Академический Документы
Профессиональный Документы
Культура Документы
(CONFIDENTIAL)
Date: ______________________________________
A. PERSONAL
Husband Wife
1. Name _________________________________________
_________________________________________
2. Other Names _________________________________________
_________________________________________
3. Addresses
a. Home _________________________________________
_________________________________________
_________________________________________
_________________________________________
b. Mailing _________________________________________
_________________________________________
_________________________________________
_________________________________________
4. Telephone
a. Home _________________________________________
_________________________________________
b. Work _________________________________________
_________________________________________
5. Birth Date _________________________________________
_________________________________________
6. Place of Birth _________________________________________
_________________________________________
Husband Wife
1. Former Spouse ________________________________________
_________________________________________
2. Marriage Date ________________________________________
_________________________________________
3. Date Marriage Terminated:
a. By Divorce ________________________________________
_________________________________________
b. By Death ________________________________________
_________________________________________
4. Obligations to or
from former spouse ________________________________________
_________________________________________
5. Child Support ________________________________________
_________________________________________
6. Separate
Maintenance ________________________________________
_________________________________________
C. CHILDREN Please indicate if child is of prior marriage. All of your children and all
children of any deceased child must be named in your Will, even though you leave
them nothing.
Husband Wife
1. Living Children:
a. Name _________________________________________
_________________________________________
Birth Date _________________________________________
_________________________________________
b. Name _________________________________________
_________________________________________
E. INTERSPOUSAL AGREEMENTS
1. Have you ever executed a Community Property Agreement?
______
2. Have you ever executed any other agreements between spouses regarding your
property? ______
3. Please furnish a copy of any agreements.
F. TRUSTS
1. Does any member of your family receive income for any trust?
______
If yes, who created the trust?
__________________________________________________________________________
___________________________________________________________________________________
_________________________
2. Has husband or wife ever created a trust, except as part of a Will?
______
If yes, please describe.
_____________________________________________________________________________
_____
___________________________________________________________________________________
_________________________
3. Does any family member expect to be named a beneficiary or remainderman of
a trust? ______
G. INSURANCE (Please list any life insurance policies in existence on the life of
either spouse.)
1. Company
________________________________________________________________________________
__
Type of insurance
________________________________________________________________________________
__
Amount and Cash
Surrender Value
________________________________________________________________________________
__
Insured
________________________________________________________________________________
__
Beneficiaries
________________________________________________________________________________
__
________________________________________________________________________________
__
Type of insurance
________________________________________________________________________________
__
Amount and Cash
Surrender Value
________________________________________________________________________________
__
Insured
________________________________________________________________________________
__
Beneficiaries
________________________________________________________________________________
__
3. Company
________________________________________________________________________________
__
Type of insurance
________________________________________________________________________________
__
Amount and Cash
Surrender Value
________________________________________________________________________________
__
Insured
________________________________________________________________________________
__
4. Company
________________________________________________________________________________
__
Type of insurance
________________________________________________________________________________
__
Amount and Cash
Surrender Value
________________________________________________________________________________
__
Insured
________________________________________________________________________________
__
Beneficiaries
________________________________________________________________________________
__
Do you own any real or personal property as joint tenants with each other or third
parties? ______
L. CHARITABLE ORGANIZATIONS
Please list the charitable organizations that you currently support:
___________________________________________________________________________________
_________________________
___________________________________________________________________________________
_________________________
___________________________________________________________________________________
_________________________
M. ASSET SCHEDULE
$____________
$____________
$____________
$____________
5. Miscellaneous Property:
(Furniture, furnishings,
antiques, automobiles,
boats, collectibles, etc.) $____________ $____________
$____________
$____________
7. LESS Liabilities:
Notes payable, other debts,
income tax payable ($____________ ) ($____________)
$____________)
$____________
Husband Wife