Personal Data Questionnaire

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To help you prepare to see your attorney, you may use the following questionnaire to compile information your attorney will need to help you develop an estate plan. Your attorney may prefer to use other questionnaires and may need additional information. Call your attorney before your appointment to see what information he or she may need. You may use the following questionnaire, either by typing your answers directly on the screen or by printing a blank copy and filling out the hard copy. If you choose to type in your answers directly on the screen, print a copy when you are finished. Exiting the program will lose any information you have typed into the questionnaire. Do not try to save your answers in a file because your answers will be erased in the saved file. You will not be asked to transmit your answers over the phone line, so your answers are as secure as your computer. Tip: Print the file often to make sure that you do not lose the information you have entered. Or, fill out a hard copy first, and then enter the information on the computer screen to print.

Name:
Address:
County of Residence:
Business Telephone:
Home Telephone:
FAX:
E-mail Address:
Date began living in North Carolina:
Date of Birth:
Place of Birth:
Citizenship:
Social Security #:
Occupation:

Note: Clicking Reset will erase all of the above information.

Spouse:
Address: (If different from above)
County of Residence:
Business Telephone:
Home Telephone:
FAX:
E-mail Address:
Date began living in North Carolina:
Date of Birth:
Place of Birth:
Citizenship:
Social Security #:
Occupation:

Note: Clicking Reset will erase the information up to the previous Reset Button.

Have either you or your spouse been married before? Husband Wife

If so, were there any children? Husband Wife

If a former marriage ended in divorce and if there is any present or future obligation to the former spouse, please provide a copy of the divorce decree, separation agreement, etc.

Note: Clicking Reset will erase the information up to the previous Reset Button.

CHILDREN: (If any children are adopted or by a prior marriage, please indicate.)

1. Name:
Social Security #:
Date of Birth:
Address:
Married Adopted Child from prior marriage

2. Name:
Social Security #:
Date of Birth:
Address:
Married Adopted Child from prior marriage

3. Name:
Social Security #:
Date of Birth:
Address:
Married Adopted Child from prior marriage

4. Name:
Social Security #:
Date of Birth:
Address:
Married Adopted Child from prior marriage

5. Name:
Social Security #:
Date of Birth:
Address:
Married Adopted Child from prior marriage

6. Name:
Social Security #:
Date of Birth:
Address:
Married Adopted Child from prior marriage

Note: Clicking Reset will erase the information up to the previous Reset Button.

OTHER DEPENDENTS: (Dependent parents, etc.)

1. Name:
Social Security #:
Date of Birth:
Address:
Married

2. Name:
Social Security #:
Date of Birth:
Address:
Married

3. Name:
Social Security #:
Date of Birth:
Address:
Married

4. Name:
Social Security #:
Date of Birth:
Address:
Married

Note: Clicking Reset will erase the information up to the previous Reset Button.

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Prepared by Carol A. Schwab, J.D., LL.M.
Professor and Extension Specialist, NC State University.

This publication is provided as a public service and is designed to acquaint you with certain legal issues and concerns. It is not designed as a substitute for legal advice, nor does it tell you everything you may need to know about this subject. Future changes in the law cannot be predicted, and statements in this publication are based solely on the laws in force on the date of publication.

WARNING: This questionnaire is designed to help your attorney prepare the appropriate legal document. Providing answers to the questionnaire has no legal effect and is not a substitute for the legal document itself.

Date: August 2000