2 Elder Law Planner

Organizer Elder Law

Print and complete.  

Also Print and Complete Asset Summary Chart.

Please bring to your appointment, along with financial statement or last tax return

Contact Data For Representative Completing Organizer

 Name________________________________________________________________                                                                             (name most often used to title property and accounts)

Birth date                                 US Citizen?  yes  no


Home Telephone                     Cell _______________  Business ___________________

County of Residence                                                                                                                  

Employer                                                                                  Position ___________________  

E-mail Address                                                                                                                                 

Marital Status      Married:  Date of Marriage                                                                                   

OR       Divorced      Widowed         Single

Spouse/Partner’s Name_________________________________________                                                                         (name most often used to title property and accounts)

Birth date                        US Citizen?                        


Telephone(s) [if different than above}__________________________________

Employer                                                                                Position ______________

E-mail Address                                                                    

q  It is okay to communicate with me via my E-mail address.

Children and/OR other FAMILY MEMBERS

(Use full legal name. Use “JT” if both spouses are the parents, “H” if husband is the                                                                     parent, “W” if wife is the parent, “S” if a single parent.).                                                                                                                       

Note any medical, physical or mental challenges the child may have, if any.

Name and  Birth date                                     Parent or Relationship