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Durable Power of Attorney Questionnaire

Step 1 of 2

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Thank you for contacting the Malhotra Law Firm regarding your estate planning needs. This process will be much quicker and easier than you think – I have created a very thorough yet concise questionnaire that will allow me to prepare the majority of your documents. Once this questionnaire is completed, please either email it to cyrusesquire@gmail.com, or if you prefer fax, please send it to 727-290-4044. I then review this form and contact you to summarize my recommended plan of action. This conversation typically only takes between 10-30 minutes. You will then receive your completed estate planning documents, along with thorough instructions. The final step entails getting the documents notarized, after which time your estate plan will be in place. Typical turnaround time for all documents is between 2-4 days from the time payment is made and the client consultation has been made.
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Referral
SECTION I: PERSONAL INFORMATION AND GENERAL QUESTIONS
CLIENT INFORMATION
Full Name:*
Date of Birth:*
Place of Birth:*
Social Security No.:*
Other Names Known by:*
Office Phone:*
Email Address:*
Mobile Phone:*
Fax No.:
SPOUSE INFORMATION (IF APPLICABLE)
Full Name:
Date of Birth:
Place of Birth:
Social Security No.:
Other Names Known by:
Office Phone:
Email Address:
Mobile Phone:
Fax No.:
HOME ADDRESS
Address*
Street Address City State ZIP Code
Is your estate more than $5.15 million if single, or $11.18 million if married? (check under appropriate response)*
- Yes
- No
Do you have an existing Will?*
- Husband
- Wife
- Both
- Neither
Do you have an existing Trust?*
- Husband
- Wife
- Both
- Neither
Have you previously been married?
Husband:*
- Widowed
- Divorced
- No
Please describe any continuing obligations under a divorce decree
Wife:*
- Widowed
- Divorced
- No
Please describe any continuing obligations under a divorce decree
Please indicate your state of domicile*
and the date established*
If you spend more than a nominal amount of time in another state or country, please identify:
Names of living children as they are to appear in your documents
How many children?
Child 1
Name of Child:
Date of Birth:
Address:
Nationality of child:
Child of:
- Both
- Husband
- Wife
Married?
- Yes
- No
Spouse name:
Grandchildren?
- Yes
- No
Please provide names and ages below:
Child 2
Name of Child:
Date of Birth:
Address:
Nationality of child:
Child of:
- Both
- Husband
- Wife
Married?
- Yes
- No
Spouse name:
Grandchildren?
- Yes
- No
Please provide names and ages below:
Child 3
Name of Child:
Date of Birth:
Address:
Nationality of child:
Child of:
- Both
- Husband
- Wife
Married?
- Yes
- No
Spouse name:
Grandchildren?
- Yes
- No
Please provide names and ages below:
Child 4
Name of Child:
Date of Birth:
Address:
Nationality of child:
Child of:
- Both
- Husband
- Wife
Married?
- Yes
- No
Spouse name:
Grandchildren?
- Yes
- No
Please provide names and ages below:
Child 5
Name of Child:
Date of Birth:
Nationality of child:
Address:
Child of:
- Both
- Husband
- Wife
Married?
- Yes
- No
Spouse name:
Grandchildren?
- Yes
- No
Please provide names and ages below:

DURABLE POWER OF ATTORNEY
A durable power of attorney gives someone you nominate the power to manage your financial affairs if you are alive but unable to.
Who will serve as attorney-in-fact under your durable power of attorney?

Each Spouse for the other?
- Yes
- No
If YES to above, the following people will be successors. If NO, the following person will be the primary Power of Attorney, followed by any alternates you choose (in case the primary cannot serve).
Husband
If No, or to name co-fiduciaries, use space below.
Name:
Relation:
City/State:
Alternate (if above person(s) unable to serve):
Relation:
City/State:
Wife
If No, or to name co-fiduciaries, use space below.
Name:
Relation:
City/State:
Alternate (if above person(s) unable to serve):
Relation:
City/State:

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Home
Probate
▼
Estate Planning
▼
- Office Locations
  ▼
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About Us
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Home
Probate
Estate Planning
- Office Locations
- Frequently Asked Questions
About Us
Contact Us