The Dean Law Firm

The Dean Law Firm

Tel: 281-277-3326 Fax: 281-277-1534

QUESTIONNAIRE FOR guardianship

This questionnaire is intended to help us provide you with the best possible legal service and advice. Please attempt to complete as much of this questionnaire as possible before your consultation. If the question does not apply to you, please indicate “N/A.” The information you provide is held in strict confidence.

Part I: Applicant’s Information

Applicant’s full legal name:
Any other names by which you have ever been known:
Your home address:
Your mailing address, if different:
County of your residence:
Your home phone number:
Your cellular phone number:
Your employer:
Position:
Work address:
Work phone number:
Your e-mail address:

Part II: Ward Information

Full name of individual for whom you are applying for guardianship (“Ward”):
Is the Ward a male or female?
Date of Birth and
age of the Ward:
Address of the Ward: Address/City/County
Where may we serve the Ward with a citation? List address if different from above.
Your relationship to the Ward:
Names, addresses, and phone numbers of persons who should receive citations (list persons who may have an interest in the Ward):
Briefly state facts supporting necessity for guardianship of the Ward:
Name, address, and phone number of the Ward’s treating physician:
Does the Ward have a guardian in this or any other state?
Name and address of the person or institution having care and custody of the Ward:
Do you have a Power of Attorney signed by the Ward?
To the best of your knowledge, list the names and addresses of Ward’s spouse, parents, siblings, and children or, if none living, of Ward’s next of kin who are adults. Include the ages of the siblings and children. List any parent, child, or sibling who is deceased.

Part III: Information About Ward’s Assets

Please put an estimated value on each asset owned bythe Ward and indicate the character of the asset by listing it in the appropriate column.

Assets

Assets / Description and Approximate Value of Assets Owned by the Ward
Home
Vacation Home
Other Real Estate
Other Real Estate
Checking Accounts
Savings
Accounts
Certificates
Of Deposit
Money Market
Mutual Funds
Securities
Royalties
Life Insurance
Furniture
Vehicles
Annuities
Jewelry
Collectibles
IRAs
401(k) or
Keogh
Other
Retirement Plans
Closely-Held
Stock
Other Assets
TOTAL

LIABILITIES

Liabilities / Liabilities of the Ward
Home Mortgage
Other Mortgage
Other Mortgage
Auto Loans
Other debt
Other debt
Other debt
TOTAL
NET WORTH

Name(s) of person(s) completing the questionnaire:

Tell us how you heard about our firm:

Date

Thank you for taking the time to complete this questionnaire. Please send it to Julia Dean at or bring it with you to our conference.

Julia Dean

The Dean Law Firm, PLLC

The Offices at Kensington

1650 Highway 6 South, Suite 100

Sugar Land, TX 77478

Tel: 281-277-DEAN (3326)  Fax: 281-277-1534

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