DECEDENT'S ESTATE DATA PACKET
1.
About the Decedent 1.01 Name:
1.02
Social Security #:
1.03
Address:
1.04 1.05
Date of Birth: Date of Death:
1.06
Age at Death:
1.07
heirs-at-law: A. Never married (i) Parents (ii) Siblings (iii) Issue of siblings Name: Address: Relationship: Name: Address: Relationship: Name: Address: Relationship:
B. Married, divorced, widow, widower (i) Spouse and issue (ii) Parents (iii) Siblings SSN: DOB: Phone: SSN: DOB: Phone: SSN: DOB: Phone:
(a)
(b)
(c)
(d)
Name: Address: Relationship: Name: Address: Relationship: Name: Address: Relationship: Name: Address: Relationship: Name: Address: Relationship: Name: Address: Relationship: Name: Address: Relationship:
SSN: DOB: Phone: SSN: DOB: Phone: SSN: DOB: Phone: SSN: DOB: Phone: SSN: DOB: Phone: SSN: DOB: Phone: SSN: DOB: Phone:
(e)
(f)
(g)
(h)
(i)
(j)
1.08 1.09
List property which decedent had any interest in Part 2. Did decedent leave a will? _________________
1.10 Who is responsible for filing decedent's last U.S. and Tennessee Income Tax Returns? ___________________________________ 1.11 Did decedent have a safe deposit box? __________________ If yes, please give the following information: (a) (b) (c) (d) Where? Number: ____________________________________________ Title on box: _____________________________________ Authorized signatories: (i) (ii) (iii)
2.
Decedent's property 2.01 Real property. Please give description of land and appraised value.
2.02 Stocks, Bonds and Marketable Securities (give number of shares, company, numbers)
2.03 Bank Accounts and Cash (give name of bank, type of account, account number, titled owner, and balance)
2.04 Life Insurance (Give name of company, policy number, beneficiary, and amount)
2.05 Automobiles and other vehicles (Give description, decedent's interest, and fair market value)
2.06 Other personal property (List all property of any value and give estimated value at death)
2.07 Debts (Give name of creditor, amount of debt)
3.
Codicil 3.01 Was there a codicil to the will? ______________________ If yes, complete the following: (a) (b) (c) Date signed: ______________________________________ Location of original: ______________________________ Witnesses: (i) (ii) Same as will? __________________________________ Others as follows: A. Name: __________________________________ Address: ______________________________________ Name: ________________________________ Address: ____________________________________
B.
(d)
Proof of signing by: (i) Affidavit ____________ Personal appearance
(e)
Describe changes made to will:
INFORMATION FOR U.S. ESTATE TAX AND TENNESSEE INHERITANCE TAX RETURNS
1.01 1.02 1.03 1.04 1.05 1.06 1.07
Domicile at death: ______________________________________ Year established: ______________ Place of birth: __________________________________________ Place of death: _________________________________________ Cause of death: ________________________________________ Length of illness: ______________________________________ Physicians: Name: ______________________________ Phone: _______________ Address: Name: _____________________________ Phone: _______________ Address:
1.08 1.09 1.10
Occupation: Retired? ____________ Marital status: ____________ If married, divorce:,
separated, or if spouse is dead give the following information: Name of spouse: ____________________________________________ Date of marriage: _______________________ Residence at date of marriage: ____________________________ If divorced, date of divorce: ______________________________ If spouse deceased, give date of death: _____________________ 1.11 Did anyone other than the decedent own life insurance on decedent's life? If yes, provide the following information: Name of owner: _______________________________ Face Amount: _____________________________________________ Name of insurance company: _________________________________ Circumstances for purchase: _________________________________ _______
1.12
Did decedent own property jointly with anyone? ______________________________________ Address: Identity of property: Circumstances:
___________ Name of joint owners:
1.13
Did decedent own any interest ma partnership or unincorporated business? __________________ Name of business: _________________________________________ Address: Phone: _______________________ EIN: ______________________ Information about other owners: Name: ________________________________________________________ Address: ____________________________________________________ Phone:
1.14 Did decedent own any articles or collections jewelry, furs, paintings, antiques, rare books, coins or stamps? __________ Description: ____________________________________________________ Value: Source of valuation: ________________________________________ 1.15 Did decedent own life insurance on the life of any other person? ____________ Name of insured: ___________________________________________ Relationship to decedent: ___________________________________ Address: Name of insurance company: _________________________________ Policy number: ___________________ Face amount: __________ Beneficiary: __________________________________________________
1.16
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? Name of payer: ________________________________________________ Address of payer: ___________________________________________ Amount to be paid: ___________________________________________ Name of payee: ______________________________________________
1.17
Did decedent transfer any property by gift within three years of death? ______________
1.18 Did decedent transfer any property subject to a condition that the recipient had to survive the decedent in order to possess or enjoy the property? ___________________________ 1.19 Did the decedent transfer property and retain the right to control possession or enjoyment? ________________________ Did the decedent transfer any property and retain the right to revoke the transfer? ________________
1.20
If the answer to any of questions .17 through .20 is yes, give the following information: Name of recipient: _________________________________________ Address: Date of transfer: _______________ Amount transferred:
Reason for transfer: _______________________________________ 1.21 Name and address of each hospital decedent was admitted to within three years of death:
1.22
Did decedent create any trust during decedent's lifetime?_______________ Date of trust: Name of trustee: Address of trustee: Has decedent filed U.S. or Tennessee Gift Tax Returns? __________ Period covered: IRS Office where filed: ____________________________________
1.23
1.24
Did decedent possess a general power of appointment? ______
1.25
Did decedent ever exercise or release a general power of appointment? ___________________
If the answers to either .24 or .25 is yes, give the following: (a) (b) 1.26 A copy of the document creating the power Information regarding the value of the property subject to the power
Was the decedent receiving an annuity at the time of decedent's death? _______________ Was the annuity paid from a qualified retirement plan? _____ How much did decedent contribute to the plan? ______________
1.27
If the decedent died while employed, was any person entitled to payment from decedent’s employer by reason of surviving the decedent? __________________ Amount receivable by the beneficiary:_____________________ Amount contributed to the fund to provide for the payment by decedent: _________________________________________________
1.28
Did decedent have an individual retirement account? _______ Name of beneficiary: _______________________________________ Address: Terms of payment to beneficiary: ___________________________
1.29 1.30
Was decedent survived by a spouse? _______________________ If decedent was not survived by a spouse, was decedent survived by a child under age 21 who has no parent living? Name: Date of Birth: _________________________ Names of parents: __________________________________________ Value of property passing from decedent to child: _______