Estate Administration Questionnaire - The Law Office of Randy Hope Steen, LTD.

ESTATE ADMINISTRATION

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

Your Information

First Name

Middle Name

Last Name

Email(Required)

Phone Number

Your Current Address

Street

City

State

Zip Code

Did someone refer you to our office?

Yes

No

Decedent Information

Decedent First Name

Decedent Middle Name

Decedent Last Name

Street (At Time of Death)

City

State

Zip Code

Date of Birth

Place of Birth

Date of Death

Place of Death

U.S. citizen

Yes

No

Children

Yes

No

Married

Yes

No

Decedent's Spouse Information

Spouse First Name

Spouse Middle Name

Spouse Last Name

Address

City

State

Zip

Spouse Birth Date

Spouse Annual Income

Spouse Phone Number

Spouse Cell Number

Spouse Fax Number

Spouse Business Phone Number

Spouse Email

Is spouse a U.S. citizen?

Yes

No

Children Information

Leave any non-applicable answers blank

Children List

Legal Name

Address

Home Phone

Work Phone

Birth Date

Beneficiary

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

Beneficiary Name

Email

Phone

Address

City

State

Zip Code

Beneficiary: Second

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

Beneficiary Name

Email

Phone

Address

City

State

Zip Code

Beneficiary: Third

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

Beneficiary Name

Email

Phone

Address

City

State

Zip Code

Executor / Administration

If decedent's executor is different than spouse, please provide the following information.

Executor Name

Email

Home Phone

Cell Phone

Business Phone

Address

City

State

Zip Code

Co-Executor / Co-Administration

Executor Name

Email

Home Phone

Cell Phone

Business Phone

Address

City

State

Zip Code

Decedent's Physician

Physician's Name

Email

Office Phone

Address

City

State

Zip Code

Decedent's Accountant

Accountant's Name

Email

Office Phone

Address

City

State

Zip Code

Decedent's Financial Advisor

Financial Advisor's Name

Email

Office Phone

Address

City

State

Zip Code

Funeral Home

Funeral Home Name

Email

Office Phone

Fax

Address

City

State

Zip Code

Expenses

We will need supporting document copies such as statements, deeds, notes and mortgages, partnership agreements, stock certificates, or policies.

Expenses of Decedent's Last Illness

Name of Provider

Address

Amount

Date Paid

Outstanding Debt

Name of Creditor

Phone

Email

Amount of Debt

Administrative Expenses

Expense

Amount

Description

Assets and Liabilities

We will need supporting document copies such as statements, deeds, notes and mortgages, partnership agreements, stock certificates, or policies.

Please list any assets or liabilities

Asset Type

Amount

Ownership

Referral Information

What is the name of the person who referred you?

What is the referrer's street address?

What is the referrer's city?

What is the referrer's state?

What is the referrer's zip?

The referrer is:

Attorney

Financial Planner

Previous Client

Other

Name of referring client:

If other, please explain:

Do you have anything else to tell us?

How can we improve our website?

Phone

This field is for validation purposes and should be left unchanged.