ESTATE ADMINISTRATION QUESTIONNAIRE

This form is extremely important. Your accuracy and completeness in responding will help me represent you. Please bring this completed form to your appointment.

Client Information

What is your First Name?

Last Name?

What email do we send this completed document to?

What is your phone number?

Were you referred to our office?

Yes

What is your address?

Address Line 1

Address Line 2

City

State

Zip Code

Decedent Information

First Name

Middle Name

Last Name

Was the decedent married?

Yes

Does the Decedent have children?

Yes

U.S. Citizen

Yes

SSN #

Date of Birth

Place of Birth

Date of Death

Place of Death

Address at time of Death

Address Line 2

City

State

Zip Code

Decedent Spouse (if married)

First Name

Middle Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone

Primary Phone Type

Phone

Cell

Secondary Phone

Secondary Phone Type

Phone

Cell

Fax

Business Phone

Spouse U.S. Citizen

Yes

Children and Other Beneficiaries

Children List

Complete the children table below. Add more slots by pressing the (+) button.

Child Legal Name	Address	Home Phone	Work Phone	Birth Date

List the names of any persons (beneficiaries) included in the Will (other than Spouse or Children)

Beneficiary Name	Address	Phone Number	Email

Executor / Administrator

Executor / Administrator Name

Phone

Cell

Business Phone

Executor Address

Address

City

State

Zip Code

Co-Executor / Co-Administrator

Co-Executor / Co-Administrator Name

Phone

Cell

Business Phone

Co-Executor Address

Address

City

State

Zip Code

Decedent's Physician

Physician Name

Phone

Physician Address

Address

City

State

Zip Code

Decedent's Accountant

Accountant Name

Phone

Accountant Address

Address

City

State

Zip Code

Decedent's Financial Advisor

Financial Advisor Name

Phone

Financial Advisor Address

Address

City

State

Zip Code

Funeral Home

Funeral Home Name

Phone

Funeral Home Address

Address

City

State

Zip Code

Expenses of Decedent's Last Illness

Please provide a list of decedent's expenses, including the name and address of the provider, the amount, and the date paid, or provide copies of invoices or cancelled checks.

Name of Provider	Address	Amount	Date Paid

Outstanding Debt

Please list all outstanding debts

Name of Creditor	Business Phone Number	Email Address	Amount of Debt

Administrative Expenses

Provide copies of any items paid relating to burial arrangements, luncheons, and other expenses incurred settling the affairs of the decedent.

Expense	Amount	Description

Assets

Bank Accounts - We require copies of Statements

Amount	Ownership (Joint, Tenants, etc.)

Real Estate: Residence - We require copy of deed

Amount	Ownership (Joint, Tenants, etc.)

Real Estate: Other- We require copy of deed

Amount	Ownership (Joint, Tenants, etc.)

Certificates of Deposit - We require copies of statements

Amount	Ownership (Joint, Tenants, etc.)

Stocks: Non Mutual Funds Held by Broker - We require copies of statements

Amount	Ownership (Joint, Tenants, etc.)

Stocks: Non Mutual Funds NOT Held by Broker - We require copies of statements

Amount	Ownership (Joint, Tenants, etc.)

Bonds: Non Mutual Funds Held by Broker - We require copies of statements

Amount	Ownership (Joint, Tenants, etc.)

Bonds: Non Mutual Funds NOT Held by Broker - We require copies of statements

Amount	Ownership (Joint, Tenants, etc.)

Referral Information - Who referred you to this office?

First Name

Last Name

Address

City

State

Zip Code

Referral is:

Attorney

Financial Planner

Previous Client of

Other

Previous Client Of / Other

Have you visited our website at www.rsteenlaw.com?

Yes

Do you have suggestions to improve our website?

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ESTATE ADMINISTRATION QUESTIONNAIRE

Client Information

Decedent Information

Decedent Spouse (if married)

Children and Other Beneficiaries

Children List

Executor / Administrator

Co-Executor / Co-Administrator

Decedent's Physician

Decedent's Accountant

Decedent's Financial Advisor

Funeral Home

Expenses of Decedent's Last Illness

Outstanding Debt

Administrative Expenses

Assets

Referral Information - Who referred you to this office?

Office Location