Probate Questionnaire | Probate Attorney Vance E. Hendrix

New Client - Probate Questionnaire

THE INFORMATION IN THIS DOCUMENT IS SUBJECT TO THE ATTORNEY-CLIENT PRIVILEGE, THE 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

ASSETS

Decedent’s Estimated Net Worth ($)

Estimated Total Value of Community Property ($)

Estimated Total Value of Decedent’s Separate Property ($)

REAL ESTATE

For all Real Property (Land/houses, etc., identify the Location/Address (include County of location).

Address

Equity

Value

Address 1

Equity 1

Value 1

Address 2

Equity 2

Value 2

Address 3

Equity 3

Value 3

Address 4

Equity 4

Value 4

Address 5

Equity 5

Value 5

Address 6

Equity 6

Value 6

OIL, GAS, AND MINERAL INTERESTS

For all oil, gas, and minerals that Decedent owned, identify the county in which such minerals are located.

BANKS AND BROKERAGE ACCOUNTS

Identify all Institutions at which Decedent owned an account.

Name of Bank/Brokerage Firm

Acct #

Beneficiary Designations

Value

Name of Bank/Brokerage Firm 1

Acct # 1

Beneficiary Designations 1

Value 1

Name of Bank/Brokerage Firm 2

Acct # 2

Beneficiary Designations 2

Value 2

Name of Bank/Brokerage Firm 3

Acct # 3

Beneficiary Designations 3

Value 3

Name of Bank/Brokerage Firm 4

Acct # 4

Beneficiary Designations 4

Value 4

Name of Bank/Brokerage Firm 5

Acct # 5

Beneficiary Designations 5

Value 5

Name of Bank/Brokerage Firm 6

Acct # 6

Beneficiary Designations 6

Value 6

Name of Bank/Brokerage Firm 7

Acct # 7

Beneficiary Designations 7

Value 7

Name of Bank/Brokerage Firm 8

Acct # 8

Beneficiary Designations 8

Value 8

Name of Bank/Brokerage Firm 9

Acct # 9

Beneficiary Designations 9

Value 9

RETIREMENT ACCOUNTS AND ANNUITIES

Identify all Institutions at which Decedent maintained a Retirement Account or Annuity.

Name of Institution

Acct #

Beneficiary Designations

Value

Name of Institution 1

Acct # 1

Beneficiary Designations 1

Value 1

Name of Institution 2

Acct # 2

Beneficiary Designations 2

Value 2

Name of Institution 3

Acct # 3

Beneficiary Designations 3

Value 3

Name of Institution 5

Acct # 5

Beneficiary Designations 5

Value 5

Name of Institution 6

Acct # 6

Beneficiary Designations 6

Value 6

DECEDENT’S LIFE INSURANCE

Identify all Life Insurance Policies maintained by or insuring the life of the Decedent.

Name of Institution

Policy #

Beneficiary Designations

Death Benefit

Cash Value

Name of Institution 1

Policy # 1

Beneficiary Designations 1

Death Benefit 1

Cash Value 1

Name of Institution 2

Policy # 2

Beneficiary Designations 2

Death Benefit 2

Cash Value 2

Name of Institution 3

Policy # 3

Beneficiary Designations 3

Death Benefit 3

Cash Value 3

Name of Institution 4

Policy # 4

Beneficiary Designations 4

Death Benefit 4

Cash Value 4

Name of Institution 5

Policy # 5

Beneficiary Designations 5

Death Benefit 5

Cash Value 5

Name of Institution 6

Policy # 6

Beneficiary Designations 6

Death Benefit 6

Cash Value 6

Name of Institution 7

Policy # 7

Beneficiary Designations 7

Death Benefit 7

Cash Value 7

VEHICLES (AUTOMOBILES, BOATS, RVS, MOTORCYCLES, TRAILERS, FARM VEHICLES, ETC.)

Year

Make and Model

Value

Year 1

Make and Model

Value 1

Year 2

Make and Model 2

Value 2

Year 3

Make and Model 3

Value 3

Year 4

Make and Model 4

Value 4

Year 5

Make and Model 5

Value 5

Year 6

Make and Model 6

Value 6

Year 7

Make and Model 7

Value 7

HOUSEHOLD FURNISHINGS, ANTIQUES, JEWELRY, FURNITURE, CLOTHING, ETC.

Generally identify the Decedent’s household furnishings, antiques, jewelry, clothing, and artwork – provide a total “garage sale” or “yard sale” value for such items

OTHER ASSETS (Business interests, Partnerships, Interests in Lawsuits, Digital Assets, Trademarks, copyrights, etc.)

ITEMS TO BRING TO CONSULTATION

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