Estate Administration
Name of Decedent
First Name
Last Name
Social Security Number
Date of Birth
-
Month
-
Day
Year
Date
Date of Death
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Citizenship
Aliases
Did Decedent die Intestate (WITHOUT A WILL)?
Yes
No
If yes to the above, date of Will?
Was Decedent ever on Medicaid?
Yes
No
Was Decedent ever on Medicare?
Yes
NO
BENEFICIARIES OR HEIRS AT LAW
Decedent's Spouse
First Name
Last Name
Date of Marriage
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Social Security Number
DECEDENT'S CHILD (1)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Social Security Number
DECEDENT'S CHILD (2)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Social Security Number
DECEDENT'S CHILD (3)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Social Security Number
DID DECEDENT OWN HAVE ANY OF THE FOLLOWING:
SAFE DEPOSIT BOX
REAL ESTATE
STOCKS AND BONDS
BANK ACCOUNTS
MONEY MARKET ACCOUNTS OR CERTIFICATES OF DEPOSIT
SAVINGS BONDS
MORTGAGES AND NOTES
ANNUITIES
INSURANCE POLICY
VEHICLE(S)
DOCUMENTS NEEDED BY THIS OFFICE
DEATH CERTIFICATE
PAID FUNERAL BILL
REAL ESTATE DEEDS
VEHICLE TITLES
COPIES OF ANY BILLS/CREDITORS ADDRESSES
LAST WILL AND TESTAMENT, IF APPLICABLE
Submit
Should be Empty: