Probate Administration Intake Form

The information requested is necessary for your case. This information will remain confidential where necessary and in your file. Please complete all fields as accurately as possible.

1 PROPOSED PERSONAL REPRESENTATIVE INFORMATION

FIRST NAME *

MIDDLE NAME

LAST NAME *

MAILING ADDRESS *

CELL PHONE *

EMAIL ADDRESS *

DATE OF BIRTH

SOCIAL SECURITY NO.

RELATIONSHIP TO DECEDENT

2 DECEDENT'S INFORMATION

FIRST NAME *

MIDDLE NAME

LAST NAME *

DATE OF BIRTH

DATE OF DEATH *

AGE AT DATE OF DEATH [number dec_age placeholder "Age" min:0 max:150]

COUNTY RESIDED IN AT DATE OF DEATH

ANY OTHER NAMES KNOWN BY

DID DECEDENT HAVE A WILL?

YesNo

IN POSSESSION OF ORIGINAL WILL?

YesNo

IF ADDRESS IS A RESIDENTIAL FACILITY, ADDRESS PRIOR TO FACILITY

3 PROBATE INFORMATION

Name and Addresses of All Beneficiaries (Spouse & Children first; if none, Parents; if none, Siblings)

NAME	YEAR OF BIRTH	ADDRESS	EMAIL	RELATIONSHIP
	[number heir1_yob placeholder "YYYY" min:1900 max:2026]
	[number heir2_yob placeholder "YYYY" min:1900 max:2026]
	[number heir3_yob placeholder "YYYY" min:1900 max:2026]
	[number heir4_yob placeholder "YYYY" min:1900 max:2026]
	[number heir5_yob placeholder "YYYY" min:1900 max:2026]

4 ESTATE ASSET INFORMATION

1. Known Real Property of Decedent

ADDRESS	TMS #	FMV ($)	DECEDENT'S % INTEREST	VALUE OF DECEDENT'S PORTION ($)

2. Known Encumbrances (Mortgages, Liens, Judgments)

TYPE	ASSET ENCUMBERED	COMPANY WITH ENCUMBRANCE	PAY-OFF AMOUNT ($)

3. All Other Known Assets (Bank Accounts, CDs, Stocks, Bonds, Life Insurance, Investments, Vehicles, Household Furnishings, Art, Business Interest, Retirement)

NAME / TYPE OF ASSET	ACCOUNT # / ID #	INSTITUTION / COMPANY	VALUE ($)

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