Legacy Wealth Planning Evaluation Form Attorney Name * Thomas E. Lubnau II Alison O. Gee Nicholas A. Norris No Preference Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Marital Status Married Divorced Widowed Single Age Group 18-30 31-45 46-60 61-75 75+ Was this information easy to understand? Yes No Would you recommend this program to others? Yes No My Current Estate Planning Document A written estate plan Have a Will Have a Living Trust Other What Really Matters to Me Please rate the level of importance on a scale of 1 to 10; with 1 being “not important at all” and 10 being “very important.” Make sure there’s a written plan to handle my affairs I want to avoid Living Probate and/or Death Probate Make sure Nursing Home costs don’t use up all my assets Make sure my wishes are honored regarding life support decisions I want to minimize all Death Taxes After my death, make sure my estate stays with my children if they get divorced Protect my life insurance from Death Taxes Protect my estate if my spouse gets remarried after my death Protect my estate from my children’s creditors after my death Protecting my child with special needs after my death Funeral planning for my final arrangements and to make it easier for my family Future Seminars If you believe this is important information for your friends, family, and groups, please help them find us. Don't worry, we won’t bother them. We’ll simply send them a personal invitation to one of our free Legacy Wealth Planning Seminars. We can do this anonymously or on your behalf. Name (of Individual or Group) Address or Email Phone (###) ### #### (optional) Comments How did you hear of this seminar? Friends/Family Letter Newspaper Email Online Other Permission to Contact I authorize the law firm to contact me by text, phone, email, or mail. I understand I can withdraw permission at any time and the law firm will not sell or share my contact information with anyone. Yes No Free Personal Consultation! For all workshop attendees ($450 value!) Yes I would like a free personal consultation! Please contact me for a personal consultation in the future No cosultation, but I'd like to be on your email or mailing list for updates If you selected a free personal consultation, which of these you are interested in? Estate Plan Nursing Home Protection Best time of day to call Best date to contact you MM DD YYYY Thank you!
