Estate Administration Questionnaire

Please complete the following questionnaire to the best of your abilities. This information is helpful to us so that we may properly plan for you and it will be held in the strictest confidence.
DECEDENT'S INFORMATION
Decedent's Name*
First Last
Decedent's Occupation*
Decedent's Social Security Number*
Decedent's Address*
Street Address Address Line 2 City State ZIP Code
Decedent's Date of Birth*
Month
Day
Year
Decedent's Date of Death*
Month
Day
Year
Decedent's Place of Death*
Decedent's Country of Birth*
Decedent's Marital Status*
Decedent's Divorces*
Decedent's Citizenship*
Predeceased Spouse's Name
First Last
Predeceased Spouse's Soc. Sec. No.
Predeceased Spouse's Date of Death
Month
Day
Year
Attach a copy of death certificate
Max. file size: 50 MB.

NOMINATED EXECUTOR/ADMINISTRATOR INFORMATION
Nominated Executor/Administrator's Name*
First Last
Relationship*
Nominated Executor/Administrator's Social Security Number
Nominated Executor/Administrator's Address*
Street Address Address Line 2 City State ZIP Code
Nominated Executor/Administrator's Phone*
Nominated Executor/Administrator's Email*

Owner(s)	Location	Estimated Value	Mortgage Balance

Owner	Bank and Account No.	Maturity Date	Date of Death Balance

Owner	No. of Shares	Company	Date of Death Value

Company & Policy No.	Face Amount	Cash Value	Loan Amount	Insured	Beneficiary

Owner	Company and Account No.	Beneficiary	Date of Death Value

DECEDENT'S INFORMATION

Name	Address	Phone	Relationship	Soc. Sec. No.

Description of Asset	Value

To Whom	Amount

To Whom	Amount