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Intake Form

Please contact Shayle Rothman at [email protected] and he will immediately forward a copy of the Will Intake Form and walk you through the process step by step.

Wills and Powers of Attorney

REQUEST BY(name in full):
Current Home Address:
(include city and code)
Date of Birth:         I am: malefemale
 
Telephone:  Res- Cell-
 
Bus:          Fax: 
 
Email:     
 
Marital Status:      Married Single Divorced Widowed Common Law
 
If married:      1st time marriage 2nd time marriage 3rd time marriage
 
If currently officially married, and you live together, spouse's name :
 
Details of children of any prior marriage or relationship (prior to existing marriage or existing relationship). State names and dates of birth and whether son or daughter:
 
Details of children of current marriage or relationship (state names and dates of birth and whether son or daughter):
 
Equal shares for all subsequent children. Yes No

WILLS

Testator
Executor
Alternate Executor
Guardian
Beneficiary
Failure Gifts
Cash Legacy

POWERS OF ATTORNEY

Your Name(s)
Power of Attorney
Alternate Attorney
Conditions
 

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