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Confidential Estate Planning Worksheet
Please complete this form before we are able to schedule a consultation. If you have questions contact our office via email at
admin@irinashea.com
or call us at (201) 327-7000
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Email
*
Your email
FAMILY INFORMATION
Your Legal Name
*
As it appears on your Driver's License
Your answer
Your age
Your answer
Home Address
Your answer
Cell Phone Number we may use.
Your answer
Relationship Status
Single
Married
Life Partner
Divorced
Widowed
Other:
Date of Marriage (If married)
MM
/
DD
/
YYYY
Are you planning to move out of NJ/NY within the next year?
Yes
No
Maybe
Clear selection
Your Spouse/Partner’s Legal Name
Your answer
Your Spouse/Partner’s age
Your answer
Your Spouse/Partner’s Home Address
(If same skip)
Your answer
Your Spouse/Partner’s Cell Phone Number
Your answer
Your Spouse/Partner’s E-mail Address that we may use
Your answer
CHILDREN
(IF NO CHILDREN—FRIENDS, SIBLINGS, NIECES/NEPHEWS WHO ARE POSSIBLE BENEFICIARIES)
Name and Age: (Use full legal name. Use “JT” if both spouses are the parents, “H” if husband is the parent, “W” if wife is the parent.)
Your answer
HOW DID YOU HEAR ABOUT US?
Your answer
WHAT IS YOUR MAIN CONCERN TODAY?
Your answer
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