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ANNUAL LEGAL CHECKUP

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ANNUAL LEGAL CHECKUP

  1. 1. INSTRUCTIONS THIS FORM, WHEN COMPLETED, CONTAINS PRIVILEGED INFORMATION AND IS FOR USE IN THE CLIENT’S PERSONAL FILE. This Annual Legal Checkup form is designed to encourage the orderly arrangement of your legal and personal affairs on a current basis. Its purpose is to provide you, your legal assistance officer or civilian attorney with information about your personal affairs, estate and probate status, real estate and other legal matters so that they may help remedy any legal problems brought forward by virtue of this form. Before you complete the form review such legal documents as your will, power of attorney and insurance policies with careful attention to beneficiary designations and change in circumstances and desires since execution. Then consult your legal assistance officer or civilian attorney if particular problems are brought to your attention, being careful to take with you all pertinent legal documents applicable to the problem. Any documents relating to legal action by or against you should be brought to the attention of the attorney. The completed form should be reviewed annually to assure up-to-date legal and factual sufficiency. It does not become an official document and should form an integral part of your personal files, to be kept readily accessible when needed. INSTRUCTIONS ON DEATH OF CURRENT OR FORMER SERVICE MEMBER In the event of the death of a current or former soldier, survivors should contact the Directorate of Personnel Administration, 1300 Military Road, Lincoln NE 68508, telephone (402) 309-7315 for information on any benefits due. ANNUAL LEGAL CHECKUP SECTION I – PERSONAL DATA PART A - MEMBER 1. NAME OF MEMBER (Last – First – Middle) 2. GRADE/RANK 3. SOCIAL SECURITY NUMBER 4. PRESENT LOCAL ADDRESS 5. TELEPHONE NUMBER 6. PERMANENT LEGAL ADDRESS (DOMICILE) 7. DATE AND PLACE OF BIRTH 8. BIRTH CERTIFICATE AND LOCATION YES NO (If no, designate other evidence of birth date) 9. U.S. CITIZEN 10. NATURALIZED 11. NATURALIZATION 12. CERTIFICATE OF CITIZENSHIP NO. YES NO YES NO CERTIFICATE NO. 13. WERE YOU ADOPTED? 14. DATE AND PLACE OF ADOPTION 15. ADOPTION PAPERS YES NO YES NO 16. DATE AND PLACE OF CURRENT MARRIAGE 17. MARRIAGE CERTIFICATE 18. ANTENUPTIAL AGREEMENT YES NO YES NO 19. IF PREVIOUSLY MARRIED, NAME(S) OF PRIOR SPOUSE(S) 20. DATE(S) AND PLACES OF PRIOR MARRIAGES 21. DATE AND METHOD PRIOR MARRIAGE(S) TERMINATED 22. DIVORCE DECREE(S) 23. DEATH CERTIFICATE(S) YES NO YES NO 1
  2. 2. PART B - SPOUSE 1. NAME OF SPOUSE 2. SOCIAL SECURITY NO. 3. PRESENT ADDRESS (If different from member) 4. TELEPHONE NUMBER 5. PERMANENT LEGAL RESIDENCE (DOMICILE)(NORMALLY SAME AS ITEM 8, ABOVE) 6. DATE AND PLACE OF BIRTH 7. BIRTH CERTIFICATE YES NO (If no, designate other evidence of birth date) 8. FURNISH INFORMATION ON CITIZENSHIP, ADOPTION, PRIOR MARRIAGE(S); SAME AS ITEM 11-24 ABOVE, IF APPLICABLE. PART C – CHILDREN NAME MOTHER’S NAME DATE OF BIRTH PLACE OF BIRTH ADOPTION, (Last – First - Middle) (Last – First – Middle) NATURALIZATION, AND CITIZENSHIP DATA PART D – OTHER FAMILY MEMBERS WHO ARE OR MAY BECOME DEPENDENTS NAME DATE OF BIRTH PLACE OF BIRTH RELATIONSHIP (Last – First – Middle) 2
  3. 3. SECTION II – ESTATE AND PROBATE MATTERS 1. DATE OF WILL 2. WHERE MADE 3. EXECUTOR’S NAME AND ADDRESS 4. HAVE THERE BEEN ANY SIGNIFICANT CHANGES IN FAMILY PERSONAL OR FINANCIAL CONDITIONS SINCE EXECUTION OF YOUR WILL? YES NO (If Yes, explain below) CHECK IF ANY OF THE FOLLOWING HAVE OCCURRED TO YOU OR ANY FAMILY MEMBER OR BENEFICIARY: a. MARRIAGE b. DIVORCE c. BIRTH OF ADOPTION d. DEATH e. MAJOR ILLNESSES HAVE THERE BEEN ANY CHANGES IN: a. ASSETS b. LIABILITIES c. HOME OWNERSHIP d. AVAILIBILITY OF WITNESSES e. LEGAL CAPACITY OF FAMILY MEMBERS REMARKS: 5. HAVE YOU MADE ANY SUBSTANTIAL GIFTS IN RECENT YEARS? YES NO EXPLAIN: 6. DOES YOUR SPOUSE HAVE A WILL? 7. DO YOU OR YOUR SPOUSE OR CHILDREN HAVE ANY RIGHTS OR EXPECTATIONS YES NO WITH REGARD TO ESTATES OF OTHERS? YES NO IF YES, EXPLAIN. IS IT A PART OF AN OVERALL ESTATE PLAN? YES NO SECTION III – POWER OF ATTORNEY 1. TYPE (General, Limited). IF LIMITED, 2. DATE OF 3. EXPIRATION 4. NAME AND ADDRESS OF GRANTEE FOR WHAT PURPOSE? EXECUTION DATE SECTION IV – TAXES 1. INCOME TAXES PAID 2. REAL ESTATE TAXES PAID YES NO FEDERAL: YES NO WHERE FILED? WHERE FILED? STATE: YES NO WHERE FILED? HAVE YOU RETAINED COPIES FOR THE PAST FOUR YEARS? 3. PERSONAL PROPERTY TAXES PAID YES NO YES NO WHERE FILED? WHERE FILED? 4. FICA TAXES ON HOUSEHOLD EMPLOYEES PAID STATE: YES NO IF NO, EXPLAIN FULL TIME PART TIME SECTION V – FINANCIAL POSITION PART A – REAL ESTATE 1. DESCRIPTION OF REAL ESTATE OWNED (List each place of realty as 2. NAMES IN WHICH HELD a separate item. Use continuation sheet if necessary). 3. HOW HELD (Joint tenancy, tenancy in entirety, etc.) 4. PERCENTAGE OF PURCHASE 5. DATE ACQUIRED PRICE PAID BY CO-OWNER 6. PURCHASE PRICE 7. PRESENT VALUE 3
  4. 4. PART A – REAL ESTATE (Cont.) 8. DEED RECORDED 9. CHECK APPROPRIATE ITEMS YES NO SURVEY OF PROPERTY TITLE INSURANCE ABSTRACT TITLE OPINION 10. ENCUMBERANCES (Mortgage, Lien, Deed of Trust, etc.) 11. NAME OF MORTGAGEE, ETC. 12. BALANCE DUE 13. MONTHLY PAYMENTS 14. DESCRIPTION OF REAL ESTATE SOLD DURING PAST YEAR 15. DATE SOLD 16. SALES PRICE 17. DESCRIPTION OF ALL LEASES (Landlord or tenant, period of time rental, etc.) 18. TYPE OF INSURANCE (Fire, Theft, Comprehensive) 19. LIMITS 20. NAME OF INSURANCE COMPANY AND ADDRESS 21. POLICY NUMBER 22. EXPIRATION DATE PART B - AUTOMOBILE 1. MAKE, MODEL, YEAR, SERIAL NUMBER 2. TITLE (State number, date) 3. JOINT OWNER (If any) AND PERCENTAGE OF PURCHASE PRICE PAID BY CO-OWNER 4. FINANCED BY 5. BALANCE DUE 7. NAME AND ADDRESS OF FINANCE COMPANY 6. MONTHLY PAYMENT 8. INSURED AGAINST YES NO LIMITS EXPIRATION ANNUAL DATE PAYMENTS BODILY INJURY PROPERTY DAMAGE PUBLIC LIABILITY OTHER (Explain) PART C – OTHER PROPERTY (Jewelry, Household Goods, etc.) 1. 2. 3. 4. 5. AMOUNT LIST PROPERTY 0F LIEN INSURANCE INFORMATION OF GREAT VALUE VALUE AND LIEN HELD BY (Company, limits, policy number, MONTHLY expiration date) PAYMENT 4
  5. 5. SECTION V – FINANCIAL POSITION PART D – CREDIT CARDS 1. 2. NUMBER OF 3. 4. OUTSTANDING NAME OF ISSUING CORPORATION OUTSTANDING PERSONS HAVING BALANCE CARDS AUTHORITY TO PURCHASE PART E – STOCKS, BONDS, MUTUAL FUNDS, OTHER SECURITIES (Attach detailed list for permanent record) 1. 2. 3. 4. 5. 6. 7. NAME, NAME OF CO-OWNER TYPE DATE ORIG PRESENT NAME AND ADDRESS ADDRESS OF COMPANY AND % OF SECURITY PURCHASED VALUE VALUE OF BROKER PURCHASE PRICE PAID PART F – BANK ACCOUNTS AND SAVINGS DEPOSITS 1. NAME AND 2. 3. TYPE 4. ACCOUNT 5. PRESENT 6. ANNUAL ADDRESS JOINT OWNER ACCOUNT NUMBER BALANCE INCOME PART G – MISCELLANEOUS ASSEST (Notes, claims, trust funds, etc.) 1. 2. CO-OWNER AND PERCENTAGE 3. 4. ANNUAL DESCRIPTION OF ASSET OF PURCHASE PRICE PAID VALUE INCOME 5
  6. 6. SECTION V – FINANCIAL POSITION (Cont.) PART H – LIABILITIES OTHER THAN CURRENT DEBTS (Not listed above) 1. 2. DESCRIPTION 3. LEGAL DOCUMENT 4. 5. ANNUAL PERSON TO WHOM OWED (Long term debt contingent EVIDENCING BALANCE PAYMENTS claim, alimony, support LIABILITY PART I – GENERAL STATEMENT OF CURRENT FINANCIAL CONDITION IN THE EVENT CURRENT EXPENDITURES EXCEED INCOME AND YOU NEED ASSISTANCE IN REACHING A SOLVENT POSITION MAKE GENERAL STATEMENT OF POSITION HERE. BRING TO INTERVIEWS SCHEDULE SHOWING SOURCE OF ALL INCOME AND LIST OF CREDITORS WITH TOTAL DEBT, MONTHLY PAYMENT, LENGTH OF TIME PAYMENTS TO BE MADE AND CURRENT DELINQUENCIES. SECTION VI – FAMILY PROTECTION PART A – INSURANCE (Life, Annuity, Health and Accident, Education (Self and Spouse)) 1. KIND OF 2. NAME AND ADDRESS 3. NAME AND RELATIONSHIP 4. POLICY NUMBER 5. EXPIRATION 6. LIMITS INSURANCE OF COMPANY OF BENEFICIARY DATE DO ANY OF YOUR LIFE INSURANCE POLICIES HAVE WAR RISK CLAUSES? YES NO PART B – SURVIVOR BENEFIT PLAN 1. ELECTION MADE YES NO (If no, explain) 2a. DATE OF 2b. YEARS OF SERVICE 3. OPTIONS ELECTION ON DATE OF ELECTION PART C – MILITARY SURVIVOR’S BENEFITS 1. LIST AMOUNTS OF BENEFITS FAMILY WOULD RECEIVE IF YOU SHOULD DIE TODAY. a. SIX MONTHS GRATUITY PAYMENT $_______________________________ b. DEPENDENTS INDEMNITY COMPENSATION $_________________ MONTHLY REDUCED TO $__________________ ON _________________ c. SOCIAL SECURITY BENEFITS $____________________ MONTHLY REDUCED TO $_____________________ ON ______________________ PART D – RETIREMENT BENEFITS (If approaching retirement) 1. DATE BEGINS 2. TYPE 3. ANNUAL INCOME TO SELF 4. ANNUAL INCOME TO 5. DEPENDENT ELIGIBLE PAYMENT SURVIVORS PART E – RECORD OF EMERGENCY DATA 1. RECORD OF EMERGENCY DATA 2. NAME OF BENEFICIARY NAMED ON RECORD TO RECEIVE SETTLEMENT OF PAY EXECUTED AND ALLOWANCES, INCLUDING SERVICEMAN’S DEPOSITS YES NO 3. DATE RECORD LAST REVIEWED 6
  7. 7. SECTION VII – LOCATION OF VALUABLE DOCUMENTS 1. SAFETY DEPOSIT BOX YES NO 2. NAME AND ADDRESS OF JOINT OWNER 3. NO. OF KEYS 4. BOX (If yes, name and address of bank) AND LOCATION NO. 5. CHECK DOCUMENTS IN BOX. LIST OTHER DOCUMENTS AND LOCATION BELOW. a. SOCIAL SECURITY CARD b. BIRTH CERTIFICATE c. NATURALIZATION CERTIFICATE d. CERTIFICATE OF CITIZENSHIP e. MARRIAGE CERTIFICATE f. DIVORCE DECREE g. REAL ESTATE DOCUMENTS h. AUTOMOBILE PAPERS i. OTHER PERSONAL PROPERTY PAPERS j. WILL k. POWER OF ATTORNEY l. DISCHARGE PAPERS m. TAX RECORDS n. INSURANCE POLICIES o. STOCKS, BONDS, ETC. p. BANK OR SAVINGS DEPOSIT BOOK REMARKS COMPLETE IN PENCIL SO THAT CHANGES CAN BE MADE DATE PREPARED DATE REVIEWED DATE PREPARED DATE REVIEWED DATE PREPARED DATE REVIEWED 7

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