Client Estate Planning Form Page 3
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AW
FFICE OF
AVID
OLDMAN
If you have more children, check this box and write information on the back.
If you have other dependents, check this box and write information on the back.
Will any minor children require the appointment of a guardian in the event of your
death? Yes
No
Is anyone in your family disabled? Yes
No
If yes, please explain:__________________________________________________________
______________________________________________________________________________
Parents Information
Is your father still living? Yes
No
If no, date of death: ____/____/_______
Is your mother still living? Yes
No
If no, date of death: ____/____/_______
If yes, please provide info below.
If you are providing elder care for a parent (or anyone else), please check this box
and describe on the back of this sheet.
Father’s Name: ________________________________ Date of Birth: ____/____/_______
Address:
_________________________________________________________________
State of Health: ______________________________________________________________
Mother’s Name: ________________________________ Date of Birth: ____/____/_______
Address:
_________________________________________________________________
State of Health: ______________________________________________________________
If either of your parents is or was remarried and there is a living spouse:
Mother’s Husband: _____________________________ Date of Birth: ____/____/_______
Address:
_________________________________________________________________
State of Health: ______________________________________________________________
Father’s Wife: __________________________________ Date of Birth: ____/____/_______
Address:
_________________________________________________________________
State of Health: ______________________________________________________________
Sibling Information
Please list siblings with birthdates, City & State of Residence, and marital status:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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Email: , Phone: 410-205-4830, Secure Fax: 602-424-0103
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