Probate Questionnaire

Probate Questionnaire
DECEDENT'S INFORMATION
LEGAL NAME:
Name on Death Certificate or Last Will and Testament
PERMANENT RESIDENCE AT TIME OF DEATH:
Prior to nursing home or hospital
CITY:
STATE:
If not FL, please contact office
ZIP CODE:
COUNTY:
DATE OF BIRTH:

MonthDayYear
Date
DATE OF DEATH:

MonthDayYear
Date
Age at Death
SOCIAL SECURITY NUMBER:
WAS DECEDENT EVER ON MEDICAID?

YESNOUNKNOWN
WAS DECEDENT EVER ON MEDICARE?

YESNOUNKNOWN
DID THE DECEDENT HAVE A WILL?*

YESNOUNKOWN

PERSONAL REPRESENTATIVE(S)

(This is most typically the client)
PERSONAL REPRESENTATIVE (NAMED IN WILL OR PROPOSED):
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
SOCIAL SECURITY #:
TELEPHONE:
Email
example@example.com
RELATIONSHIP TO DECEDENT:
THE PERSONAL REPRESENTATIVE (PLEASE CHECK ALL THAT APPLY):

Has never been convicted of a felony.Is a Florida resident.Is related to the decedent by blood or marriage.
IS THERE A CO-PERSONAL REPRESENTATIVE?

YesNo

DECEDENT'S FAMILY MEMBERS
WAS THE DECEDENT MARRIED AT THE TIME OF HIS OR HER DEATH?

YesNo

ANY OTHER CHILDREN OF THE DECEDENT?

YesNo
PLEASE ADD ANY ADDITIONAL CHILDREN ALONG WITH THEIR INFORMATION, HERE.
WERE ANY OF THE DECEASED CHILDREN SURVIVED BY CHILDREN?

YesNoNot Applicable
PLEASE LIST NAMES, DOB, AND ADDRESS/CONTACT INFO FOR ANY PREDECEASED CHILDREN'S CHILDREN.

DECEDENT'S PARENTS
DECEDENT'S PARENTS
DID BOTH THE DECEDENT'S PARENTS PREDECEASE THE DECEDENT?

YesNo
PARENT #1:
ADDRESS:
CITY:
STATE:
ZIP CODE:
TELEPHONE:
DECEASED?

YesNo
IF DECEASED, DATE OF DEATH:

MonthDayYear
Date
PARENT #2:
ADDRESS:
CITY:
STATE:
ZIP CODE:
TELEPHONE:
DECEASED?

YesNo
IF DECEASED, DATE OF DEATH:

MonthDayYear
Date

DECEDENT'S ASSETS
DID THE DECEDENT HAVE A SAFE DEPOSIT BOX?

YesNo

CHECKING, SAVINGS, MONEY MARKET, INVEST.
PLEASE USE THE FOLLOWING ABBREVIATIONS:

TYPE:
C=checking, S=savings, MM=money market, CD=Certificate of Deposit, O=Other

HOW TITLED:
I=Individually in Decedent's Name, J=Joint, O=other

PLEASE PROVIDE THE FOLLOWING BANKING INFORMATION:

	Type	Last 4 Digits of Acct No.	Bank/Institution Name	DOD Value	How Titled	Beneficiaries, if any
Account #1
Account #2
Account #3
Account #4
Account #5
Account #6
Account #7

RETIREMENT ACCOUNTS
PLEASE USE THE FOLLOWING ABBREVIATIONS:

TYPE:
IRA=Individual Retirement Account, IIRA=Inherited IRA, 401k, 529, O=Other

PLEASE PROVIDE ANY RETIREMENT ACCOUNT INFORMATION:

	Type	Last 4 Digits of Acct No.	Bank/Institution Name	DOD Value	Beneficiaries, if any
Account #1
Account #2
Account #3
Account #4
Account #5
Account #6
Account #7

LIFE INSURANCE

PLEASE PROVIDE ANY LIFE INSURANCE INFORMATION:

	Last 4 Digits of Policy No.	Company Name	Death value	Beneficiaries
Policy #1
Policy #2
Policy #3

VEHICLES

PLEASE PROVIDE ANY VEHICLE INFORMATION:

	Make	Model	Year	How Titled	DOD Value
Vehicle #1
Vehicle #2
Vehicle #3

OTHER ASSETS

PLEASE PROVIDE ANY ADDITIONAL ASSET INFORMATION:

	Type	How Titled	Identifying No.	Institution/where located	DOD Value
Asset #1
Asset #2
Asset #3
Asset #4
Asset #5
Asset #6

CREDIT CARDS
NAME OF LENDER:
ADDRESS:
CITY:
STATE:
ZIP CODE:
ESTIMATED DATE OF DEATH BALANCE:
DOES THE DECEDENT HAVE ANY OTHER CREDIT CARDS?

YesNo

VEHICLE LOANS
NAME OF LENDER:
ADDRESS:
CITY:
STATE:
ZIP CODE:
ESTIMATED DATE OF DEATH BALANCE:
WHAT VEHICLE IS SECURED BY THIS LOAN?
DOES THE DECEDENT HAVE ANY OTHER VEHICLE LOANS?

YesNo

DOCUMENTS NEEDED BY THIS OFFICE:

DEATH CERTIFICATE WITHOUT CAUSE OF DEATH (SHORT FORM)COPY OF PAID FUNERAL BILL WITH $0.00 BALANCE OR PROOF OF PAYMENTCOPIES OF ANY REAL ESTATE DEEDSCOPIES OF ANY VEHICLE TITLESCOPIES OF ANY BILLSLAST WILL AND TESTAMENT (IF ONE EXISTS, ORIGINAL NEEDED)
Upload any relevant documents here:

Browse Files

Cancelof
Upload any relevant documents here:

Browse Files

Cancelof
PRINT YOUR NAME*
ADDRESS IF NOT ALREADY PROVIDED ABOVE:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PHONE NUMBER

Area CodePhone Number
EMAIL
example@example.com
Save time, snap a photo of your ID now:
Please verify that you are human*
How did you hear about us?
Google, Avvo, Word of Mouth, etc
Should be Empty: