1/27/20171

DECEDENT’S ESTATE QUESTIONNAIRE

Interviewer:Interview Date:

Client:DOB:

Address:SSN:

Telephone(s):mobilehomework

Email(s):

DECEDENT’S NAME AND COURT CASE NUMBER:

WILL or NO WILL

Decedent’s Permanent Residence at time of Death:

Deceased’s Date and Place of Death: ______

Decedent’s Date of Birth: Decedent’s Social Security Number: ______

Has the will been filed with the Clerk of Circuit Court?YesNoDate filed:

If Court case has been filed, who has Petitioned for Letters of Office?

Copy Provided / Document / Date / Location of Original Document
Will
Revocable Trust
Irrevocable Trust
Healthcare Power of Attorney/Living Will
Property Power of Attorney
Guardianship of Estate

PERSONAL REPRESENTATIVE

If no Will:

Who wants to be the administrator?

NameRelationship AddressTelephone

The statutory preference for administrator are the following, in order:

1. Surviving spouse or any person nominated by surviving spouse

2. Legatee or any person nominated by them, with preference to legatees who are children

3. Children or any person nominated by them

4. Grandchildren or any person nominated by them

5. Parent or any person nominated by them

6. Sibling or any person nominated by them

7. Nearest kindred or any person nominated bythem

8. Guardian of the estate of a deceased ward

Note any likely contest or objection to a Petition for Letter of Administration and by whom:

If Will:

If the will or any other communication from the Decedent indicates who should be Personal Representative (“executor”) of the Deceased’s estate, please state:

NameRelationship AddressTelephone

Executor:

Successor:

DECEDENT’S FAMILY INFORMATION

Decedent was Married / Divorced / Widowed / Never Married

Spouse:

Name / Address:

Previous Marriages:

For prior marriages, please indicate name of prior spouse, marriage date, termination date, reason for termination (divorce, death) and whether prior spouse is living.

Client must provide copy of divorce decrees and/or death certificates.

Notes:

Please list decedent’s children in order of birth.

CHILDREN / MALE OR FEMALE? / PARENT / CITY AND STATE OF RESIDENCE
(if not residing with you) / BIRTH DATE (MM/DD/YY) / SPOUSE
(if married) / NOTES*
1 / ❒Male
❒Female / //
2 / ❒Male
❒Female / //
3 / ❒Male
❒Female / //
4 / ❒Male
❒Female / //
5 / ❒Male
❒Female / //

In the case of each grandchild listed below, indicate that grandchild’s parent by placing the number of such parent (from the previous chart) in the column to the left of the grandchild’s name.

# / GRANDCHILDREN/ GREAT GRANDCHILDREN / MALE OR FEMALE? / PARENTS / CITY AND STATE OF RESIDENCE / BIRTH DATE (MM/DD/YY) / SPOUSE
(if married) / NOTES*
❒Male
❒Female / //
❒Male
❒Female / //
❒Male
❒Female / //
❒Male
❒Female / / /
❒Male
❒Female / / /
❒Male
❒Female / / /
❒Male
❒Female / //

* Note if adopted or deceased and any relevant issues regarding health, financial condition, or ability to handle money responsibly. Note if a child has or is likely to require a guardian (if or when the child is over age 18), or may be eligible for public benefits, complete a Supplemental Questionnaire for Special Needs Planning for that child. Please contact us if you do not already have the Supplemental Questionnaire.

SIBLINGS
(include deceased siblings) / SPOUSE
(if married) / CITY AND STATE OF RESIDENCE / NOTES
(include relevant health or financial condition)
❒Deceased❒Half-Sibling❒Step-Sibling
❒Deceased❒Half-Sibling❒Step-Sibling
❒Deceased❒Half-Sibling❒Step-Sibling
❒Deceased❒Half-Sibling❒Step-Sibling
❒Deceased❒Half-Sibling❒Step-Sibling
❒Deceased❒Half-Sibling❒Step-Sibling
PARENTS
(include deceased parents) / AGE / CITY AND STATE OF RESIDENCE / NOTES
(include relevant health or financial condition)
❒Deceased
❒Deceased
❒Deceased
❒Deceased

Have any children received an advance on their inheritance or are any children financially indebted to the deceased?

Yes___

No___

INFORMATION REGARDING DECEASED’S PROFESSIONAL RELATIONSHIPS

Please provide the following information for professionals / advisors of decedent, if known:

Personal banker
Bank
Phone
Accountant
Firm
Phone
Retirement / Investment Advisor/Financial Planner
Firm
Phone
Life Insurance Company / Agent
Firm
Phone
Other Advisor (e.g. Business Lawyer, Public Benefits Planner)
Firm
Phone
Safe Deposit Box / ❒Yes❒ No
Bank
City/State
Co-Signers
Who has access

INFORMATION REGARDING THE DECEASED’S PERSONAL ASSETS

The client must provide enough information about Real Estate, Life Insurance Policies, Bank Accounts, Investment and Retirement Accounts so that we can determine how these are held (e.g. Jointly with Rights of Survivorship), whether they designate beneficiaries, or how if they will pass upon death

1. Estimated net worthof estate: $ ______

2. Personal Property: To the extent possible, collect information and documents regarding all of the following:

Copy Provided / Document / Description and Location / Administrator / Broker
Cash
Bank Accounts
Real Estate Deed (Home)
Other _
Auto / Truck / Trailer / Boat(s)
Motor home / Recreational vehicle(s)
Stocks / Bonds
Savings Bonds, T Bills, other gov’t securities
Individual Investment and Retirement Accounts: IRA, etc.
Employer provided Retirement Accounts: 401(k), Pension, etc.

3. Real estate:Provide information for Decedent’s residence and any other parcels owned at the time of death and whether Deceased was purchasing any of the properties on a contract for deed.

Copy of Deed Provided / Residence / Residence? / Description and Location / Administrator / Broker

4. Life Insurance Policies: For life insurance policies insuring the Deceased, indicate the name of the insurance company, the face amount of the policy,and the type of policy.

Insurance Company / Face Amount / Type of Policy / Named Beneficiary(ies) if known

5. Annuities: Please indicate the name of the annuitant and the type of annuity and amount. Do not list annuities under which no benefits are payable after the death of the annuitant.

Regular annuities payable for guaranteed minimum term or amount:

Tax deferred annuities:

6. Other Personal property:

Copy Provided / Document / Description and Location / Administrator / Broker / Value
Household furniture and appliances
Collections, art, antiques, valuable jewelry
Personal equipment and tools
Farm or ranch machinery and equipment (other than general tools)
Livestock

7. Liabilities: Make a list of known personal liabilities or personal debts of the deceased.

Copy Provided / Document / Description and Amount

CONTESTS / SETTLEMENT:

Provide an account of contested issues and / or what the beneficiaries / heirs / legatees have agreed to or what they want:

INFORMATION REGARDING THE DECEASED’S BUSINESS

8. Business Organization: Complete this section if the deceased was engaged in business.

[ ] Business is organized as a corporation: How many corporations?

[ ] How many corporations are subchapter S corporations?

[ ] Business is organized as a partnership: How many partnerships?

[ ] Business is a sole proprietorship: How many different firms?

9. Business Property / Assets:

Copy Provided / Document / Description and Location / Administrator / Broker / Value
Fixtures, Furnishing, Appliances
Tools, Machinery
Other equipment
Business Accounts
Inventory, Material
Receivables

10. Receivables: If any money is owed to the Deceased, as payments on contracts, where the Deceased sold a business, as payments on obligations secured by real estate, or where the Deceased loaned money to someone and held a note, indicate the other party and type of indebtedness:

[ ] Promissory note(s) secured by real estate: Amount(s) owed:

[ ] Installment contract(s) of sale of personal property: Amount(s) owed:

[ ] Unsecured promissory note(s): Amount(s) owed: