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JODI HEAD LOPEZ & ASSOCIATES P.C.
Jodi Head Lopez
Shawn E. Vandenberg
Tanya R. Swenson
CLIENT INTERVIEW SHEET
Date: _________________________
Please complete this questionnaire. If you will spend the time to complete all
items, you will give us the background information necessary to begin to understand the
complexity of the personal aspects of your probate issue. All information will be held in
strict confidence.
PART I - PERSONAL DATA
NAME of DECEDENT:_________________________________________________________
Alias Names (if any):____________________________________________________________
Street Address:_________________________________________________________________
City:___________________________ State:____________________ Zip Code:_____________
Date of Birth:__________________________________________________________________
Place of Birth:__________________________________________________________________
Date of Death:__________________________________________________________________
Place of Death:_________________________________________________________________
Social Security Number:__________________________________________________________
Was Decedent a U.S. citizen? Yes: _ No:___
If naturalized U.S. citizen, Date and Place of Naturalization:_____________________________
______________________________________________________________________________
Location of Will, if any:__________________________________________________________
Date of Will:___________________________________________________________________