PROBATE QUESTIONNAIRE

Transcription

1 CATHERINE E. DAVEY, J.D., LL.M. Post Office Box Maitland, Florida Telephone (407) Facsimile (407) PROBATE QUESTIONNAIRE 1. LEGAL NAME OF DECEDENT: PERMANENT RESIDENCE AT TIME OF DEATH (prior to nursing home): CITY: STATE: DATE OF BIRTH: COUNTY: ZIP CODE: DATE OF DEATH: SOCIAL SECURITY NUMBER: WAS DECEDENT EVER ON MEDICARE? YES WAS DECEDENT EVER ON MEDICAID? YES NO NO 2. LOCATION OF WILL, IF ANY: DATE OF WILL: LOCATION OF CODICIL, IF ANY: DATE OF CODICIL: Page 1 of 14

2 3. PROPOSED PERSONAL REPRESENTATIVE: RELATIONSHIP TO DECEDENT: ALTERNATE PERSONAL REPRESENTATIVE: RELATIONSHIP TO DECEDENT: 4. BENEFICIARIES OR HEIRS AT LAW: DECEDENT'S SPOUSE: Page 2 of 14

3 DECEDENT'S CHILDREN: CHILD # 1: CHILD # 2: CHILD # 3: CHILD # 4: Page 3 of 14

4 CHILD # 5: CHILD # 6: OTHER BENEFICIARIES: NAME: RELATIONSHIP TO THE DECEDENT: NAME: RELATIONSHIP TO THE DECEDENT: Page 4 of 14

5 NAME: RELATIONSHIP TO THE DECEDENT: ASSETS: SAFE DEPOSIT BOX: YES: NO: LOCATION: REAL ESTATE: COUNTY: DOD VALUE: HOMESTEAD: YES: NO: COUNTY: DOD VALUE: HOMESTEAD: YES: NO: Page 5 of 14

6 COUNTY: DOD VALUE: HOMESTEAD: YES: NO: STOCKS AND BONDS: NAME OF COMPANY: TYPE OF SECURITY: LOCATION OF CERTIFICATE: NAME OF COMPANY: TYPE OF SECURITY: LOCATION OF CERTIFICATE: NAME OF COMPANY: TYPE OF SECURITY: LOCATION OF CERTIFICATE: Page 6 of 14

7 BANK ACCOUNTS: BANK NAME: ACCOUNT NUMBER: BANK NAME: ACCOUNT NUMBER: BANK NAME: ACCOUNT NUMBER: MONEY MARKET ACCOUNTS OR CERTIFICATES OF DEPOSIT: NAME OF INSTITUTION: ACCOUNT NUMBER: Page 7 of 14

8 NAME OF INSTITUTION: ACCOUNT NUMBER: NAME OF INSTITUTION: ACCOUNT NUMBER: U.S. GOVERNMENT SAVINGS BONDS (E, EE, H): LOCATION OF BONDS: TO BE CASHED: YES NO IF YES, NAME OF TRANSFEREE: MORTGAGES AND NOTES (RECEIVABLE): MORTGAGOR: TERMS OF OBLIGATION: Page 8 of 14

9 MORTGAGOR: TERMS OF OBLIGATION: INSURANCE ON DECEDENT'S LIFE: COMPANY NAME: POLICY #: BENEFICIARIES NAMED: LOCATION OF POLICY: COMPANY NAME: POLICY #: BENEFICIARIES NAMED: LOCATION OF POLICY: COMPANY NAME: POLICY #: BENEFICIARIES NAMED: LOCATION OF POLICY: Page 9 of 14

10 COMPANY NAME: POLICY #: BENEFICIARIES NAMED: LOCATION OF POLICY: ANNUITIES: COMPANY NAME: POLICY #: BENEFICIARY NAMED: LOCATION OF POLICY: COMPANY NAME: POLICY #: BENEFICIARY NAMED: LOCATION OF POLICY: COMPANY NAME: POLICY #: BENEFICIARY NAMED: LOCATION OF POLICY: Page 10 of 14

11 VEHICLES: MODEL: YEAR: LOCATION OF TITLE: MODEL: YEAR: LOCATION OF TITLE: MODEL: YEAR: LOCATION OF TITLE: MISCELLANEOUS PERSONAL PROPERTY: Page 11 of 14

12 OTHER QUESTIONS: 1. Are any of the children of the Decedent disabled? 2. If yes, please identify and provide additional information regarding nature of disability. DOCUMENTS NEEDED BY THIS OFFICE: DEATH CERTIFICATE (certified copy without cause of death, if available) PAID FUNERAL BILL (Showing $0 balance and indicating paid by whom) REAL ESTATE DEEDS (copies) BANK STATEMENTS (copies) VEHICLE TITLES (copies) COPIES OF ANY BILLS/CREDITORS ADDRESSES LAST WILL AND TESTAMENT (ORIGINAL MUST BE FILED WITH CLERK OF COURT) PERSONAL REPRESENTATIVE 1. Has applicant ever been charged with, arrested for or convicted of a felony? If "yes" was answered, please give date and complete details Page 12 of 14

13 2. Has applicant ever been charged with, arrested for or convicted of any other crimes? If "yes" was answered, please give date and complete details 3. Does applicant have any physical disabilities? If "yes" was answered, please explain 4. Will any physical disability listed above affect ability to serve as personal representative? 5. Has applicant ever been treated for the following? a. Mental condition b. Alcohol c. Drugs d. Other Nature of Condition If "yes" was answered to any of the above, please state date, time, location of treatment, and name of physician or professional involved Page 13 of 14

14 UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE INFORMATION PROVIDED IS TRUE AND ACCURATE TO THE BEST OF MY INFORMATION AND BELIEF. DATED THIS DAY OF, 20. PRINT NAME: Page 14 of 14