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Wills
Mobile Notary
Real Estate / Closings
Deposit Refunds
Bankruptcy
Talk to an Attorney
About Us
Contact Us
Phone: 561.482.9493
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1
Additional Information
2
Spouse Information
3
Family Information
4
Additional Information
5
Medical/Disability
6
Financials
Last Will & Testament Plan:
Last Will and Testament Plan
Client Information:
Full Legal Name
First
Last
Sex
Male
Female
Date of Birth
Marital Status
Address
Address Line 1
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Mobile Phone
Work Phone
Home Phone
Email
I authorize Remote Law Group to contact me by:
Phone
Email
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Spouse Information:
Full Legal Name
Spouse Sex
Male
Female
Spouse Date of Birth
If spouse is deceased, date of death
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Family Information
Please enter information regarding your family:
Date of Marriage
Children from this Marriage:
First Born Full Legal Name
Address
Address Line 1
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Home Phone
Mobile Phone
Work Phone
First Born's Spouse Name
Spouse Date of Birth
If spouse is deceased, date of death:
First Born Grandchildren
Next Born Information:
Date of Birth
Address
Address Line 1
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Home Phone
Mobile Phone
Work Phone
Spouse Name
Spouse Date of Birth
If spouse is deceased, date of death:
Next Child Grandchildren
Grandchildren:
List Grandchildren (Full Legal Name - Date of Birth): (copy)
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Additional Information
Have you or your spouse been married before?
Yes
No
Name of your prior spouse
Children from previous marriage
Do you or your spouse have any children who have died leaving children?
Yes
No
Does anyone to whom you may be leaving part of your estate require any help or protection in managing money or other property?
Yes
No
Do you and your spouse have a pre-nuptial or post-nuptial agreement?
Yes
No
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Medical/Disability
Is anyone in your family disabled?
Yes
No
Medical Disability Explanation
Is anyone at risk for becoming seriously ill or disabled because of a medical condition or family history?
Yes
No
Medical Disability Explanation (copy)
Has anyone in your family recently entered a hospital or skilled nursing facility?
Yes
No
Name of Facility
Date of Admission
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Date of Discharge
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YYYY
2023
2022
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2020
2019
2018
2017
2016
2015
2014
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2012
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1920
Diagnosis
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Financials
Income-Producing Assets
Bank and brokerage accounts, stocks, corporate or U.S. bonds, etc.
Have you or your spouse made any transfers or gifts in excess of $10,000 or more during the past 3 years?
Yes
No
Real Estate and Business:
Real Estate and Business
Put 1 Entry per line
Do you or your spouse have any interest in any business?
Yes
No
Do you have life insurance?
Yes
No
Other Property with Designated Beneficiaries
Do you or your spouse expect an inheritance?
Yes
No
Are you or your spouse the beneficiary of any trust?
Yes
No
Liabilities:
Mortgages, notes to banks, notes to others, loans on insurance, or other – 1 Entry per line
Location of important papers
Notes, deeds, etc.
Monthly Expenses
Current Legal Documents:
Last Will and Testament:
Date Executed
Location of Document
Durable Power of Attorney:
Date Executed
Location of Document
Mortgage/Rent Payment:
Date Executed (copy)
Location of Document (copy)
Living Will/Healthcare Proxy:
Date Executed
Location of Document (copy) (copy)
Living Trust:
Date Executed
Location of Document
I am the legally appointed guardian of
I am serving as a power of attorney for
Serving as executor or administrator
Involved in lawsuits
I have lived in a community property state (Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, Wisconsin):
Yes
No
If yes
Property states: Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, Wisconsin
Other legal concerns
Email
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