Estate Planning Intake Form
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- Peter Wheeler
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1 Estate Planning Intake Form Client s Legal Name: (name most often used to title property and accounts) Also Known As: (other names used to title property and accounts Prefer to be called: Birth : SS# US Citizen? Home Telephone: County of Residence: Employer: Business Telephone: Position: Business Address: City: State: Zip: Address: G It is okay to communicate with me via my address. of marriage: Client s Spouse or Second Grantor s Legal Name: (name most often used to title property and accounts) Also Known As: (other names used to title property and accounts Prefer to be called: Birth : SS# US Citizen? Home Telephone: County of Residence: Employer: Business Telephone: Position: Business Address: City: State: Zip: Address: G It is okay to communicate with me via my address. of marriage: 1
2 Name: Birth : Parent or Relationship: Name: Birth : Parent or Relationship: Name: Birth : Parent or Relationship: Name: Birth : Parent or Relationship: Name: Birth : Parent or Relationship: Name: Birth : Parent or Relationship: 2
3 Contact & General Information Sources Of Income Amount Company: Salary: Commissions and Bonus: Interest and Dividends: Real Estate Income: Business Name: Other Income: Itemized: Employer: Employer s Address: Position/Profession: Length of Time in Present Position: Income: Have you ever filed for bankruptcy? State all trusts in which you possess a present or expectancy interest? Are you relying on your own income & assets for daily living expenses? If yes, list your annual income, total assets, and total liabilities. Are you relying on the income & assets of another for daily living expenses? If yes, list the income, assets & liabilities of both you and the other person. 3
4 Assets % of Checking and Savings Accounts Securities: Stocks, Mutual Funds (Market ) Bonds: (Market ) Retirement Accounts (401k, IRA s) (Market ) Other Investments (Market ) Real Estate (Market ) Vehicle, Boat, Planes, Etc. (Market ) Personal & Home Assets (Market ) Other Assets (Market ) Liabilities % of Real Estate Loans/Mortgages Payable Vehicle, Boats, Planes, Etc. Loans Payable Credit Card Debt Payable Loans Payable on Personal/Home Assets Loans Payable to Banks or Credit Unions Other Liabilities or Debts Payable Unpaid Taxes or Liens Payable Net Worth 4
5 Assets Checking and Savings Accounts Type of Account Name of Account Address of Institution Account Opened Securities: Stocks, Mutual Funds (Market ) (Type Name of Stock, etc.) Number of Shares Market Bonds: (Market ) (Type and Name of Bond) Market 5
6 Retirement Accounts (401k, IRA s) (Market ) (Type and Name of Fund Market Other Investments (Market ) (Type of Investment) Shares or % Ownership Miscellaneous Decription, If Needed Market Real Estate (Market ) Describe Type of Property Market 6
7 Vehicle, Boats, Planes, Etc. Loans Payable Market Personal & Home Assets (Market ) (If Known) Market Business Interests (Market ) (If Known) Market 7
8 Other Assets (Market ) Market Liabilities Real Estate Loans/Mortgages Payable Name of Loan or Mortgage Holder Behind on Payments? Interest Rate Monthly Payment Amount Vehicle, Boats, Planes, Etc. Loans Payable Behind on Payments? Interest Rate Market 8
9 Credit Card Debt Payable Type of Card Behind on Payments? Interest Rate Monthly Payment Amount Loans Payable on Personal/Home Assets (If known) Market Loans Payable to Banks or Credit Unions Name of Bank or Credit Union Interest Rate Payment Amount 9
10 Other Liabilities or Debts Payable Name of Individual or Creditor Interest Rate Payment Amount Unpaid Taxes or Liens Payable To Whom Payable Type of Tax Lien Against What Property Due Contingent Liabilities Are you the co-signer on any loans or agreements? Are you involved in any lawsuits or legal action? Other Contingent Liabilities
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HEIDI H. ROMEO, ESQ. hhromeo@verizon.net BRIAN D. MITCHELL, ESQ. mitchellbriand@yahoo.com MARK S. STAFFORD, ESQ. staffordmarks@yahoo.com LAW OFFICES OF HEIDI ROMEO & ASSOCIATES ATTORNEYS AT LAW 255 West
PLEASE NOTE: We will hold your application on file for 14 days while we wait to receive your application fee.
There are certain requirements that must be met in order for you to apply for a loan from our credit union. These include: A $20.00 loan application fee Your two most recent paystubs If you rent an apartment,
Santa Barbara Teachers Federal Credit Union SPONSORED BY THE SANTA BARBARA COUNTY SCHOOLS
Santa Barbara Teachers Federal Credit Union SPONSORED BY THE SANTA BARBARA COUNTY SCHOOLS VEHICLE LOAN APPLICATION PLEASE READ DIRECTIONS CAREFULLY THE APPLICANT IS THE PRIMARY ACCOUNT HOLDER 1) Complete
VERIFIED PERSONAL FINANCIAL STATEMENT
VERIFIED PERSONAL FINANCIAL STATEMENT EACH PARTY MUST PROVIDE THE OTHER WITH A COMPLETED COPY OF THIS VERIFIED PERSONAL FINANCIAL STATEMENT WITHIN TWENTY ONE (21) DAYS AFTER DEFENDANT FILES THIS FIRST
SIMPLE BACKGROUND INFORMATION
1 SIMPLE BACKGROUND INFORMATION The information you provide in this section provides us with important objective information about you, your age, marital status, where you live, and how best to communicate
DR-502 Page 1 of 7 Rev 4/18
COURT OF COMMON PLEAS DOMESTIC RELATIONS DIVISION CLERMONT COUNTY, OHIO Plaintiff Case Number: vs. Defendant Instructions: Check local court rules to determine when this form must be filed. List ALL OF
INITIAL INTERVIEW QUESTIONNAIRE (BANKRUPTCY)
DATE: MACHI & ASSOCIATES, P.C. 1521 N. Cooper, Suite 550 990 N. Walnut Creek, Suite 2016 Arlington, Texas 76011 Mansfield, Texas 76063 Local 817-335-8880 Metro 972-445-5387 Toll Free 866-DEBTDRS (866-332-8377)