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 Address 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? Address 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 |