Nevada Attorney General - Office Of Military Legal Assistance Wills Workshop Intake
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3NEVADA ATTORNEY GENERAL
Office of Military Legal Assistance
Wills Workshop Intake
Telephone: (775) 684-1160
Facsimile: (775) 684-1162
Date:___________
County of Residence: _____________________
Last Name: _______________________
First Name: ____________________ M.I.: _____
Mailing Address: ______________________________________
Apt/Space No.: ______________
City: __________________ State: NV Zip Code: _____________
Tel No:_____________________
E-Mail: ______________________________
Cell No:_____________________
Age: ___
Work No: ___________________
☐Male
☐Female
Date of Birth: ___________
SSN (last 4 digits): _________
Gender:
Marital Status: ☐Single
☐Married
☐Divorced
☐Widowed
Form Submitted by:
☐Self ☐Spouse ☐Child
Number of Adults in Household: _____
Number of Children: ____
☐Active Duty ☐ Active Reserve ☐ National Guard
Branch of Service:
Military Status:
☐Army ☐Navy
☐Air Force
☐Marines
☐Coast Guard
☐Veteran ☐ Retired
Grade (E-1, etc.): _______ MOS:______________
Characterization of Discharge:
☐Honorable
☐General
☐ Other Than Honorable*
(*Specify) ______________________
*Other than honorable discharge may render the service member
ineligible for this program.
Legal Issue**:
☐Wills / Power of Attorney Instruments
☐ Other _______________________
☐ Name of Opposing Party, if any _______________________
**C
N
A
G
O
M
L
A
URRENTLY THE
EVADA
TTORNEY
ENERAL
FFICE OF
ILITARY
EGAL
SSISTANCE PROGRAM SERVICES
V
W
P
A
. T
OFFERED TO
ETERANS WILL BE LIMITED TO
ILLS AND
OWER OF
TTORNEY INSTRUMENTS ONLY
HE PROGRAM
.
HOPES TO EXTEND ALL LEGAL AREAS TO VETERANS IN THE NEAR FUTURE
Briefly describe your legal problem:
Click here to enter
Click here to enter
How are you hoping to resolve your issue?
text.
text.
How did you find out about the program?
MONTHLY HOUSEHOLD
EXPENSES:
☐Bar Association
☐Nevada Legal Services
Mortgage or Rent
☐District Attorney
☐Self-Help Center-Civil
$___________
Utilities Child
☐Court
☐NV Dept.VA Services ☐
$___________
Care/Transportation
☐Service Member
$___________
Relative/Friend/Neighbor
Child/SpousalSupport
$___________
☐Veteran Organization
☐Active Military
Debt Payments
$___________
☐Medical Provider
☐Internet
☐VARN
Work Related
$___________
☐Legal Aid Center of So. NV
☐Washoe Legal Services
Unreimbursed Medical
$___________
☐State/County Law Enforcement/Non-Profit Agency
Current/Back Taxes
$___________
☐Public Service Announcement (TV/Radio/Internet)
Total Monthly Expenses
☐Other (Specify): ____________________________
$___________
Page 1
OMLA/NLS – Intake Form - Veteran/Rev. 6.22.15
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