Wrongful Death - Litigation Support Questionnaire

There are a lot of implications for a person who's life is taken from them prematurely, either entirely or partly, because of someone else's neglegent behavior.

Decedent's Information

*bold fields are required    
   
   

Plaintiff's Information

       
   
   
   

Defendant's Information

   
 
   
   

Attorney Information

   
 
A value is required.
   
 
   
   
   

Case Information

   
 
   
   
 
 
   

Demographic Information

   
 
   
 
 
 
 
If victim has children under the age of 18, please fill out their information below
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*If you have more than 5 children under the age of 18, please note that in the "summary of incident" area.

   
 
 
 
 
 
 
 

Other Information

 
A value is required.