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Next of Kin Authorization Form

The document is a Next of Kin Information Form from The Angelo Law Firm for client Michael James Burry, detailing his personal information and emergency contact authorization. It allows the firm to contact his designated Next of Kin in case of emergencies or legal notifications. The form includes sections for client information, Next of Kin details, authorization, and office use, ensuring compliance with legal and administrative protocols.

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Blaze Yusuf
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183 views2 pages

Next of Kin Authorization Form

The document is a Next of Kin Information Form from The Angelo Law Firm for client Michael James Burry, detailing his personal information and emergency contact authorization. It allows the firm to contact his designated Next of Kin in case of emergencies or legal notifications. The form includes sections for client information, Next of Kin details, authorization, and office use, ensuring compliance with legal and administrative protocols.

Uploaded by

Blaze Yusuf
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

THE ANGELO LAW FIRM

290-2912 Oits Ave, Bronx, NY 10465


Phone: (532) 930 098 891 | Email: peterangelo@[Link] | Website:
[Link]

NEXT OF KIN INFORMATION FORM


Date Submitted: ____________________________

I. CLIENT / PRIMARY PARTY INFORMATION

Full Legal Name: Michael James Burry


Date of Birth (DD/MM/YYYY): 19th June, 1971
Place of Birth: San jose california
Home Address:
1000 Brickell plaza penthouse 6002Miami fl 33131
Mailing Address (if different):
1000 Brickell plaza penthouse 6002Miami fl 33131
Phone Number(s):
+15302146428
Email Address:
Michaeljamesburry@[Link]
Identification / ID Number:
Occupation / Employer:
Hedge fund manager/ ceo of Scion Asset Management

II. NEXT OF KIN / EMERGENCY CONTACT INFORMATION


Full Legal Name:
Relationship to Client:
Date of Birth (if known):
Address:
Phone Number(s):
Email Address:
Alternate Contact (optional):

III. AUTHORIZATION & CONSENT


I hereby authorize The Angelo Law Firm, its attorneys, staff, and authorized representatives to
contact the above Next of Kin in the event of an emergency, incapacity, death, or when notification is
legally required. I understand this authorization permits the firm to share necessary information
related to my legal matters, medical status (where lawful), and case updates as deemed appropriate
THE ANGELO LAW FIRM
290-2912 Oits Ave, Bronx, NY 10465
Phone: (532) 930 098 891 | Email: peterangelo@[Link] | Website:
[Link]

for administrative or emergency purposes.

This authorization remains in effect until revoked in writing by me. I affirm that all provided information
is true and accurate to the best of my knowledge.

IV. SIGNATURE & ACKNOWLEDGMENT


Signature of Client / Representative: ____________________________
NINA NOLFF
Printed Name: ____________________________
Date: ____________________________

If signed by representative:
Name of Representative: ____________________________
Relation / Authority: ____________________________

V. FOR OFFICE USE ONLY

Received By:
Date Received:
File / Client ID #:
Remarks / Notes:

VI. CLOSING REMARK


In the event of the client’s incapacitation, severe illness, or death, the designated Next of Kin may be
contacted by The Angelo Law Firm for administrative or estate coordination purposes. Any financial or
estate matters will be handled strictly in accordance with applicable laws, valid wills, court orders, or
authorized powers of attorney.

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