The information requested is necessary for your case. This information will remain confidential where necessary and in your file. Other information is needed in order to administer the Decedent's estate. Please write the information requested as accurately as possible. Proposed Personal Representative Information First Name * Middle Name Last Name * Address * Cell Phone * Email * Employer Occupation Business Phone Date of Birth * Social Security Number Relationship to Decedent * Decedent's Information First Name * Middle Name Last Name * Any Other Names the Decedent Was Known By Did Decedent Have a Will? * YesNo Are You in Possession of Original Will? YesNoN/A Date of Birth * Date of Death * Age at Date of Death County Resided in at Date of Death * If Address is a Residential Facility (nursing home, prison, etc.), Address Prior to Facility Probate Information Family Information List spouse, children; if no spouse or children, list parents; if no parents, list siblings Family Members (Please list: Name, Year of Birth, Address, Email, Relationship to Decedent) Estate Asset Information Real Property List Known Real Property of Decedent (Address, TMS, FMV, Decedent's % Interest, Value of Decedent's Portion) Encumbrances Known Encumbrances (Type, Asset Encumbered, Company with Encumbrance, Payoff Amount) Other Assets List All Other Known Assets Not Paid to a Beneficiary Including: Bank Accounts, CDs, Stocks, Bonds, Life Insurance, Investments, Vehicles, Household Furnishings, Art, Business Interest, and Retirement (Name/Type, Account#/ID#, Company, Value) Additional Information Additional Comments or Information
