PROBATE ESTATE ADMINISTRATION CHECKLIST The purpose of this Probate Questionnaire is to 1) help prepare you for our upcoming estate settlement consultation; 2) provide us with important personal and asset information related to the decedent s estate so that we are able to properly advise you regarding your situation; and 3) streamline the estate settlement process while minimizing attorney fees and costs for you. Please complete this worksheet with as much information as you can provide. If you are unsure of how to answer a question simply leave it blank and we will discuss it during our initial consultation. It is very important that the completed questionnaire arrives in our office at least three (3) business days before our consultation so that we may properly prepare for our meeting. If you have any questions please call our office at (719) 444-8900. Contact Information: Name of person completing this form: Address: Phone: ( ) - Fax: ( ) - E-mail: How did you hear about Buell & Ezell, LLP? 1
I. About the Decedent A. General Information 1. Name : 2. Address: 3. County of Residence: 4. D.O.B: 5. D.O.D: 6. SS#: 7. County of Death: 8. Marital Status: 9. If Married, date of Marriage: 10. Name of Spouse: B. Beneficiaries and Heirs at Law- persons who will benefit from the estate 1. If never married: Parents, Siblings, Issue of Deceased Siblings 2. If married, divorced, or widowed: Spouse and Issue, Parents, Siblings a) Info for the above b) Info for the above 2
c) Info for the above d) Info for the above e) Info for the above 3
f) Info for the above g) Info for the above h) Info for the above 4
C. Did Decedent have a Will?; if yes provide the following information: 1. Will Date: 2. Prepared By?: 3. Was Will Witnessed? yes no 4. Was there a Codicil? yes no 5. Codicil Date: 6. Prepared By? 7. Were there any beneficiaries of the Will which are not listed in Item B above? D. Did Decedent have a safe deposit box? yes no; If yes provide the following information: 1. Bank: 2. Branch: 3. Titled in sole or joint names?: 4. Additional authorized signatories: E. Did Decedent have a CPA? If yes provide the following information: 1. Name: 2. Address: 3. Phone: F. Did Decedent have a Financial Advisor? If yes provide the following information: 1. Name: 2. Address: 3. Phone: 5
II. Decedent s Property Please provide detailed info regarding all assets and their value at date of death and info regarding any debts. If known, indicate whether the property is separate property, the surviving spouse s separate property, or jointly held property. If any property is titled out of state, please indicate. Please attach a separate sheet if necessary. Real Property: please provide copies of all deeds, property tax notices, and mortgages. Stocks, Bonds, Marketable Securities: include number and shares. If held in brokerage accounts, please provide copies of account statements for the period including the date of death. If held in certificate form, please provide copies of certificates. If held in book entry form, please provide copies of statements from holding entity. Bank Accounts, Credit Union Accounts, Cash: include account numbers. Please provide copies of statements for all accounts, for the period most recent to the date of death. Life Insurance: include name of company, policy number and beneficiary. Please provide copies of statements received regarding payment. Annuities, Retirement Benefits, IRAs, 401Ks, etc: Please provide copies of statements for all accounts, for the period including the date of death. Business Interests: Please provide name and description of business, including the decedent s ownership % in the business. 6
Automobiles and Other Vehicles (including boats and RV s, etc.): Please provide year, make, model, fair market value, and name(s) of owner(s). Personal Property: Please provide estimated value of decedent s household furnishings, clothing, jewelry and other personal property. (Note: this value is the amount anticipated if personal property were sold in an estate sale, not its replacement value.) Other Assets: Please provide details regarding any assets owned by the decedent which are not listed above. Debts and Mortgages: Please provide information regarding any debts or mortgages owned by the decedent, including the balance owed at the date of death. 7
III. Financial Summary The following financial summary provides us with information necessary to determine whether the estate may incur estate taxes. Please provide us with a fair market value estimate of the value of the estate assets by completing the following schedule. For life insurance policies, please provide the death benefit or the face value, whichever is greater (NOT THE CASH VALUE). For all other assets use your best estimate of each asset s fair market value (round to nearest $1,000). Please also list all debts associated with the asset in column D. Asset Personal Residence Asset in Decedent s Name Alone Asset in Spouse s Name Alone Asset in Joint Names w/spouse, etc. Amount of Debt on the Asset (if applicable) Other Real Estate IRAs, 401(k)s & Retirement Plans Annuities Life Insurance Policies Business Interests (Sole Proprietorships, C-Corps, S- Corps, LLC s, & Partnerships) Stocks, Bonds, & Mutual Funds Cash Accounts (Checking, Savings, & CDs) Money Owed to You (Notes Receivable) Motor Vehicles Household Furniture & Appliances Jewelry, Art, Collectibles, & Other Personal Property Other (Assets or Debts) Totals: A. Probate Summary of Total Net Estate Value (A + B + C D): B. C. Non Probate D. $ 8
Additional Financial Information Did decedent own real property outside of the state of Colorado? If yes, please describe the type of property and give location (city and state): Did decedent ever make one or more lifetime gifts the total value of which were over $10,000 (or $20,000 combined between husband and wife) to any one person during a single calendar year? Yes No Did decedent ever file a federal Gift Tax Return during their lifetime (i.e., IRS Form 709)? Yes No Known Creditors of the Estate (persons the decedent owed money): Was Decedent ever on Medicare for their medical care? Yes No 9
IV. Information for U.S. Estate Tax Return A. Please provide the following information regarding decedent: 1. Country of Birth: 2. Occupation: 3. Retired? yes no 4. Marital Status: married divorced single widowed a) Name of Spouse: b) Birthdate of Spouse: c) If divorced, date of divorce: d) If spouse deceased, date of death: and SS # 5. Did anyone other than the decedent own life insurance on decedent s life? If yes, please provide the following information: a) Name of owner: b) Face amount: c) Name of Insurance Company: d) Circumstances of Purchase: 6. Did decedent own property jointly with anyone? If yes, which property and who were joint owners? 7. Did decedent own any interest in a partnership or unincorporated business, a LLC, or a Corporation?; If yes provide the following: a) Name of Business: b) Address: c) Phone: d) EIN: e) Names and Address of other owners: 10
8. Did the decedent own and articles or collections (jewelry, art, antiques, coins, etc.)?; If yes provide details: 9. Did the decedent own life insurance on the life of any other person? If yes, provide details: 10. Did the decedent s estate, spouse, or other person receive or become entitled to receive any bonus or award as a result of the decedent s death? yes no 11. Did decedent transfer any property by gift within three (3) years prior to death yes no 12. Did the decedent transfer any property subject to a condition that the recipient had to survive the decedent in order to possess or enjoy the property? yes no 13. Did the decedent transfer property and retain the right to control possession or enjoyment? yes no 14. Did the decedent transfer any property and retain the right to revoke the transfer? yes no 15. Did the decedent create any trust during their lifetime? If yes, please provide a copy of the trust(s). 16. Has the decedent filed US Gift Tax Returns? If yes, provide copies. 17. Did the decedent possess a general power of appointment? yes no 18. Did the decedent ever execute or release a general power of appointment? yes no; If either 17 or 18 is yes, please obtain the following: a) Copy of the document creating the power b) Information regarding the value of the property subject to the power 19. Was the decedent receiving an annuity at the time of decedent s death? If yes, provide the following information: 11
V. Decedent s Designees a) Was the annuity paid from a qualified retirement plan? b) How much did the decedent contribute to the plan? 20. If the decedent died while employed, was any person entitled to payment from decedent s employer by reason of surviving the decedent? If yes, please provide the following: a) Amount receivable by the beneficiary b) Amount contributed to the fund by decedent to provide for the payment? 21. Did decedent have an individual retirement account (IRA)? If yes, provide the following: a) Name of Beneficiary: b) Address: c) Terms of payment of beneficiary: 22. Will appraisals be obtained on the real estate, jewelry, or other items? yes no A. Personal Representative 1. Name : 2. Address: 3. Home Phone: 4. Work Phone: 5. Cell Phone: 6. E-mail: 7. Fax: 8. Relationship to Decedent: B. Alternate Personal Representative or Co-Personal Representative 12
1. Name : 2. Address: 3. Home Phone: 4. Work Phone: 5. Cell Phone: 6. E-mail: 7. Relationship to Decedent: 8. Alternate or Co-Representative? C. Trustee (i.e. the person who will be responsible for the long-term management of property for the surviving spouse, children, or other beneficiaries.) 1. Name : 2. Address: 3. Home Phone: 4. Work Phone: 5. Cell Phone: 6. E-mail: 7. 1 st Alternate Trustee: 8. 2 nd Alternate Trustee: D. Guardian of Minor Children (i.e. the person who will take physical care of any minor children of the decedent, if applicable) 1. Name : 2. Address: 3. Home Phone: 4. Work Phone: 13
5. Cell Phone: 6. E-mail: 7. 1 st Alternate Guardian: 8. 2 nd Alternate Guardian: VI. Necessary Documents- In addition to any documents requested above, please bring the following documents with you to the initial consultation: 1. Copy/Original of death certificate (If estate will be probated, provide one (1) original death certificate) 2. Income tax returns filed by decedent for the three (3) years prior to death 3. All gift tax returns filed by the decedent (state and federal) 4. Copy of any appraisals 5. Copy of any pre-marital agreements 6. Copy of any divorce decrees (if within 10 years) 7. Copy of Will 8. Copy of Trust(s) 9. Deeds to Real Property 10. Copy of Paid Funeral Bills 11. Copy of Mortgages 12. Vehicle Titles Please return to: Buell & Ezell, LLP Attorneys at Law 24 S. Weber Street, Suite 375 Colorado Springs, CO 80903 buellandezell@gmail.com Phone: (719) 444-8900 Fax: (719) 471-2838 DISCLAIMER: The information contained in this document is for informational purposes only and is not intended to constitute legal or tax advice. An attorney should be consulted regarding your particular situation. IRS CIRCULAR 230 NOTICE: To ensure compliance with requirements imposed by the IRS, we inform you that any U.S. federal tax advice contained in this communication (or in any attachment) is not intended or written to be used, and cannot be used, for the purpose of (i) avoiding penalties under the Internal Revenue Code or (ii) promoting, marketing or recommending to another party any transaction or matter addressed in this communication (or in any attachment). 2013 Buell & Ezell, LLP. All Rights Reserved. 14