Kimberly L. Kelly * Deborah A. Baglio Jamie L. Kelaher * LAW OFFICE OF KIMBERLY L. KELLY, LLP 92 Montvale Avenue, Suite 2700 Stoneham, MA 02180 Kimberly@kimberlykellylaw.com Deborah@kimberlykellylaw.com Jamie@kimberlykellylaw.com David Aptaker of Counsel Telephone: (781) 438-5222 Facsimile: (781) 438-0556 *Admitted in MA and CT www.kimberlykellylaw.com PROBATE AND ESTATE TAX QUESTIONNAIRE INSTRUCTIONS: Attach an original death certificate and Will (if applicable). Complete the information below, if space is insufficient, please attach separate sheets with additional information. PLEASE RETURN QUESTIONNAIRE, TOGETHER WITH COPIES OF THE DECEDENT'S LAST FEDERAL AND STATE INCOME TAX RETURNS FOR THE PAST TWO YEARS AND ANY ADDITIONAL INFORMATION REQUESTED BELOW. Decedent's name(s): Social Security No. Decedent's residence Year residence established Other residence USA citizen? Yes No Date of Birth: Place of Birth Date of Death Name and address of Decedent's physician: Hospitals decedent admitted to within last year: Length of last illness: decedent's occupation: Retired? Spouse's name: Spouses s S.S. Was spouse alive at time of decedent's death? If "Yes", date of spouse's birth: Date and place of marriage:
Decedent's domicile at time of marriage: If not, date of spouse's death HEIRS OF DECEDENT: Name Address Relationship Social Security No. Date of Birth Unless already listed under Heirs of Decedent, please list same information (name, address, relationship, social security number and date of birth) for the following: Living children of Decedent Deceased children and children of deceased children of Decedent Living parents of Decedent Living sisters/ brothers of Decedent Probate and Estate Tax Questionnaire Page 2 of 11
Deceased sisters/brothers and children of deceased siblings PROPERTY IN DECEDENT'S NAME ONLY (List joint property in next section) A. Real Estate: address of each location; assessed value; fair market value at time of death; attach copy of real estate tax bill & deed. _ B. STOCKS AND BONDS: name of company; number of shares; value at time of decedent's death, if known; CUSIP; provide copies of certificates. C. BANK ACCOUNTS: name of bank(s), account number(s) and amount(s) on date of death, address of bank - provide statement(s) for date of death balance(s) Probate and Estate Tax Questionnaire Page 3 of 11
D. MORTGAGES: including name and address of lender, borrowers and balance due at time of death - provide mortgage statement as of date of death E. NOTES PAYABLE TO DECEDENT: include name and addresses of maker and balance due to decedent at time of death - (provide documentation) F. CASH in decedent's possession at death G. LIFE INSURANCE: Life insurance on decedent's life (forward check stubs and/or accompanying statement of benefits and/or Form 712, if payment has been received; or original life insurance policies if claims has not yet been made); include address of life insurance company. Name of Company Policy # Face Amount Beneficiary Probate and Estate Tax Questionnaire Page 4 of 11
H. LIFE INSURANCE: Life insurance owned by decedent on life of another: Name of Company Policy # Face Amount Beneficiary I. TANGIBLES: cars (need Year, Make, Model, Odometer reading as of date of death, vehicle I.D #), boats, art collections, valuable rugs, jewelry, etc.; indicate fair market value or book value) of each item. J. PENSIONS: ANNUITY, PROFIT SHARING, IRA'S, KEOGHS, SEPS: was the decedent receiving pension, annuity, profit sharing at time of death? If so, name and address of company, policy #, documentation or any correspondence from company indicating value, terms, beneficiaries, and/or contributions by decedent. Is pension, annuity, or profit sharing payable to any survivor of decedent? If so, please describe to whom and how: Probate and Estate Tax Questionnaire Page 5 of 11
_ Is Plan "Qualified"? Name, telephone number and position of person who can answer technical questions about pension plan. K. TRANSFERS, GIFTS: transfers within three (3) years of death for less than cash value (specify name and address of recipient, value paid to decedent and actual value of property); any gift tax returns filed? If so, attach copies of all gift tax returns. _ L. POWERS OF APPOINTMENT: Did the decedent hold any powers of appointment in any Wills or trusts?. If so, attach copy of instrument giving rise to power of appointment. JOINT PROPERTY: Property held in name of decedent and one or more other persons; state name and address of each joint owner. A. REAL ESTATE: address of each location, assessed value, fair market value, and copies of real estate tax bill & deed. _ Probate and Estate Tax Questionnaire Page 6 of 11
_ B. BANK ACCOUNTS: specify bank and address, account number, amount as of date of death; forward copy of all statements closest to date of death. C. STOCKS AND BONDS: name of company, number of shares, name of any joint owners, CUSIP number, face value of bonds, and market value at death. D. TANGIBLES: cars, boats, art collections, rugs, jewelry, etc. Include estimate (or book value) of each item, Vehicle I.D # and/or Title #. _ Probate and Estate Tax Questionnaire Page 7 of 11
EXPENSES A. FUNERAL BILLS: name and address of provider as well as amounts for services for ground fees, monuments, flowers, telephone calls, catering service, clergy, food, liquor, etc., for reception following funeral gathering. Attach funeral statement. Include any travel and hotel expenses for the Executor or Administrator of the Estate. B. UNPAID MEDICAL BILLS AND DEBTS AS OF DATE OF DEATH: include name and address of provider of medical bills, utilities, credit cards, unpaid taxes and all other debts owed by decedent at death. Be specific. C. ALL BILLS PAID AFTER DATE OF DEATH: include name and address of creditor, account numbers if applicable, and nature of debt. Be specific. _ Probate and Estate Tax Questionnaire Page 8 of 11
D. MORTGAGES AND LIENS: specify lender or mortgagee, address, account # and outstanding balance as of date of death; attach any statement nearest to the date of death. MISCELLANEOUS Had decedent entered into any contracts before death? If so, please describe Are there any civil actions pending by or against decedent? If so, please describe, including court in which action is pending, names of all parties, court docket number, type of action, etc. Were there in existence at time of death any trust created by decedent during decedent's lifetime? If yes, state date of creation of trust, beneficiaries of trust, and whether decedent was Trustee or had any beneficial interest in trust. _ Have federal gift tax returns ever been filed? If so, when? where? Probate and Estate Tax Questionnaire Page 9 of 11
Attach copies of gift tax returns. Did decedent own a safe deposit box? Where? If jointly owned, with whom?. Did contents include anything of value (except valuable papers, such as deeds, insurance policies, etc.)? If so, please list owner of contents and estimated value of each: Did the decedent receive any Medicaid benefits? How much did he or she receive after reaching age 65? Probate and Estate Tax Questionnaire Page 10 of 11
CHECKLIST OF DOCUMENTS NEEDED TO ADMINISTER THE ESTATE A. Of immediate importance: (1) original will (and codicils); (2) original trust instruments (and amendments) created by the decedent (3) certified death certificate. (4) certified death certificate of predeceased spouse (if applicable) B. Of secondary importance: (1) federal and state income tax returns for the past two years; (2) all previously filed gift tax returns, if any; (3) copies of passbooks or statements for all bank accounts and term certificates in which decedent has an interest, individually, as joint owner, "trustee," or otherwise closest to date of death; (4) account statement of all stocks, bonds, and other securities owned individually or jointly by decedent closest to date of death; (5) copies of brokerage statements closest to date of death; (6) stock option documents for outstanding options; (7) life insurance policies (whether or not on decedent's own life) owned by decedent; (8) last annual summary, if any, of death benefits provided by decedent's employer; (9) statement or summary, if any, of death benefits provided by prior employer(s) of decedent to which decedent is entitled; (10) pension or profit sharing plan statements and beneficiary designations; (11) individual retirement account (IRA) statements and beneficiary designations; (12) documents concerning prior divorce or separation of decedent; (13) documents concerning armed services record of decedent; (14) copies of any will or trust agreement of which the decedent was a beneficiary; (15) copies of any will or trust agreement of which the decedent was a fiduciary; (16) any contracts, not completed prior to decedent's death, to which the decedent was a party; and (17) copies of deeds to real estate. Probate and Estate Tax Questionnaire Page 11 of 11 Law Office of Kimberly L. Kelly, LLP * 92 Montvale Avenue, Suite 2700 * Stoneham, MA 02180