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Maguire Schneider Hassay, LLP

1650 Lake Shore Drive, Suite 150 Columbus, Ohio 43204

If you are a LegalShield Member, please contact us at 800-464-2266

We welcome your communications, but please do not include confidential information in any communication. We may be unable to work with you due to a conflict of interest, workflow difficulty or other concern. Unless we have agreed to work with you, information you send us will not be treated as confidential and sending information will not create an attorney-client relationship.

Thank you for your consideration.

First Name *

Last Name *

Email Type

Email *

Reason for contacting MSH *

Full name and any other names by which you have been known *

Date of Birth *

Age *

Gender *

Citizenship *

Current Address *

Phone number *

Marital status *

Married

Single

If Married: spouse's full name, date of birth, date of marriage, please of marriage

Is there a prenuptial agreement which identifies and disposes of separate spousal property? *

Yes

N/A

Have you been divorced? *

Yes

If yes: date of marriage, date of divorce judgment, court rendering judgment. If spouse is deceased- date of death

Has your spouse been divorced? *

Yes

N/A

If yes for spouse: date of marriage, date of divorce judgment, court rendering judgment, if spouse is deceased- date of death

Do you or spouse have any trusts or made gifts through trusts to others? *

Yes

CHILDREN - GRANDCHILDREN

Please list names of children, dates of birth, and if child is of current marriage

Please list any deceased or legally adopted children if applicable

Please list deceased child's children, if applicable

Do you have stepchildren?

Yes

If yes, please list names, dates of birth

Would you like these stepchildren to be treated as natural born or adopted children?

Yes

Do you have grandchildren?

Yes

If yes, please list names, parent's name, grandson/granddaughter, dates of birth

Are any of your children or beneficiaries mentally or physically disabled or have special needs?

Yes

If yes, note any special provisions (SSI benefits, special needs trust)

Are your children are under the age of 18?

Yes

If under 18, please state the full name of the person you would like to act as their guardian

Guardian full address

Your relationship to Guardian

Please name an alternate Guardian

Alternate Guardian full address

Relationship to Alternate Guardian

Do you want the appointed Guardian to also be named the Trustee (conservator) of any inherited assets?

Yes

If no, please list the person or entity you wish to act as their Trustee (financial custodian)?

Trustee full address

At what age would you like your children to inherit assets (Must be at least 18 years old)?

* You should get the consent of the person(s) you are naming Guardian/Trustee before executoin of Will.

Please list how you want your assets to pass- Choose only 1 Option:

Option A

I want my assets to pass to my spouse and children as follows:

1. To my spouse, if surviving

2. If my spouse predeceases me, to my children in equal shares.

3. If any of my children predecease me, that child's share shall be distributed to his or her children in equal shares (per stirpes).

4. In the event that my spouse and all of my children predecease me, my assets should be distributed as follows:

Answer for 4.

Option B

I am unmarried with children and want my assets to pass as follows:

1. In equal shares to my children.

2. If one or more of my children predecease me, that child's share is ot be distributed to his/her children in equal shares.

3. In the event that all my children predecease me, I want my assets to be distributed as follows:

Answer for 3.

Option C

None of the above.

I want my assets distributed as follows:

Please list any personal items that you would like to leave to a specific person. List the item name, identifying feature, and whom you would like to distribute.

Do you wish to disinherit any children or grandchildren? *

Yes

N/A

If so, please list their full name(s):

EXECUTOR INFORMATION

If married and your spouse is still alive, do you want your spouse to serve as your Executor? *

Yes

If no, please list the name of the person you want to serve as your Executor: *

Address of Executor *

Phone number of Executor *

Please list an Alternate Executor in the event your Executor is unwilling or unable to serve: *

Address for Alternate Executor *

Phone number for Alternate Executor *

Do you wish to waive the fiduciary bond requirement? *

Yes

Need additional information

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Maguire Schneider Hassay, LLP
Phone: 614-224-1222 • LegalShield: 800-464-2266