Step 1 of 5 20% EmailThis field is for validation purposes and should be left unchanged.PERSONAL INFORMATIONPlease complete this form as best you can then click the submit button at the end of the form.1. Individual 1 / Spouse 1Full Name(Required) First Middle Last Relationship to Individual 2/Spouse 2 below:U.S. Citizen Yes No Florida Resident Yes No Country of Residence if not USAPhone number(Required)Email Address(Required) 2. Individual 2 / Spouse 2Name First Middle Last U.S. Citizen Yes No Florida Resident Yes No Country of Residence if not USAPhone / CellEmail 3. Addresses for Individual 1 and Individual 2Individual 1 / Spouse 1 Address(Required)Individual 1 County(Required)Individual 2 / Spouse 2 AddressIndividual 2 County4. If Married, Date of Marriage Month Day Year Prenuptual Agreement Yes No FAMILY INFORMATION5. ChildrenNameAddressAgeChild's ParentsPhone NumberMale or Female Add RemoveClick the plus to add more. PLANNING INFORMATION AND RETIREMENT ASSETS6. Have you ever established a trust?(Required) Yes No If yes, please bring a copy with you.Date Established Month Day Year 7. Are you a beneficiary under any trust?(Required) Yes No If yes, please bring a copy with you.8. Do you have a preference whether you are buried or cremated? 9. AssetsIRA(s)LocationOwnerValueBeneficiaries Add RemoveClick the plus to add more.401kLocationOwnerValueBeneficiaries Add RemoveClick the plus to add more.Life InsuranceLocationOwnerValueBeneficiaries Add RemoveClick the plus to add more.BrokerageLocationOwnerValueBeneficiaries Add RemoveClick the plus to add more.AnnuitiesLocationOwnerValueBeneficiaries Add RemoveClick the plus to add more.Cash AccountsLocationOwnerValueBeneficiaries Add RemoveClick the plus to add more.Other Assets:Liabilities (loans/debts):What is the estimated gross value of your total estate? CertificationI/We certify that this information is correct to the best of my knowledge.Individual 1 / Spouse 1Date Month Day Year Individual 2 / Spouse 2Date Month Day Year
