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Estate Summary Sheet

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PRIMARY

Primary's Name Birthdate SSN Occupation

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SPOUSE

Spouse's Name Birthdate SSN Occupation

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ADDRESS / PHONE

Address City State ZIP Home Phone Work Phone Fax Phone EMail Address

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MARRIAGE

Place of Marriage Date of Marriage

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CHILDREN

Child #1 Name Child #1 Birthdate Child #1 Residence

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Child #2 Name Child #2 Birthdate Child #2 Residence

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Child #3 Name Child #3 Birthdate Child #3 Residence

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GRAND-CHILDREN

Grandchild #1 Name Grandchild #1 Birthdate Grandchild #1 Residence

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Grandchild #2 Name Grandchild #2 Birthdate Grandchild #2 Residence

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Grandchild #3 Name Grandchild #3 Birthdate Grandchild #3 Residence

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EXISTING DOCUMENTS (check each box for documents you already have)

		Living Will
		Power of Attorney
		Trust Agreement
		Last Will & Testament

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This form may not be reproduced, in whole or in part, by any means without the express written consent of PAUL J. MALIKOWSKI, ESQ.