Probate & Trust Administration Intake Form


    Your Information

    Name

    Address

    City, State, Zip

    Home Phone

    Cell Phone

    Email

    SSN

    Date of Birth

    Relationship to Decedent

    Referred By:

    Name/Company:

    Phone/E-mail:

    Decedent’s Information

    Name

    Address

    City, State, Zip

    SSN

    DOB

    Date of Death:

    Marital Status

    DOD

    Children


    How Many Living:
    How Many Predeceased:

    Decedent’s Estate Planning

    ESTATE PLAN

    DID DECEDENT HAVE

    DATE EXECUTED

    Will

    Trust

    Decedent’s Family (use additional sheets if needed)

    DECEDENT'S CHILDREN, STEPCHILDREN, OR ADOPTED CHILDREN:

    Name: Date of Birth:

    Address:

    Home Phone: Cell Phone: Email:

    Is this child? Spouse’s Name (if applicable):

    Any children? If yes, how many and what are their ages?

    Name: Date of Birth:

    Address:

    Home Phone: Cell Phone: Email:

    Is this child? Spouse’s Name (if applicable):

    Any children? If yes, how many and what are their ages?

    Name: Date of Birth:

    Address:

    Home Phone: Cell Phone: Email:

    Is this child? Spouse’s Name (if applicable):

    Any children? If yes, how many and what are their ages?

    Name: Date of Birth:

    Address:

    Home Phone: Cell Phone: Email:

    Is this child? Spouse’s Name (if applicable):

    Any children? If yes, how many and what are their ages?

    Name: Date of Birth:

    Address:

    Home Phone: Cell Phone: Email:

    Is this child? Spouse’s Name (if applicable):

    Any children? If yes, how many and what are their ages?

    Name: Date of Birth:

    Address:

    Home Phone: Cell Phone: Email:

    Is this child? Spouse’s Name (if applicable):

    Any children? If yes, how many and what are their ages?

    OTHER NAMED BENEFICIARIES:

    Name: Date of Birth:

    Address:

    Home Phone: Cell Phone: Email:

    Relationship to Decedent:

    Name: Date of Birth:

    Address:

    Home Phone: Cell Phone: Email:

    Relationship to Decedent:

    Name: Date of Birth:

    Address:

    Home Phone: Cell Phone: Email:

    Relationship to Decedent:

    Name: Date of Birth:

    Address:

    Home Phone: Cell Phone: Email:

    Relationship to Decedent:

    Name: Date of Birth:

    Address:

    Home Phone: Cell Phone: Email:

    Relationship to Decedent:

    Name: Date of Birth:

    Address:

    Home Phone: Cell Phone: Email:

    Relationship to Decedent:

    Decedent’s Assets

    TYPE OF ASSET

    (CASH, IRA, STOCKS)

    LOCATION

    (COMPANY, BANK, ETC )

    ACCOUNT NO.

    VALUE

    JOINT ACCOUNT HOLDER

    (OR PAYABLE ON DEATH BENEFICIARY)

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    Decedent’s Liabilities

    TYPE OF LIABILITY

    (MORTGAGE, CREDIT CARD, LIENS, ETC)

    CREDITOR

    ACCOUNT NO.

    AMOUNT OWED

    JOINT ACCOUNT HOLDER

    $

    $

    $

    $

    $

    $

    $

    Are there any beneficiaries with special needs or require special consideration?

    If yes, please explain:

    Is there anything you would like us to know about the decedent or any of his or her beneficiaries?

    If yes, please explain: