Online Forms

The following forms are available online in pdf format. You may view, download and/or print them by clicking on the appropriate form.
  • As an option, the "Estate and Medicaid Planning Questionnaire" may be completed below and submitted directly to the Timothy Rice Estate and Elder Law Firm. Please print and complete the "Estate Planning Client Asset Information" form and bring it with you for your first visit.

  • ESTATE & MEDICAID PLANNING QUESTIONNAIRE

  • YOUR NAME: (required)
  • a/k/a (if any)
  • SPOUSE (if applicable):
  • a/k/a (if any)
  • HOME ADDRESS: (required)
  •  
  • HOME PHONE NUMBER: (required)
  • YOUR EMAIL ADDRESS:
  • YOUR OCCUPATION:
  • Employer's Name & Address
  • Work Telephone No.
  • CHILDREN (IF APPLICABLE)

  • CHILD #1
  •  
  •  
  •  
  • CHILD #2
  •  
  •  
  •  
  • CHILD #3
  •  
  •  
  •  
  • CHILD #4
  •  
  •  
  •  
  • GRANDCHILDREN (IF APPLICABLE)

  • GRANDCHILD #1
  •  
  •  
  •  
  • GRANDCHILD #2
  •  
  •  
  •  
  • GRANDCHILD #3
  •  
  •  
  •  
  • GRANDCHILD #4
  •  
  •  
  •  
  • ARE ALL OF YOUR CHILDREN AND GRANDCHILDREN IN GOOD HEALTH?
  • ARE ANY OF YOUR CHILDREN OR GRANDCHILDREN RECEIVING SSI OR OTHER FORM OF GOVERNMENT AID?
  • DATE OF MARRIAGE:
  • HAVE YOU ENTERED ANY PRENUPTIAL, POSTNUPTIAL OR PROPERTY SETTLEMENT AGREEMENT WITH YOUR SPOUSE REGARDING DIVISION OF PROPERTY UPON DIVORCE OR DEATH?
  • IS THIS YOUR FIRST MARRIAGE?
  • If no, please list date(s) and method of termination (death, divorce, annulment) of prior marriages, including name(s) of former spouse(s):
  • IS THIS YOUR FIRST SPOUSE'S MARRIAGE?
  • If no, please list date(s) and method of termination (death, divorce, annulment) of prior marriages, including name(s) of former spouse(s):
  • If no, please list date(s) and method of termination (death, divorce, annulment) of prior marriages, including name(s) of former spouse(s):
  • Are you and your spouse U.S. Citizens?
  • If no, please indicate which spouse is not a U.S. Citizen and country of citizenship:
  • YOUR SOCIAL SECURITY NUMBER:
  • YOUR SPOUSE'S SOCIAL SECURITY NUMBER:
  • YOUR DATE OF BIRTH:
  • YOUR SPOUSE'S DATE OF BIRTH:
  • WHO REFERRED YOU TO TIMOTHY RICE ESTATE AND ELDER LAW FIRM OR HOW DID YOU LEARN ABOUT US?
  • WHAT TYPE OF SERVICE ARE YOU INTERESTED IN US PROVIDING FOR YOU?
  • ADDITIONAL COMMENTS
  • PLEASE LIST NAME, ADDRESS, AND TELEPHONE NUMBER:

  • FAMILY/CORPORATE ATTORNEY:
  • ACCOUNTANT:
  • FINANCIAL PLANNER/BROKER:
  • BANKER:
  • INSURANCE AGENT:

Note: If you provide your email address, we will email a copy of your completed form to you.