Asset Protection Survey

This is the questionnaire the attorney needs to begin the process of creating your customized asset protection blueprint. Your information will be kept confidential and is protected by attorney client privilege. Your blueprint will be completed by one of the finest and most experienced asset protection attorneys in the country. The blueprint will clearly illustrate the legal entities you need to best protect your assets and is customized and tailored based on your profession, assets, goals, and the state in which you live.

Personal Information

Yourself

First Name:

Middle Name:

Last Name:

Occupation:

Year of Birth:

Your Spouse

First Name:

Middle Name:

Last Name:

Occupation:

Year of Birth:

Maiden Name:

Prior Marriages:

Primary Phone:

Mobile Phone:

Office Phone:

Fax Number:

Street Address:

City:

Country:

State:

Zip:

Email:

Children / Beneficiaries

Name:

Relationship:

Other:

Age:

Comment:

Name:

Relationship:

Other:

Age:

Comment:

Name:

Relationship:

Other:

Age:

Comment:

Name:

Relationship:

Other:

Age:

Comment:

Name:

Relationship:

Other:

Age:

Comment:

Assets / Liabilities Section

Assets

Value in $(USD)

How Titled / Type of Entity

Cash:

Money Market Account:

Savings Accounts:

Stocks:

Mutual Funds:

Bonds:

Precious Metals:

Homes:

Investment Real Estate:

Investment Real Estate II:

Business interests:

Business interests II:

Automobiles:

Automobiles II:

IRA Assets:

Other Retirement Assets:

Other Assets:

Other Assets II:

Total: Assets

Liabilities

Value in $(USD)

Home Mortgages:

Other R/F Mortgages:

Other:

Total Liabilities:

Insurance

Value in $(USD)

Insurance on You:

Insurance on Spouse:

Last Survivor Insurance:

Total Insurance:

YOUR NET WORTH:

$0.00

Additional Details, Goals, And Concerns

We certify that to the best of our knowledge, the forgoing is true, correct, and complete. You may rely on this information in providing advice and preparing documents for our estate and business plans. By my/our signature(s) below. I/We hereby provide Attorneys with our informed consent to share my/our information with representatives from American Society for Asset Protection, and acknowledge that I/we understand that this consent represents a waiver of any Attorney/Client privilege otherwise available. By signing below you authorize us to deal with your other advisors, and your other advisors to so deal with us.

Date: Saturday 21st of December 2024

Your Signature:

Spouse Signature:

Asset Protection Blueprint

SENDING...

Personal Information

Yourself

Your Spouse

Children / Beneficiaries

Assets / Liabilities Section

$0.00

Additional Details, Goals, And Concerns