Probate Intake Form

Name of Estate Representative (person acting on behalf of the deceased)

First NameMiddle NameLast Name
Mailing Address for Documents about the Estate:

Street Address

Street Address Line 2

CityState

Zip Code
Representative's Phone Number
Please enter a valid phone number.
Email for Communication
example@example.com
Personal Representative's Relationship to Decedent:

Surviving SpouseAdult Child of Decedent (biological or adopted)Parent of DecedentSibling of DecedentOther
Full Legal Name of Deceased

First NameMiddle NameLast NameSuffix
Decedent's Date of Birth

MonthDayYear
Date
Date of Death

MonthDayYear
Date
Decedent's Social Security number
Decedent's Mother's Full Name

First NameMiddle NameLast NameSuffix
Date of Death (Mother of Deceased)

MonthDayYear
Date
Decedent's Father's Full Name

First NameMiddle NameLast NameSuffix
Date of Death (Father of Deceased)

MonthDayYear
Date
Beneficiary Listing - Biological Child of Decedent #1 (by age)

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary Listing - Biological Child of Decedent #2

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary Listing - Biological Child of Decedent #3

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary Listing - Biological Child of Decedent #4

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary Listing - Biological Child of Decedent #5

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState

Zip Code
All Other Known Living Biological Relatives with Addresses and Dates of Birth
Example: John Doe, Uncle, age 52, 123 Main Street, SF, CA