Kevin Chaffin Law Offices in Ventura

Select your type of case and confidentially submit information for immediate attorney review and response.

Wrongful Death
Wrongful Termination
Sexual Harassment
Hostile Work Environment
Failure to Pay Wages
Overtime and Salary Claims
Retaliation and Whistleblower
Medical Malpractice
Elder Abuse & Nursing Homes
Train Accidents
Car & Motorcycle Accidents
Personal Injury

Home | Ventura County, California - Ph 805-650-8200 - | About Us

Wrongful Death Questionare

This questionnaire is meant solely for the use of the consulting attorney for purposes of analyzing and evaluating the prospective client's case. The contents of this document are therefore protected by the attorney-client privilege and the attorney work product doctrine. It is very important that you be completely truthful, accurate and complete in answering the following questions. The defendant in this case will likely obtain all relevant records about you. Therefore, it is crucial that we are aware of all information, including information you may believe will damage your case, in order to best represent you. If we decline to take your case, it does not mean you do not have a case. Therefore, if we decline your case you should contact another attorney. Most of our clients are employees or injured persons. If you are an employer, or you are concerned you might be sued by someone else, do not complete a questionnaire. Instead, you must first contact our office by telephone.

1 What is your name?

2 What is your age?

3 What is your mobile cell phone number?

4 What is your home phone number?

5 What is your e-mail address?

6 What is your street address?



Zip Code

7 What is the name of the person who died? (first, middle, and last)

8 When did the person die? (This Date Is Extremely Important)

9 Where did the person die? (City, State)

10 How did the person die?

Describe How Death Occurred (Give as much detail as possible)
11 How are YOU related to the person who died? (Are YOU their Parent, Child, Relative, etc.)

Describe How You Are Related To The Person Who Passed Away: (Give as much detail as possible)

12 If any law enforcement agencies investigated the circumstances that led to death, please provide details:
Name of Agency (City Police, County Sheriff, CHP, FBI, etc.)

Report Number

Status and Results of Investigation

Names of Law Enforcement Officers or Investigators Involved

13 Did the person who died provide you with any type of support? (Financial, Emotional, Relationship, etc.)

14 Is there anything that you need that we may be able to help you with? (Grief Counseling, Spiritual Support, Emotional Support, Funeral, Burial, Benefits, etc.)

We are deeply sorry for the loss you have experienced. The Chaffin Law Office is here to help you, and help your loved ones, regardless of whether or not you have a legal case. If you are in need, please let us know. We have access to a broad network of support. While there may be a legal right to recover something to assist you or your loved ones with the financial and emotional damages caused by a wrongful death, we are first and foremost concerned with helping you.
Chaffin Law Office - P.O. Box 3076, Ventura, California 93006 - Phone 805-650-8200 - email: