Estate Administration Questionnaire

Your Full Name:

Date of birth:

Place of birth:

Social Security Number: Please call our office at 978-465-2043 to supply this information securely.

Place of domicile:

Occupation:

Marital status:

Spouse name:

Spouse Social Security number: Please call our office at 978-465-2043 to supply this information securely.

Family Members Information

Name:
Relationship:
Address:
Social Security: Please call our office at 978-465-2043 to provide this information securely.
Telephone:

Name:
Relationship:
Address:
Social Security: Please call our office at 978-465-2043 to provide this information securely.
Telephone:

Name:
Relationship:
Address:
Social Security: Please call our office at 978-465-2043 to provide this information securely.
Telephone:

Name:
Relationship:
Address:
Social Security: Please call our office at 978-465-2043 to provide this information securely.
Telephone:

Name:
Relationship:
Address:
Social Security: Please call our office at 978-465-2043 to provide this information securely.
Telephone:

Name:
Relationship:
Address:
Social Security: Please call our office at 978-465-2043 to provide this information securely.
Telephone:

Does the decedent have a safety deposit box?

YesNo

If "Yes", please list all property in safety deposit box:

Life Insurance Policies

Name of Insurance:
Address:
Beneficiary:
Beneficiary's Address:
Amount:

Name of Insurance:
Address:
Beneficiary:
Beneficiary's Address:
Amount:

Name of Insurance:
Address:
Beneficiary:
Beneficiary's Address:
Amount:

Please list all property with a value of more than $2,000.

Please list automobiles in Descendant's name alone to include VIN#, Make, Model Year.

List all jointly held assets (example; bank accounts).

List all accounts in Descendant's name alone.

List all stocks, bonds, annuities in Descendant's name.

List all property owned by Descendant.

Is an Accountant going to file the Federal Estate Tax Return?

YesNo

Has an estate bank account been open?

YesNo

If "Yes", which bank?

Has a federal identification number been applied for?

YesNo

If "Yes", what is the number?