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Estate Planning Contact Form

We so often hear that hard work is the path to achieving the American dream. But retaining as much of our earnings as possible for our families can be a challenge. An estate planning attorney can work with you to assure that your hard work results in the accumulation of assets that are protected from liabilities. Asset protection planning can help you to ensure that gift and estate tax liabilities are minimized for your family after you have gone.

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Estate Planning Contact Form

*First Name

*Last Name

*Email Address

*Phone Number

*Zip

Street Address

Apt/Ste

Incident Street Address

Incident Apt/Ste

*Incident Zip

Date of Birth

U.S. Citizen?
Yes  No 

Spouse Name

Date of Birth

U.S. Citizen?
Yes  No 

State of Residence

What is your marital status?

Have you or your spouse ever been divorced?
Yes  No 

For whom do you want to provide in your Will or Trust?

If you have children, do you wish to treat all of your children equally?
Yes  No 

After your death, at what age do you want distribution to your children, if not immediately?

If you have grandchildren, do you wish to leave a specific amount of money or a percentage of your estate to your grandchildren?
Yes  No 

If so, how much and to whom?

At what age, if not immediately?

Do you want to leave a specific amount of money or other assets to any charity?
Yes  No 

If so, how much?

Name and Address of Charity

Assets

I own the following real estate (provide address/addresses)

Legal description

This property is held as follows

I have debt on this real estate with the following lender(s):

Name

Address

Telephone

Name

Address

Telephone

Asset Value

Personal Property

Checking   $
Savings   $
Cash   $
Bonds   $
Stocks   $
CD's   $
Household Goods/Furnishings   $
Automobile   $
Other (list)   $

Real Estate

Home   $
Vacation Home   $
Rental Property   $
Land   $

Outstanding Debts

Mortgage   $
Automobile   $
Credit Cards   $
Medical Expenses   $
Other   $

How did you out about find us?

If somebody referred you to us, who was it?

Special Concerns

Asset protection concerns

Elder law, Medicaid or Nursing Home concerns

Special needs of family members or other beneficiaries

Pending lawsuits

Pending divorce

Desire to disinherit a family member

Other concerns

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Estate Planning Center

Contact Information

John J. Pembroke & Associates LLC
422 N. Northwest Highway
Suite 150
Park Ridge, IL 60068-3272
Phone: 847-696-0060
Fax: 847-696-0950

Park Ridge Law Office

By Appointment Only:
9746 S Roberts Road
Palos Hills, Illinois 60465
Phone: 708-770-9422

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