Fill and Sign the Name of Former Spouses

- 1 - ESTATE PLANNING QUESTIONNAIRE FOR: DATE: PERSONAL INFORMATION Name Birth date U.S. Citizen Principal Residence Any other Domicile: Domicile in community property states(s) (if ever): Birthplace: Social Security Number Dates of such domicile Community property acquired Business or profession Still: Active Retired Current marital status Single Married Widowed Divorced Prior Marriages (if any) Name of former spouse(s) Name and ages of children of prior marriages How and when prior marriage(s) ended: (if divorce, get copies of any agreements and decrees)
Date of last marriage(s): date of last dissolution of marriage (or, if divorced, get divorce decree(s) of divorce from probate) date last divorce order granted by probate court: date last dissolution of previous marriage: date last separation, annulment or other judicial separation: if you do take these information from the questionnaire (not included at your request, only for your own record), you should promptly notify the local authorities of your whereabouts at the address above, including the social security number which you provided on your questionnaire. Please also notify the department of the treasury and the federal bureau of investigation (FBI) when any of these persons reside at the address listed above. You will be advised of any criminal activity of the persons listed, with a copy of the information to which you received such information. Who should be notified? information may be used by federal and state agencies to identify and locate individuals involved in fraud. When you report that you were victim of any type of fraud it is in your best interest to notify the local law enforcement officials responsible for the investigation in the jurisdiction where the incident occurred. When can the irs help? the irs does not prosecute crime and cannot act against someone as a result of information obtained through an information collection operation or any other means. What if my information is not complete? some cases may never be solved. In such a case, we will continue to evaluate your information and continue to request additional information, as needed. If additional information is provided, then your credit score will be modified and may be placed on permanent review. Please contact us if you still have pending inquiries which involve unresolved issues. I was victim of identity theft. How is the credit reporting affected by the incident? as explained above, your credit score is subject to review when one of several factors (for example, criminal activity, fraudulent use of information, bankruptcy, property damage or medical or dental records) are involved. Your original report is not affected by identity theft. But because it represents the “official" document submitted by the creditor, and as such, may affect the credit score of other people who subsequently apply for.