(iii).
Date of Birth |
16d(iii).
Date of Birth |
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| 16c(iv).
Social Security Number |
16d(iv).
Social Security Number |
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17.
Have either you or your spouse legally adopted any children,
including the adoption of a spouse's child or children
from a prior marriage?
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Yes
No
N/A
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18. If
yes, give each adopted child's name, date of birth, and
social security number: |
| 18a(i).
Adopted Child's Name |
18b(i).
Adopted Child's Name |
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| 18a(ii).
Address |
18b(ii).
Address |
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| 18a(iii).
Date of Birth |
18b(iii).
Date of Birth |
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| 18a(iv).
Social Security Number |
18b(iv).
Social Security Number |
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| 18c(i).
Adopted Child's Name |
18d(i).
Adopted Child's Name |
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| 18c(ii).
Address |
18d(ii).
Address |
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| 18c(iii).
Date of Birth |
18d(iii).
Date of Birth |
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| 18c(iv).
Social Security Number |
18d(iv).
Social Security Number |
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Prior
Estate Plans
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| 1.
Do you currently have a will? |
Yes
No
N/A
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| 2.
Do you have a power of attorney, living will or advance
directive? |
Yes
No
N/A
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| 3.
Do you have a trust? |
Yes
No
N/A
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4. Do
you want me to use your existing documents in preparing
your new estate plan?
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Yes
No
N/A
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| (If
you want me to use prior documents you may fax, mail or
e-mail them to me in full confidence of an attorney-client
relationship.) |
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Your
Assets
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1.
Do you have assets, including real estate, cash, stocks
and bonds, antiques, collectibles, jewelry, artwork, bank
accounts, life insurance, retirement accounts, pension plans,
assets in trust or assets owned or controlled by a Corporation,
Partnership or other legal entity you own or control, that
total more than $1,000,000.00?
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Yes
No
N/A
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| 2.
Have you ever made a gift of cash or property with a value
in excess of $10,000 to any one person, trust, corporation
or non charitable organization during a single calendar
year? |
Yes
No
N/A
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| Disposative
Provisions |
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1.
Do you, your spouse or any of your children or your spouse's
children have any physical, mental, or emotional disability,
difficulties managing money, real property or other assets
or do they require financial assistance or support?
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Yes
No
N/A
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2.
Would you or your spouse be able to manage assets or seek
competent advice in managing assets if either was the surviving
spouse?
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Yes
No
N/A
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3.
Do you have children under age 18 or would you want a trustee
to manage your children's assets?
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Yes
No
N/A
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4.
If yes, how old would you want them to be before they received
unrestricted access to their inheritance?
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18
21
25
26
30
Other
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5. Whom
would you choose to act as Trustee of any trust for the
surviving spouse, minor children or children requiring
assistance in managing estate assets?
(This should be someone who is trusted, has experience
managing large sums of money or real property and could
act as a responsible adviser -- It could be a family member,
friend, attorney, accountant, financial adviser or a professional
fiduciary such as a banker or trust officer.)
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| 5a.
Trustee Name |
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| 5b.
Address |
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| 5c.
Telephone Number |
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6.
Whom would you choose to act as guardians for any minor
children?
(The guardian would be responsible for taking care of your
minor children) |
| 6a.
Guardian Name |
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6b.
Address
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| 6c.
Telephone Number |
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7.
Whom would you choose to act as Personal Representative
of your estate?
(The Personal Representative, also known as Executor, is
responsible for getting the estate through probate - inventorying,
appraising and distributing the property in your estate)
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| 7a.
Personal Representative Name |
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| 7b.
Address |
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| 7c.
Telephone Number |
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8. If
the person named as guardian or personal representative
could not serve, who would you want to serve in their
place?
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| 8a.
Alternate Guardian Name |
Alternate
Personal Representative Name |
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| 8b.
Address |
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| 8c.
Telephone Number |
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| 8d.
Relationship to you if any? |
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| 9.
Do you want your spouse to inherit all of your property
upon your death? |
Yes
No
N/A
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| 10.
Do you want your children to equally divide your estate
if your spouse dies before you do? |
Yes
No
N/A
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| 11.
Have you any reason for treating your children other than
equally? |
Yes
No
N/A
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12.
If you have a reason to treat your heirs differently, state
the reason:
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13.
Do you want shares divided equally or in different pecentages
to each heir?
(State Percentage to each Heir in the box below)
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Equally
Differently
N/A
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| Name |
Percentage
of Shares (total 100 %) |
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% |
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% |
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% |
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% |
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% |
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% |
| 14.
If you have specific wishes in connection with your funeral
or burial, have you discussed these wishes with your family?
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Yes
No
N/A
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| 15.
Do you want these plans included in your will? |
Yes
No
N/A
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16.
Described your funeral plans in the box:
(The funeral often occurs before the will is read and it
is best to specify wishes to your family or preplan the
funeral before death rather than to include funeral plans
in the Will)
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17a.
Do you want your assets to be sold and the proceeds divided
among your heirs?
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Yes
No
N/A
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17b.
Do you want the property to be distributed to them as a
particular item or property or as a particular asset?
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Yes
No
N/A
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18.
Do you have personal items of significant monetary or sentimental
value that you want to go to certain people?
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Yes
No
N/A
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| 19.
If yes, please list them specifically: |
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| Recipient's
Name: |
Item: |
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Once
you have completed
this Questionnaire, please select any of the
following that apply, then please print this form and
fax or send it via postal service to my office.
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1.
Reply to my completed Questionnaire. I need a simple will,
and or powers of attorney at prices quoted above.
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Yes
No
N/A
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2.
Please contact me about a Revocable Living Trust or other
Trust.
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Yes
No
N/A
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| 3.
I have an estate of more than $1,000,000.00. Contact me
about a marital deduction trust and about planning to reduce
Federal Estate Taxes. |
Yes
No
N/A
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