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475 Metro Place South, Suite 150, Dublin, Ohio 43017
1-614-469-4778
info@beckerlilly.com

Questionnaire

If you would like to be contacted by Becker & Lilly, LLC to discuss your estate planning needs, please complete the Questionnaire below and Submit it. One of our attorneys will contact you within 24 hours to discuss our potential representation. All information is kept in strict confidence and will be deleted/destroyed upon your request. We look forward to speaking with you.

-Becker & Lilly, LLC

Begin Questionnaire

    Do you currently have an estate plan? * YesNo
    If yes, have events in your life such as changes in marital status, birth of new children or grandchildren, family deaths, retirements, change of residence to another state, length of time, changes in state, federal or gift tax law prompted you to want to have your current plan reviewed for possible updating? * YesNo
    Section 1 -- Please Tell Us About You
    Your Name: * If you are married, your Spouse's Name: Home Address: Telephone Number: E-mail Address: * Your Occupation: Your Spouse's Occupation Date/Place of Marriage: Special Medical Situation: Have you been married before? * YesNo Has your spouse been married before? * YesNo
    Section 2 -- Please Tell Us About Your Family
    Your Children
    Child 1: * YesNo
    a. Name: Child of: * BothHusbandWife Date of Birth: Special Medical Situation: Spouse's Name Children of this child: Name: Date of Birth: Name: Date of Birth:
    Child 2:* YesNo
    b. Name: Child of: * BothHusbandWife Date of Birth: Special Medical Situation: Spouse's Name Children of this child: Name: Date of Birth: Name: Date of Birth:
    Other Potential Beneficiaries:
    Section 3 -- Please Tell Us About Your Net Worth and Business Interests
    Your Net Worth: Real Estate
    You:
    Your Spouse:
    Joint:
    Investments/Cash
    You:
    Your Spouse:
    Joint:
    Retirement Plans
    You:
    Your Spouse:
    Joint:
    Business
    You:
    Your Spouse:
    Joint:
    Personal Property
    You:
    Your Spouse:
    Joint:
    Total Assests
    You:
    Your Spouse:
    Joint:
    Real Estate
    You:
    Your Spouse:
    Joint:
    Business Interests Do You Own a Business? * YesNo
    Name of Business: Nature of Business: Kind of Entity: * Sole ProprietorshipPartnershipLimited Liability CompanyC CorporationS Corporation If other: (explain) Percentage of interest owned: By You: By Your Spouse: By Others: Children involved in the business:
    Name of Child:
    Percentage Owned:
    Name of Child:
    Percentage Owned:
    If you have other information you believe to be pertinent, please add it here: