Marital Status Information - Estate Information Sheet

Marital Status Information - Estate Information Sheet
Marital Status
Marital Status

ApplicableNot applicable, the deceased was never married

Adult Interdependent Partner
Adult Interdependent Partner

ApplicableNot applicable, the deceased was never had an adult interdependent partner

a) Full legal name of Spouse

First NameMiddle NameLast Name
b) Address of Spouse

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
c) Email of Spouse
example@example.com
d) Date of Death (if applicable)

MonthDayYear
Date
e) Was the Deceased the adult interdependent partner of any other person’s at any time within the one-year period immediately preceding the deceased’s death?

YesNo
If so, pleaseprovide the following information about each adult interdependent partner:
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
f) The adult interdependent partner lived with the deceased in a relationship of interdependence; (complete all that apply)
i. For a continuous period of not less than three years beginning insert date and ending insert date .
ii. Of some permanence of which there is a child:

Born (date of birth)
Adopted (date of adoption)
The adult interdependent partner is / is not related to the deceased by blood or adoption.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
g) The adult interdependent partner entered into an adult interdependent partner agreement with the deceased dated:

MonthDayYear
Date
Does this person have capacity to make decisions respecting financial matters?

YesNo
If the person lacks capacity, is this person represented by either an attorney or trustee?

Yes - by an attorneyYes - by a trusteeNo
i. If the answer is “yes” provide the following of the Attorney or Trustee:
Full legal Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Email
example@example.com
ii. Does this person have the legal capacity to be served?

YesNo

Former Spouse / Former Adult Interdependent Partner
Former Spouse / Former Adult Interdependent Partner

ApplicableNot applicable, the deceased never had a Former Spouse / Former Adult Interdependent Partner

1. Full legal name of Spouse

First NameMiddle NameLast Name
2. Address of Spouse

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. Email of Spouse
example@example.com
4. Date of Death of Spouse (if applicable)

MonthDayYear
Date
5. Date of Divorce or Separation (if applicable)

MonthDayYear
Date
Does this person have capacity to make decisions respecting financial matters?

YesNo
If the person lacks capacity, is this person represented by either an attorney or trustee?

Yes - by an attorneyYes - by a trusteeNo
If the answer is “yes” provide the following of the Attorney or Trustee:
Full legal name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Email
example@example.com
Does this person have the legal capacity to be served?

YesNo

Separated Spouse (Not yet divorced)
Separated Spouse (Not yet divorced)

ApplicableNot applicable, the deceased doesn't have a Separated Spouse (Not yet divorced)

1. Full legal name

First NameMiddle NameLast Name
2. Date of separation

MonthDayYear
Date
3. Are there current divorce proceedings filed with the court?

YesNo
4. Address of Spouse

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
5. Email Address of Spouse
example@example.com
6. Date of Death of Spouse (if applicable)

MonthDayYear
Date
Does this person have capacity to make decisions respecting financial matters?

YesNo
If the person lacks capacity, is this person represented by either an attorney or trustee?

Yes - by an attorneyYes - by a trusteeNo
i. If the answer is “yes” provide the following of the Attorney or Trustee:
Full legal name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Email
example@example.com
ii. Does this person have the legal capacity to be served?

YesNo

Should be Empty:

Marital Status Information - Estate Information Sheet

Marital Status

Current Spouse

Adult Interdependent Partner

Former Spouse / Former Adult Interdependent Partner

Separated Spouse (Not yet divorced)