Probate Questionnaire

Probate Questionnaire

Bertsch & Boze Elder Law, PC
PLEASE REMEMBER TO BRING A COPY OF THE DEATH CERTIFICATE AND THE ORGINAL WILL.
Name of Applicant (Client):

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Last 4 of Social Security No.
Last 4 of Driver's License
State

Texas
Other State if not Texas
Have you ever been convicted of a felony?

YesNo
Information about Deceased Person:
Name of the Deceased

First NameLast Name
Place of Birth
Date of Death

MonthDayYear
Date
Place of Death
Last 4 of TX Driver's Lic. or ID
Last 4 of Social Security No.
Was Deceased married at the time of death?

YesNo
if yes, complete below:
Name of Spouse

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Marriage

MonthDayYear
Date
Place of Marriage
Was Deceased on Medicaid at the time of death?

YesNo
Did the Deceased have any prior Marriages?

YesNo
If yes, complete below:
Prior Spouse #1 Name

First NameLast Name
Where there children of this marriage?

YesNo
Date of Marriage

MonthDayYear
Date
Place of Marriage
Date of divorce

MonthDayYear
Date
Place of Divorce
Prior Spouse #2

First NameLast Name
Were there children of this marriage?

YesNo
Date of Marriage

MonthDayYear
Date
Place of Marriage
Date of Divorce

MonthDayYear
Date
Place of Divorce
Prior Spouse #3 Name

First NameLast Name
Where there children of this marriage?

YesNo
Date of Marriage

MonthDayYear
Date
Place of Marriage
Date of Divorce

MonthDayYear
Date
Place of Divorce
Persons or Charities Inheriting from Deceased (Beneficiaries): (If the applicant is the only one, skip to next section)
Beneficiary #1 Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Relationship to the Deceased
Is this Beneficiary Married?

YesNo
Beneficiary #2 Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Relationship to the Deceased
Is the Beneficiary Married?

YesNo
Beneficiary #3 Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Relationship to the Deceased
Is this Beneficiary Married?

YesNo
Beneficiary #4 Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Relationship to the Deceased
Is this Beneficiary Married

YesNo
(If there are more than 4 Beneficiaries, Please list on a separate page)

Is anyone who would have inherited already deceased?
Deceased Beneficiary #1 Name

First NameLast Name
Date of Death

MonthDayYear
Date
Deceased Beneficiary #2 Name

First NameLast Name
Date of Death

MonthDayYear
Date
Below Witness Info Only Needed in Some Instances-Attorney will Advise If Needed

Witnesses for the Estate: Two (2) people who knew the deceased for at least 10-15 Years or more and are not in the line of inheritance (i.e., not spouse, child or grandchild of someone who would inherit).
Witness #1 Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Witness #2 Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
ASSETS OF THE DECEASED
Real Estate
Mineral Rights
Finanacial Accounts (only those that don't have Pay On Death Beneficary)
IRA's
Banking
Investments
Stocks, Bonds, Etc.
Vehicles (including RV's Boats, Etc.)
Household Goods. Personal Items and Furnishings (you do not need to itemize, please estimate the total amount based on GARAGE SALE VALUES)
US Dollars
Approximate Total Value of Estate
US Dollars
Should be Empty: