Appendix A: Sample Data-Gathering Form

Personal Information

 

Client

Spouse

Full Name

  

Gender

  

Maiden Name (if applicable)

  

Current Marital Status

  

Prior Marriages (if yes, date of dissolution)

  

US Citizen (yes/no)

  

Current Address

  

Phone Number

  

Cell Phone Number

  

Prior State of Residence

  

Birthdate

  

Age

  

Birthplace

  

Scer

  

Occupation

  

Employer

  

Length of Current Employment (years)

  

Business Phone Number

  

Family Members Who Depend on Your Support

  

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Family Advisors and Representatives

 

Name

Phone Number

Attorney

  

Banker

  

Doctor

  

Executor(s)

  

Financial ...

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