Personal Profile

Please complete this form. You'll need your passport or driver license information to complete the form. All information provided is strictly confidential.

Legal Name*
Prefix First Middle Last Suffix
Prefer to be called:
Preferred Name
Sex*
Please choose what is listed on your passport (or driver license if no passport)
Residential Address*
Street Address Address Line 2 City State ZIP Code
County (NOT country)
In which COUNTY is your address located?
Is your mailing address the same as your residential address?*
- Yes
- No
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Email*
Home/Cell Phone*
Work Phone
Other Phone
Date of Birth*
Place of Birth (City/Town/Village)*
Country of Birth*
US Citizen?*
- Yes
- No
If no, what nationality?*
Are you a US resident alien?*
- Yes
- No
Are you a citizen of any other countries?*
- Yes
- No
Other citizenships*
Please list the countries of which you are a citizen
Are you a tax resident of any other countries?*
Do you pay taxes in other countries?
- Yes
- No
Other tax residency*
Please list the countries where you pay taxes
Social Security Number or TIN
We will need this for any IRS communications.
Do you currently have a valid USA passport?*
- Yes
- No
Passport Number*
Expiration Date of Passport*
Month
Day
Year
Driver License Number*
Issuing State of Driver License*
Expiration Date of Driver License*
Month
Day
Year
Occupation*
Politically Exposed Person*
Are you or any members of your immediate family a politically exposed person or PEP?
- Yes
- No
Legal Issues*
Have you or any legal person of which you have been an officer, director, shareholder, manager, member, authorized person, founder, or council member been involved in any court proceedings, litigation, or been declared bankrupt or insolvent - past, current, or pending?
- Yes
- No
Criminal Conduct*
Have you ever been indicted or convicted of any criminal offense or offenses that constitute financial misconduct?
- Yes
- No
Further Information*
If you answered YES to any of the previous three questions, please provide further details
Source of Wealth*
Please indicate the source(s) of wealth or business that will be transferred into your trust or LLC
- Inheritance
- Business Income
- Employment (e.g. salary, wages, bonus, etc.)
- Gifts
- Loan
- Sale of Shares
- Sale of property
- Other (please provide details below)
Other Source of Wealth
Please provide details as to the source of wealth
Marital Status*
- Never Married
- Divorced
- Widowed
- Married
Name of Spouse?*
First Middle Last
Date of Marriage
Number of dependents
Family
Do you have children?*
- Yes
- No

Children's Names and Ages*

Add additional children by clicking the "+" icon to the right

First Name	Last Name	Date of Birth

Do you have an existing Will?
- Yes
- No
Have you ever executed a trust (either revocable or irrevocable)?
- Yes
- No
Have you ever filed a Federal Gift Tax Return?
- Yes
- No
Do you have an existing General Power of Attorney?
- Yes
- No
Thank you for completing this worksheet! Be sure to click the Submit button below and look for the green checkmark for success. If you don't see the green checkmark, please review the worksheet for any missing fields. Missing fields will be highlighted in red.
Comments
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LayRoots
500 Yale Ave N, #100
Seattle, WA 98109

Phone: 206-219-9559 or Schedule

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