Estate Administration Questionnaire - Sussan, Greenwald & Wesler

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MEET OUR ATTORNEYS

To maximize the effectiveness and efficiency of our first meeting together, we ask that you provide as much of the information sought in this form as possible. Your accuracy and completeness in responding will help us to best represent you in this matter. Please bring this information with you to our initial appointment. Throughout this form we refer to the person who has passed away as the “Decedent” and you as our “Client.”

Personal & General Information

Client's Information

Full Legal Name(Required)

Birth Date(Required)

Social Security Number(Required)

U.S. Citizen?(Required)

Home Phone(Required)

Home Email(Required)

Work Phone(Required)

Work Email(Required)

Work FAX(Required)

Cell Phone(Required)

Full Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Decedent's Information

Full Legal Name(Required)

Birth Date(Required)

Social Security Number(Required)

U.S. Citizen?(Required)

Date of death(Required)

Cause of death(Required)

Full Mailing Address (at time of death)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

How did you hear about us?

How did you hear about us?(Required)

Ex: Seminar/Community Education, Referral, Google, MSN, Yahoo, Postcard, Yellow Pages, other

Decedent’s Children & Marriage(s)

(please indicate if children were adopted)

Date of current marriage (with spouse at time of death)(Required)

Does the decedent have any children from a previous marriage?

Yes

Was decedent or decedent’s spouse ever been married before?

Yes

Please provide name(s) of former spouse(s) and date(s) of divorce(s) and/or death(s)(Required)

Are any of the children listed below disabled?

Yes

Please describe the disability and the child(ren) effected by such disability(Required)

Are any of the children listed below receiving SSI or other government benefits?

Yes

Please list the benefits and child(ren) receiving them(Required)

Are any of the children listed below deceased?

Yes

Please list the name(s) of the deceased child(ren) and the name(s) of their living child(ren), if any(Required)

Total Number of Children(Required)

Hidden

child1

Child #1 Full Legal Name(Required)

Date of Birth(Required)

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

From Previous Marriage? (Wife)

Yes

From Previous Marriage? (Husband)

Yes

# of children (i.e., your grandchildren)(Required)

Add Another Child

Yes

Hidden

child2

Child #2 Full Legal Name(Required)

Date of Birth(Required)

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

From Previous Marriage? (Wife)

Yes

From Previous Marriage? (Husband)

Yes

# of children (i.e., your grandchildren)(Required)

Add Another Child

Yes

Hidden

child3

Child #3 Full Legal Name(Required)

Date of Birth(Required)

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

From Previous Marriage? (Wife)

Yes

From Previous Marriage? (Husband)

Yes

# of children (i.e., your grandchildren)(Required)

Hidden

Section Break

Decedent's Extended Family

Decedent's Parents

Father Full Name(Required)

Father Date of Birth(Required)

Father Phone Number(Required)

Father Date of Death(Required)

Father Full Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mother Full Name(Required)

Mother Date of Birth(Required)

Mother Phone Number(Required)

Mother Date of Death(Required)

Mother Full Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Decedent's Siblings

Total Number of Siblings(Required)

Sibling #1 Full Name(Required)

Sibling #1 Age(Required)

Sibling #1 Phone Number(Required)

Sibling #1 Date of Death(Required)

Sibling #1 Number of Children(Required)

Sibling #1 Full Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Add Sibling

Yes

Hidden

sib2

Sibling #2 Full Name(Required)

Sibling #2 Age(Required)

Sibling #2 Phone Number(Required)

Sibling #2 Date of Death(Required)

Sibling #2 Number of Children(Required)

Sibling #2 Full Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Add Sibling

Yes

Hidden

sib3

Sibling #3 Full Name(Required)

Sibling #3 Age(Required)

Sibling #3 Phone Number(Required)

Sibling #3 Date of Death(Required)

Sibling #3 Number of Children(Required)

Sibling #3 Full Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Hidden

Section Break

Financial Summary (Assets)

Checking Account

Joint - Checking Account(Required)

Spouse - Checking Account(Required)

Decedent - Checking Account(Required)

Savings Account

Joint - Savings Account(Required)

Spouse - Savings Account(Required)

Decedent - Savings Account(Required)

Real Estate (residence)

Joint - Real Estate (residence)(Required)

Spouse - Real Estate (residence)(Required)

Decedent - Real Estate (residence)(Required)

Real Estate (other)

Joint - Real Estate (other)(Required)

Spouse - Real Estate (other)(Required)

Decedent - Real Estate (other)(Required)

Certificates of Deposit

Joint - Certificates of Deposit(Required)

Spouse - Certificates of Deposit(Required)

Decedent - Certificates of Deposit(Required)

Money Market Funds

Joint - Money Market Funds(Required)

Spouse - Money Market Funds(Required)

Decedent - Money Market Funds(Required)

Stocks - (Not Held by Broker)

Joint - Stocks - (Not Held by Broker)(Required)

Spouse - Stocks - (Not Held by Broker)(Required)

Decedent - Stocks - (Not Held by Broker)(Required)

Stocks - (Held by Broker)

Joint - Stocks - (Held by Broker)(Required)

Spouse - Stocks - (Held by Broker)(Required)

Decedent - Stocks - (Held by Broker)(Required)

Bonds - (Not Held by Broker)

Joint - Bonds - (Not Held by Broker)(Required)

Spouse - Bonds - (Not Held by Broker)(Required)

Decedent - Bonds - (Not Held by Broker)(Required)

Bonds - (Held by Broker)

Joint - Bonds - (Held by Broker)(Required)

Spouse - Bonds - (Held by Broker)(Required)

Decedent - Bonds - (Held by Broker)(Required)

Mutual Funds

Joint - Mutual Funds(Required)

Spouse - Mutual Funds(Required)

Decedent - Mutual Funds(Required)

Notes and Mortgages Receivable

Joint - Notes and Mortgages(Required)

Spouse - Notes and Mortgages(Required)

Decedent - Notes and Mortgages(Required)

Business Interests

Joint - Business Interests(Required)

Spouse - Business Interests(Required)

Decedent - Business Interests(Required)

Expected Inheritance

Joint - Expected Inheritance(Required)

Spouse - Expected Inheritance(Required)

Decedent - Expected Inheritance(Required)

Automobiles

Joint - Automobiles(Required)

Spouse - Automobiles(Required)

Decedent - Automobiles(Required)

Jewelry & Collections

Joint - Jewelry & Collections(Required)

Spouse - Jewelry & Collections(Required)

Decedent - Jewelry & Collections(Required)

Non-IRA Qualified Retirement Plans

Joint - Non-IRA Qualified Retirement Plans(Required)

Spouse - Non-IRA Qualified Retirement Plans(Required)

Decedent - Non-IRA Qualified Retirement Plans(Required)

IRAs

Joint - IRAs(Required)

Spouse - IRAs(Required)

Decedent - IRAs(Required)

Life Insurance

Joint - Life Insurance(Required)

Spouse - Life Insurance(Required)

Decedent - Life Insurance(Required)

Annuities

Joint - Annuities(Required)

Spouse - Annuities(Required)

Decedent - Annuities(Required)

Other Assets

Joint - Other Assets(Required)

Spouse - Other Assets(Required)

Decedent - Other Assets(Required)

Total Assets

Joint - Total Assets(Required)

Spouse - Total Assets(Required)

Decedent - Total Assets(Required)

Financial Summary (Liablities)

Notes Payable on Real Estate (i.e., mortgages)

Joint - Notes Payable on Real Estate(Required)

Spouse - Notes Payable on Real Estate(Required)

Decedent - Notes Payable on Real Estate(Required)

Other Loans Payable (e.g., home equity, etc.)

Joint - Other Loans Payable(Required)

Spouse - Other Loans Payable(Required)

Decedent - Other Loans Payable(Required)

Credit Card Debt

Joint - Credit Card Debt(Required)

Spouse - Credit Card Debt(Required)

Decedent - Credit Card Debt(Required)

Other Miscellaneous Debt

Joint - Other Miscellaneous Debt(Required)

Spouse - Other Miscellaneous Debt(Required)

Decedent - Other Miscellaneous Debt(Required)

Total Liablities

Joint - Total Liablities(Required)

Spouse - Total Liablities(Required)

Decedent - Total Liablities(Required)

Decedent's Estate Planning Information

Which, if any, estate planning document does the decedent have in place?(Required)

Will(s)

Trust(s)

Medical Power(s) of Attorney

Financial Power(s) of Attorney

Does the decedent have a Safe Deposit Box?

Yes

With Whom?(Required)

Did the decedent make any gifts within the three years before passing?

Yes

End of Estate Administration Questionnaire

Enter your email(Required)

Thank you for completing the Estate Administration Questionnaire. If you don't receive confirmation in your email, please check your junk mail.

Please remember to bring copies of the following to the initial meeting:

• Recent account statements for all assets
• Recent statements for all life insurance policies
• Deed(s), land contracts, mortgages, notes, and tax statements for all real estate
• Documents evidencing any business interests (i.e. - corporations, LLCs, etc.)
• Motor vehicle titles
• Estate planning documents (i.e. - wills, trusts, amendments, powers of attorney, etc)
• Letters of Authority (For court-appointed guardians and/or conservators)
• Proof of liabilities, creditors, debts, and outstanding bills
• Proof of income and deductions
• Private health insurance coverage policies and recent statement
• Proof of identification, including driver's license, SS card, and birth certificate
• Several certified copies of the decedent’s death certificate

Please note that we will not keep any documentation you provide unless you decide to retain us, in which case, we will request copies of said documentation.

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REGULATIONS Part 300
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28 C.F.R. Part 35 28 C.F.R. Part 35
NONDISCRIMINATION ON THE BASIS OF DISABILITY IN STATE AND LOCAL GOVERNMENT SERVICES
REHABILITATION ACT OF 1973 SECTION 504
FAMILY EDUCATION RIGHTS & PRIVACY ACT (FERPA)
DEVELOPMENTAL DISABILITIES ASSISTANCE AND BILL OF RIGHTS ACT OF 2000
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