Client Information
Client's Name
First Name
Last Name
Clients Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
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Please upload a picture of your license for verification purposes.
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Decedents Information
Deceased's Name (please include all alias)
Deceased Address at the time of passing
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Decedents Social Security Number
Decedents Date of Birth
-
Month
-
Day
Year
Date
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Additional Information
Decedent Date of Passing
/
Month
/
Day
Year
Date
Age at the time of passing
Decedents address at the passing
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Documentation
Did you receive a Death Certificate?
Yes
No
Does the Death Certificate need any corrections?
Yes
No
If you have a copy of the death certificate, please upload a copy.
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Did the Decedent have a personal representative at the time of passing?
Yes
No
If yes, please click here to provide additional information
Personal representative's name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to Decedent
Email
example@example.com
Phone Number
Please enter a valid phone number.
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Did the Decedent have a will at the time of passing?
Yes
No
I don't know
Other
If yes, do you know the date of decedents last will?
Yes
No
I don't know
Do you have a copy of the decedent's last will?
Yes
No
I don't know
If yes, please feel free to upload a copy of decedents will.
If yes, please feel free to upload a copy of the decedents last will and testament
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Additional Information
Do you know if the decedent had a codicil, or additional documents in regards to the administration of property with their estate?
Yes
No
I don't know
If yes, do you know the location, or an individual in possession of these documents?
Yes
No
I don't know
Other
If you have a copy of additional documents regarding the will, please feel free to upload.
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Beneficiaries
Please provide the information of all known beneficiaries regarding the decedents estate
Beneficiary #1 Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Relation to the Decedent
Share of the Decedents estate.
Beneficiary #2
Beneficiary #2 Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Relation to the Decedent
Share of the Decedents estate.
Beneficiary #3
Beneficiary #3 Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Relation to the Decedent
Share of the Decedents estate.
Beneficiary #4
Beneficiary #4 Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Relation to the Decedent
Share of the Decedents estate.
Beneficiary #5
Beneficiary #5 Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Relation to the Decedent
Share of the Decedents estate.
Beneficiary #6
Beneficiary #6 Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Relation to the Decedent
Share of the Decedents estate.
Beneficiary #7
Beneficiary #7 Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Relation to the Decedent
Share of the Decedents estate.
Beneficiary #8
Beneficiary #8 Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Relation to the Decedent
Share of the Decedents estate.
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Asset Information
Homes
Homestead Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Titled Owner
First Name
Last Name
Assessed Value
Mortgage Amount
What are your plans for this property?
Other Real Property
Property 2
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Titled Owner
First Name
Last Name
Assessed Value
Mortgage Amount
What are your plans for this property?
Property #3
Address 3
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Titled Owner
First Name
Last Name
Assessed Value
Mortgage Amount
What are your plans for this property?
Property #4
Address 4
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Titled Owner
First Name
Last Name
Assessed Value
Mortgage Amount
What are your plans for this property?
Property #5
Address 5
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Titled Owner
First Name
Last Name
Assessed Value
Mortgage Amount
What are your plans for this property?
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Vehicles
Vehicle #1 Information
Make of Vehicle
Model of Vehicle
Year
State / Province
Titled Owner
First Name
Last Name
Assessed Value
Loan Amount
Is the vehicle insured?
Please Select
Yes
No
If yes, who is the vehicle insured with?
What are your plans for this property?
Vehicle #2
Vehicle #2 Information
Make of Vehicle
Model of Vehicle
Year
State / Province
Titled Owner
First Name
Last Name
Assessed Value
Loan Amount
Is the vehicle insured?
Please Select
Yes
No
If yes, who is the vehicle insured with?
What are your plans for this property?
Vehicle #3
Vehicle #3 Information
Make of Vehicle
Model of Vehicle
Year
State / Province
Titled Owner
First Name
Last Name
Assessed Value
Loan Amount
Is the vehicle insured?
Please Select
Yes
No
If yes, who is the vehicle insured with?
What are your plans for this property?
Vehicle #4
Vehicle #4 Information
Make of Vehicle
Model of Vehicle
Year
State / Province
Titled Owner
First Name
Last Name
Assessed Value
Loan Amount
Is the vehicle insured?
Please Select
Yes
No
What are your plans for this property?
If yes, who is the vehicle insured with?
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Banking Information
Bank Name
Bank Name
Type of Account (Savings, Checking, Totten, ect)
Account Number
Routing Number
Last Known Balance
Is this a joint bank account or are there any beneficiaries on the account?
Please Select
Yes
No
I don't know
If yes, please list the known names on the account?
Bank Account #2
Bank Name
Bank Name
Type of Account (Savings, Checking, Totten, ect)
Account Number
Routing Number
Last Known Balance
Is this a joint bank account or are there any beneficiaries on the account?
Please Select
Yes
No
I don't know
If yes, please list the known names on the account?
Bank Account #3
Bank Name
Bank Name
Type of Account (Savings, Checking, Totten, ect)
Account Number
Routing Number
Last Known Balance
Is this a joint bank account or are there any beneficiaries on the account?
Please Select
Yes
No
I don't know
If yes, please list the known names on the account?
Bank Account #4
Bank Name
Bank Name
Type of Account (Savings, Checking, Totten, ect)
Account Number
Routing Number
Last Known Balance
Is this a joint bank account or are there any beneficiaries on the account?
Please Select
Yes
No
I don't know
If yes, please list the known names on the account?
Bank Account #5
Bank Name
Bank Name
Type of Account (Savings, Checking, Totten, ect)
Account Number
Routing Number
Last Known Balance
Is this a joint bank account or are there any beneficiaries on the account?
Please Select
Yes
No
I don't know
If yes, please list the known names on the account?
Additional Banking Information
Type a question
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Did the decedent have a safety deposit box?
Yes
No
I don't know
Safety Deposit Information
Bank Name
Location
Account Number
Routing Number
Last Known Balance
Contents of the Safety Deposit box
Are there any beneficiaries on the safety deposit box?
Please Select
Yes
No
I don't know
If yes, please provide the corresponding names and information below.
Safety Deposit Box #2
Safety Deposit Information
Bank Name
Location
Account Number
Routing Number
Last Known Balance
Contents of the Safety Deposit box
Are there any beneficiaries on the safety deposit box?
Please Select
Yes
No
I don't know
If yes, please provide the corresponding names and information below.
Safety Deposit Box #3
Safety Deposit Information
Bank Name
Location
Account Number
Routing Number
Last Known Balance
Contents of the Safety Deposit box
If yes, please provide the corresponding names and information below.
Are there any beneficiaries on the safety deposit box?
Please Select
Yes
No
I don't know
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Stocks and bonds
Stock 1
Company
Type of Shares (common, preferred ect)
Number of Shares
Value of Shares
Postal / Zip Code
Disposition under will
If you have a ledger of the current stock account please feel free to upload rather than adding the information below
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Stock 2
Stock 2
Company
Type of Shares (common, preferred ect)
Number of Shares
Value of Shares
Postal / Zip Code
Disposition under will
Stock 2
Stock 2
Company
Type of Shares (common, preferred ect)
Number of Shares
Value of Shares
Postal / Zip Code
Disposition under will
Stock 3
Stock 3
Company
Type of Shares (common, preferred ect)
Number of Shares
Value of Shares
Postal / Zip Code
Disposition under will
Stock 4
Stock 4
Company
Type of Shares (common, preferred ect)
Number of Shares
Value of Shares
Postal / Zip Code
Disposition under will
Stock 4
Stock 4
Company
Type of Shares (common, preferred ect)
Number of Shares
Value of Shares
Postal / Zip Code
Disposition under will
Stock 5
Stock 5
Company
Type of Shares (common, preferred ect)
Number of Shares
Value of Shares
Postal / Zip Code
Disposition under will
Stock 6
Stock 6
Company
Type of Shares (common, preferred ect)
Number of Shares
Value of Shares
Postal / Zip Code
Disposition under will
Stock 7
Stock 7
Company
Type of Shares (common, preferred ect)
Number of Shares
Value of Shares
Postal / Zip Code
Disposition under will
Stock 8
Stock 8
Company
Type of Shares (common, preferred ect)
Number of Shares
Value of Shares
Postal / Zip Code
Disposition under will
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Life Insurance and Policy Information
Life Insurance 1
Life Insurance Company
Type of Insurance (life, accident, funeral, ect)
Policy No.
Value of policy
Postal / Zip Code
Beneficiary Names
If you have a copy of the policy, please feel free to upload
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Life Insurance
Life Insurance 2
Life Insurance Company
Type of Insurance (life, accident, funeral, ect)
Policy No.
Value of policy
Postal / Zip Code
Beneficiary Names
If you have a copy of the policy, please feel free to upload
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Life Insurance 3
Life Insurance 3
Life Insurance Company
Type of Insurance (life, accident, funeral, ect)
Policy No.
Value of policy
Postal / Zip Code
Beneficiary Names
If you have a copy of the policy, please feel free to upload
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Life Insurance 4
Life Insurance 4
Life Insurance Company
Type of Insurance (life, accident, funeral, ect)
Policy No.
Value of policy
Postal / Zip Code
Beneficiary Names
If you have a copy of the policy, please feel free to upload
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Life Insurance 5
Life Insurance 5
Life Insurance Company
Type of Insurance (life, accident, funeral, ect)
Policy No.
Value of policy
Postal / Zip Code
If you have a copy of the policy, please feel free to upload
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Beneficiary Names
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Personal Property Information
Personal Property #1
Type of Property
Value of Property
City
State / Province
Postal / Zip Code
Was this property specifically devised?
Yes
No
I don't know
Is someone in the wrongful possession of this property?
Yes
No
I don't know
Other
Personal Property #2
Personal Property #2
Type of Property
Value of Property
City
State / Province
Postal / Zip Code
Was this property specifically devised?
Yes
No
I don't know
Is someone in the wrongful possession of this property?
Yes
No
I don't know
Other
Personal Property #3
Personal Property #3
Type of Property
Value of Property
City
State / Province
Postal / Zip Code
Was this property specifically devised?
Yes
No
I don't know
Is someone in the wrongful possession of this property?
Yes
No
I don't know
Other
Personal Property #4
Personal Property #4
Type of Property
Value of Property
City
State / Province
Postal / Zip Code
Was this property specifically devised?
Yes
No
I don't know
Is someone in the wrongful possession of this property?
Yes
No
I don't know
Other
Personal Property #5
Personal Property #5
Type of Property
Value of Property
City
State / Province
Postal / Zip Code
Was this property specifically devised?
Yes
No
I don't know
Is someone in the wrongful possession of this property?
Yes
No
I don't know
Other
Personal Property #6
Personal Property #6
Type of Property
Value of Property
City
State / Province
Postal / Zip Code
Was this property specifically devised?
Yes
No
I don't know
Is someone in the wrongful possession of this property?
Yes
No
I don't know
Other
Personal Property #7
Personal Property #7
Type of Property
Value of Property
City
State / Province
Postal / Zip Code
Was this property specifically devised?
Yes
No
I don't know
Is someone in the wrongful possession of this property?
Yes
No
I don't know
Other
Personal Property #8
Personal Property #8
Type of Property
Value of Property
City
State / Province
Postal / Zip Code
Was this property specifically devised?
Yes
No
I don't know
Is someone in the wrongful possession of this property?
Yes
No
I don't know
Other
Personal Property #9
Personal Property #9
Type of Property
Value of Property
City
State / Province
Postal / Zip Code
Was this property specifically devised?
Yes
No
I don't know
Is someone in the wrongful possession of this property?
Yes
No
I don't know
Other
Personal Property #10
Personal Property #10
Type of Property
Value of Property
City
State / Province
Postal / Zip Code
Is someone in the wrongful possession of this property?
Yes
No
I don't know
Other
Was this property specifically devised?
Yes
No
I don't know
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Creditors and Debts
Please provide the following information below
Did the deceased have any outstanding debts?
Yes
No
I don't know
If yes, please click to provide the following information below
Creditor #1 Name
Creditor Name
Type of Debt (credit card, loan, ect)
Debt Amount
Amount paid
Postal / Zip Code
Creditor #2 Name
Creditor Name
Type of Debt (credit card, loan, ect)
Debt Amount
Amount paid
Postal / Zip Code
Creditor #3 Name
Creditor Name
Type of Debt (credit card, loan, ect)
Debt Amount
Amount paid
Postal / Zip Code
Creditor #4 Name
Creditor Name
Type of Debt (credit card, loan, ect)
Debt Amount
Amount paid
Postal / Zip Code
Creditor #5 Name
Creditor Name
Type of Debt (credit card, loan, ect)
Debt Amount
Amount paid
Postal / Zip Code
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Judgements and Liens
Did the deceased have any outstanding judgement and liens against them?
Yes
No
I don't know
If yes, please click to provide the following information below
Judge Creditor #1 Name
Creditor Name
Type of Debt (credit card, loan, ect)
Debt Amount
Case No
Court
Basis for Action
Judge Creditor #2 Name
Creditor Name
Type of Debt (credit card, loan, ect)
Debt Amount
Case No
Court
Basis for Action
Judge Creditor #3 Name
Creditor Name
Type of Debt (credit card, loan, ect)
Debt Amount
Case No
Court
Basis for Action
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Medicaid
Did the deceased have medicaid?
Please Select
Yes
No
I don't know
If yes, please provide corresponding information below
Medicaid Number
Date and reason why the decedent was medicaid qualified?
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Is there anything additional you would let the attorneys know about the decedents estate?
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