msword - DSouza Law Office, LLC

By Herman Watson,2014-07-10 18:06
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msword - DSouza Law Office, LLC ...

    D’Souza Law Office LLC

    7979 Old Georgetown Road, Suite 1100

    Bethesda, Maryland 20814

    (301) 452-1888

    The Purpose of this Questionnaire

     Please keep in mind when completing this questionnaire that estate planning requires a

    thorough analysis of your estate by yourself and your attorney. The information you provide will

    enable your attorney to determine the documents necessary to fulfill your estate planning goals. It

    may also provide helpful information to the person you seek to be your Personal Representative

    after your death or your Power-of-Attorney during your lifetime.

     Please fill these documents to the best of your ability, and indicate if you are uncertain

    about your answer to any question. All information provided shall be kept confidential.

    Notice Regarding Joint Representation of Married Couples or Domestic Partners

     If you are married or have a domestic partner, please be advised that you both have the

    option of obtaining a separate attorney for your estate planning needs. The goals of many couples

    are the same when it comes to wills and estate planning. However, many individuals (especially

    individuals that have children from prior marriages) have differing views on the ownership of

    property, the identity of beneficiaries, the identity of executors, trustees and guardians, etc. If both

    of you were to obtain a different attorney, you would receive completely independent and

    confidential advice.

    In representing you jointly, this law practice’s advice will be directed to you jointly and

    nothing will be kept confidential as between the two of you. If you are unsure of whether you want

    to obtain separate attorneys, this law practice would be happy to discuss the matter with you in

    more detail before you make your decision.

     Please note a substantial conflict may exist in the determination of what constitutes

    community property and what is separate property. That determination may be more beneficial for

    one of you than for the other. Although unlikely, the possibility of a divorce must also be

    recognized. Consequently, the law practice’s present recommendations could affect the income,

    property, and support provision in any such divorce or after the death of one or both of you.


     Date:__________________ Your Full Name:_________________________ Other Names Used:____________________ I. FAMILY HISTORY Home Address:__________________________ Home Phone: ________________________ County:________________________________ Cell Phone:__________________________ E-Mail:________________________________ Best Method Of Contact:________________ Date Of Birth:___________________________ Place Of Birth:________________________ Social Security No.: ______________________ Citizenship:__________________________ Spouse’s Full Name:______________________ Other Names Used:____________________ Date Of Birth:___________________________ Place Of Birth: _______________________ Date Of Marriage: _______________________ Place Of Marriage: ____________________ Social Security No. :______________________ Citizenship:__________________________ If married, have you and your spouse lived or owned property in a community property state?

     Yes No. If yes, please circle state(s): Arizona, California, Idaho, Louisiana, Nevada, New Mexico,

    Texas, Washington, Wisconsin Children and Deceased Children

    Name Of Child 1:

    Other Names Used:

    Date Of Birth:

    Social Security No.:

Adopted Or Child Only Of One Spouse:_______________________________________________________



    Spouse’s Name:

    Name And Date Of Birth Of Each Child’s Child:

    Name Of Child 2:

    Other Names Used:

    Date Of Birth:

    Social Security No.:

Adopted Or Child Only Of One Spouse:_______________________________________________________



    Spouse’s Name:

Name And Date Of Birth Of Each Child’s Child:

Are any children (natural or adopted) anticipated? Yes No

    Please note “children” as used in the will shall include any children born or adopted after the making of the will, but

    not step-children.

Do you or your spouse have any other dependents for support now or in the future?


    Do you, your spouse, or your children have any special medical, educational, or financial needs? Yes No

     If yes, please describe___________________________________________________________________________

Do you or your spouse need skilled nursing care and related services, rehabilitation services, or health related services

    above the level of room and board? Yes No

     Is care needed on a daily basis? Yes No

     Is care required to be provided on an inpatient basis? Yes No

     Is care provided by a facility that is certified for participation in Medicaid? Yes No

     Is care ordered by and provided under the direction of a physician? Yes No Please explain any other special medical, educational or financial needs, for you, your spouse, or your children and how you would like to provide for them.


Prior Marriage SELF SPOUSE

    Former Spouse’s Name _____________________ __________________________

    Date of Marriage___________________________ ________________________

    Place of Marriage: _________________________ ________________________

    Date of Death/Divorce:______________________ ________________________

     Court_______________________ _______________________

Do you have a marital or property settlement agreement? Yes No. If yes, please attach.

Do you have an prenuptial agreement? Yes No. If yes, please attach.

Do you have a domestic partnership agreement? Yes No. If yes, please attach.

    Do you have any child support, alimony, insurance, or other obligations? Yes No. If yes, what is the obligation and how much is the monthly amount required?___________________________________ Others Are there any other individuals or charitable organizations that you would like to named beneficiaries? Other Persons: Address and Phone Number Age: Relationship, if any ________________ ____________________________ _______ ___________________ ________________ ____________________________ _______ ___________________ Charity Address and Phone Number ________________ ________________________________________________________________ ________________ ________________________________________________________________



Insurance Agent:______________________________________________________________

Broker/Investment Advisor:_____________________________________________________

     Financial Planner:_____________________________________________________________


    Prior Estate Planning Self Spouse