LegalLife™ Checkup

Part 1. - Your Personal Information

Personal Information
Your Name: / U.S. Citizen / Yes / No
Address: / Date of Birth: Age:
City / State: / Zip:
Where do you presently live, if different than address above?
How long have you lived at your present address?
How long did you live at former address, if applicable?
Do you share your residence with another adult person? Yes No / If yes, is there an agreement regarding sharing expenses, etc? Yes No
® For Roommate Agreement forms see Part 18.
Are you a party to any cohabitation agreement? Yes No
Birth State and County
If you are an immigrant, do you plan to obtain permanent resident status? Yes No
Are you a member of the military? Yes No Are you a member of the Reserves or National Guard? Yes No ® For Military forms see Part 18.
Are you registered to vote? Yes No
Have you ever lived in a community property state? / Yes / No
If yes, what state?
Do you have a known future residence address? Yes No
If yes, list address:
Education level
Employment
Are you employed? Yes No Retired
Position:
Address: / City: / State: / Zip
Phone: / Fax
How long employed at present employer?
Previous employer: / Position:
Address: / City: / State: / Zip:
Are you collecting Social Security benefits?
® For Social Security forms see Part 18.
Are you collecting a pension?
® For Pension forms see Part 18.
Family
Are you married? Yes No Divorced Engaged Widowed / Is there a premarital agreement between you and your spouse? Yes No
® For Premarital Agreement forms see Part 18.
Do you have children? Yes No / Any deceased children? Yes No
Have you designated a guardian for any minor children upon your death? Yes No n/a
Do you have any adopted children? Yes No If yes, who was the child adopted by?
® For Adoption forms see Part 18.
Are your parents alive? Father: Yes No
Mother: Yes No / Do you have any step-parents? Yes No
Step-mother
Step-father
Do you have any brothers or sisters? Yes No
Do you have any step-brothers or sisters? Yes No

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