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October 2017

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We have moved! PK Law has consolidated its Bel Air, MD South (836 South Main Street Suite 102) and Bel Air, MD North (139 North Main Street Suite 100) offices and MOVED to Belcamp, MD.

Baltimore, MD

901 Dulaney Valley | Suite 500
Towson, MD 21204
P: 410.938.8800 | F: 410.832.5600

Columbia, MD

10500 Little Patuxent Parkway | Suite 650
Columbia, MD 21044
P: 410.740.2000 | F: 410.884.7484

Belcamp, MD

4690 Millennium Drive | Suite 200
Belcamp, MD 21017
P: 410.938.8800

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Powers of Attorney Questionnaire

Power of Attorney Questionnaire

Are you seeking a Power of Attorney for yourself?

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Are you married?

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What is your age?

The person creating/signing the document is called the principle and the person you are designating authority to act to is called the agent. Have you identified the person you would designate as an agent?

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Have you identified an alternate agent?

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Do you have any question as to the competency of the person you intend to designate as your agent or alternative agent?

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Do you have a high level of trust in the person you intend to designate as your agent or alternate agent?

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Do you have any concerns about the power of attorney that becomes effective immediately and not when you become incapacitated?

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Elder Law Questionnaire

Elder Law Questionnaire

What is your relationship to the person needing elder care?

Do you have any question as to the competency of the person you are seeking elder care for?

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Does the individual have a power of attorney in place?

Yes

No

Where do they currently reside?

Would you like them to continue to reside at this location?

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If yes, do they have long term care insurance?

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Is there a home or other real estate you would like to protect?

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If yes, has the property been transferred within the past five years?

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If yes, how and in whose name is the deed titled? (sole ownership, joint tenancy, tenancy in common)

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Health Care Directives Questionnaire

Health Care Directives Questionnaire

Are you seeking a Healthcare Directive for yourself?

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Do you already have a Healthcare Directive?

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No

If yes, does it:

Include HIPPA protections?

Name all family members with equal power to make decisions?

Allows the withholding of life support?

Do you have adult children?

Yes

No

If you do not have a spouse or adult children or do not intend to designate any of them as your agent, do you have someone you are close with to designate as your agent?

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Is the person you intend to designate as your agent in good health and able to function, including traveling to and from hospital, relatively easily and independently?

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Have you considered giving your family members or those you are close to your end of life healthcare wishes?

Yes

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Acknowledgement *

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Will Questionnaire

Wills Questionnaire

Are you married?

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If yes, is this your first marriage?

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Do you have children?

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What are the ages of your children?

Are any of your children married?

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Do you have grandchildren?

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Do any of your family members suffer from a disability or have any substance abuse issues?

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Do you own real estate?

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Is any of the real estate you own located out of Maryland?

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Do you own or partially own a business?

Yes

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Estates are taxable when they exceed $5.5 million. Will you need a plan that takes this into consideration?

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Are your assets currently positioned to avoid going through probate?

Yes

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I don't know

Additional Information

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