D. H. Robertson & Associates

Estate Planning Preliminary Questionnaire

PART ONE

Name [instructions]	[instructions] Work Phone Cell Phone Home Phone
Spouse/Second Party [instructions]	Work Phone Cell Phone
Address [instructions]
Address 2	}
City, St. Zip	,
County
	How did you find out about our service? [instructions]
	Husband, Unmarried Male or Domestic Partner	Wife, Unmarried Frmale or Domestic Partner
Full Given Name [instructions]
Marital Status [instructions]	Married Single/Widowed/Divorced In a Committed Relationship	Married Single/Widowed/Divorced In a Committed Relationship
Children [instructions]	No Children Do Not Plan to Have Any Children Do Plan to Have Children Minor Children (Under 18) Young Adult Children (19-29) Mature Adult Children (Over 30)	No Children Do Not Plan to Have Any Children Do Plan to Have Children Minor Children (Under 18) Young Adult Children (19-29) Mature Adult Children (Over 30)
How would you like for us to send to you additional information and document drafts?
	E-mail to . We can send documents as attachments in Acrobat Portable Document Format (.pdf). That requires you to have Adobe Acrobat Reader. This is our preferred method. Fax to . Please call before faxing. Mail to the above address.