Long-Term Care Planning Questionnaire

The following information is required for the preparation of the petition for probate and/or administration proceedings. Those questions that do not apply to you, your family, or your financial situation may simply be ignored. Please feel free to provide other information you feel is relevant.

*You can "Save" and come back to this form at any time.
Today's Date

MonthDayYear
Date
Petitioner's Information
Petitioner's Name

First NameMiddle NameLast Name
Petitioner's Email
example@example.com
Petitioner's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Petitioner's Phone Number (Home):
Please enter a valid phone number.
Petitioner's Phone Number (Cell)
Please enter a valid phone number.
Decedent's Information
Decendent's Name

First NameMiddle NameLast Name
Decedent's Address at Time of Death:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Decedent's Date of Birth:
Decedent's Date of Death:
Decedent's Marital Status:

Decedent's Children/Distributees:

List All Children
1. Name of Child/ Distributee

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
2. Name of Child/ Distributee

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
3. Name of Child/ Distributee

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
4. Name of Child/ Distributee

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.

Decedent's Financial Information
1. Asset
Location
Estimated Value
2. Asset
Location
Estimated Value
3. Asset
Location
Estimated Value
4. Asset
Location
Estimated Value
5. Asset
Location
Estimated Value

Decedent's Debts
1. Institution / Person Owed
Amount Owed
Type of Debt / Explanation
2. Institution / Person Owed
Amount Owed
Type of Debt / Explanation
3. Institution / Person Owed
Amount Owed
Type of Debt / Explanation
Documents Needed by this Office
Please upload the applicable documents:
- Death Certificate
- Paid Funeral Bill
- Real Estate Deeds
- Vehicle Titles
- Copies of ay Bills/Creditors Addresses
- Last Will and Testament
File Upload

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Please feel free to provide other information you feel is relevant.
Should be Empty: