Client Form

Law Offices of Cheryl L. Walsh, APC
27282 Calle Arroyo, Suite 200
San Juan Capistrano, CA 92675
Tel: (949)240-9003; Fax: (949)240-9083
Email: Cheryl@WalshSeniorLaw.com
Estate Plan Client Questionnaire
PERSONAL INFORMATION
Full Name

First NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
U.S. Citizen?
Phone Number

Area CodePhone Number
Last 4 Digits of SS#
Occupation
Employer
Employer Phone

Area CodePhone Number
Name of Spouse

First NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
U.S. Citizen?
Phone Number

Area CodePhone Number
Last 4 Digits of SS#
Occupation
Employer
Employer Phone

Area CodePhone Number

MARITAL INFORMATION
Date of Marriage

MonthDayYear
Prenuptial Agreement?
Prior Marriage?
His/her Deceased Spouse(s) and Date of Death
His/her Divorced Spouse(s) and Date of Divorce

DISTRIBUTION AND PLAN OBJECTIVES
How and whom do you want your assets distributed at death? Do not be concerned with the "legalisms", just explain how you wish the property to be distributed and who should receive the property.
If you have minor children, provide the following information as to your first and second choice as guardian:
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship
Please provide the following information as to your choice of a personal representative and first alternate personal representative in your Will.
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship
Please provide the following information of a successor trustee in your Living Trust if a Trust is recommended.
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship
Please provide the following information of the person you would designate to act as your agent in the event you cannot act for yourself in a Durable Power of Attorney document.
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship
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Law Offices of Cheryl L. Walsh, APC

27282 Calle Arroyo, Suite 200San Juan Capistrano, CA 92675Tel: (949)240-9003; Fax: (949)240-9083Email: Cheryl@WalshSeniorLaw.com

Estate Plan Client Questionnaire

PERSONAL INFORMATION

MARITAL INFORMATION

FAMILY INFORMATION

DISTRIBUTION AND PLAN OBJECTIVES

27282 Calle Arroyo, Suite 200
San Juan Capistrano, CA 92675
Tel: (949)240-9003; Fax: (949)240-9083
Email: Cheryl@WalshSeniorLaw.com