Heirship Affidavit Questionnaire

New Client - Heirship Affidavit Questionnaire

THE INFORMATION IN THIS DOCUMENT IS SUBJECT TO THE ATTORNEY-CLIENT PRIVILEGE, CONTENTS OF THIS DOCUMENT ARE CONFIDENTIAL AND WILL NOT TO BE DISCLOSED TO THIRD PERSONS OTHER THAN IN FURTHERANCE OF PROFESSIONAL LEGAL SERVICES.

PLEASE COMPLETE THE FOLLOWING.

Clear Form

PERSONAL DATA

Questionnaire Completed by*

NAME*

Address*

City*

State*

Zip Code*

Cell #*

Work #

E-mail*

Relationship to Decedent

Have you been convicted of a Felony?YesNo

DECEDENT NAME*

Alias Names (if any)

Street Address*

City*

State*

Zip Code*

Date of Birth*

Date of Death

Country of Death

Driver's License Number

Social Security Number

Was Decedent a U.S. citizen?YesNo

If naturalized U.S. citizen, Date and Place of Naturalization

Location of Will, if any

Date of Will/codicils

Did Decedent receive Medicaid BenefitsYesNo

FAMILY INFORMATION

SPOUSE

Street Address

City

State

Zip Code

Cell #

Work #

E-mail

Date and place of marriage

Status of Spouse:LivingDeceased

Please provide the following information regarding decedent's former marriages, if any

Name of former spouse

Living

Date of Death or Divorce

Name of former spouse 1

Living 1DivorceDeath

Date of Death or Divorce 1

Name of former spouse 2

Living 2DivorceDeath

Date of Death or Divorce 2

Name of former spouse 3

Living 3DivorceDeath

Date of Death or Divorce 3

CHILDREN

Name

Living

Birthdate

Married

Address

For each child, state the name of the child's other parent, if not decedent's surviving spouse/partner.

Please list the names of decedent's parents, brothers and sisters, and state whether they are living, and if so, list their city and state or residence.

Name

Relationship

Living

Address

Name 1

Relationship 1

Living 1YesNo

Address 1

Name 2

Relationship 2

Living 2YesNo

Address 2

Name 3

Relationship 3

Living 3YesNo

Address 3

Name 4

Relationship 4

Living 4YesNo

Address 4

ITEMS TO BRING TO CONSULTATION

Wills and any codicils
Death certificate
Trust instruments in which client is grantor, trustee, or beneficiary
Deeds to property