CONFIDENTIAL ESTATE PLANNING QUESTIONNAIRE
STUART A. RADER, Esq.
Rader & Coleman, P.L.
Attorneys at Law
2101 Northwest Boca Raton Boulevard, Suite 1
Boca Raton, Florida 33431
(561) 368-0545 Fax (561) 367-1725
www.raderandcoleman.com
stuart.rader@raderandcoleman.com
Date:
1. Husband¿s Full Name:
Date of Birth: Place of Birth:
Social Security No. U.S. Citizen: Yes No
Other Names known by:
Are you presently employed? Yes No For how long?
Occupation (former if retired):
Employer:
Business Address:
Office Telephone No.: Email Address:
Mobile Phone No. Fax No.:
2. Wife's Full Name:
Date of Birth: Place of Birth:
Social Security No. U.S. Citizen: Yes No
Other Names known by:
Are you presently employed? Yes No For how long?
Occupation (former if retired):
Employer:
Business Address:
Office Telephone No.: Email Address:
Mobile Phone No. Fax No.:
3. Home Address: Resident Since:
Street Address/P.O. Box:
City: State: Zip Code:
County: Home Telephone Number:
Other Residences:
4. Advisors:
Accountant:
Trust Officer:
Insurance Agent:
Investment Advisor:
5. Date of Marriage: Where Living When Married:
6. Prior Marriages: Husband: Yes No Wife: Yes No
7. Names of children of present marriage, whether natural or adopted:
A. Phone No.:
Date of Birth: SSN:
Name of Child's Spouse (if any):
Address:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
B. Phone No.:
Date of Birth: SSN:
Name of Child's Spouse (if any):
Address:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
C. Phone No.:
Date of Birth: SSN:
Name of Child's Spouse (if any):
Address:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
8. Names of children of prior marriage (indicate whether husband¿s or wife¿s);
A. Phone No.:
Date of Birth: SSN:
Name of Child's Other Parent:
Name of Child's Spouse (if any):
Address:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
B. Phone No.:
Date of Birth: SSN:
Name of Child's Other Parent:
Name of Child's Spouse (if any):
Address:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
C. Phone No.:
Date of Birth: SSN:
Name of Child's Other Parent:
Name of Child's Spouse (if any):
Address:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
9. Do you have any other relatives dependent upon you for support? Yes No
(If yes, give names and relationships):
10. Names and addresses of other or alternate persons to receive property:
11. Please list any specific items or amounts that you wish to give to any individuals or organizations:
