Please tell us about yourself
Name:		Address:
City:	State:	Zip:	Cell Phone:
Home Phone:		Work Phone:
Email Address:
Please tell us about your inheritance
Deceased's Name:		Deceased's Relationship to you:
Date of Death:	Percentage of inheritance you expect to inherit: Amount:
Did the decedent leave a will or trust? Will: Trust: None:
Have you received any portion of the inheritance? Yes: Amount: No:
Location of assets/property:			Country:
Type of property:
Estimated value of property:
Who is in charge of the estate? (Executor/Administrator)			Phone:
Who is the Estate Attorney?			Phone:
Who are the heirs?
Name(s):		Phone:
Comments:	Please enter any additional information here.
Signature:	By checking this box you are providing an electronic signature and agree that, to the best of your knowledge, all information provided is valid and may be used by Landmark Alliances, Inc in any manner necessary to provide our services.