Probate Questionnaire by iSz7XL

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									                                             STEVEN A. EARLY, J.D., CFP®
                                                        ATTORNEY AT LAW
                                                     5850 COLLEYVILLE BLVD.
                                                   COLLEYVILLE, TEXAS 76034
                                          Telephone: (817) 605-8880 • Fax: (817) 605-8882
                                                  email: steve@lawyerearly.com

                          PROBATE INFORMATION QUESTIONNAIRE
Your appointment with this office is:                                                       at
       We ask a lot of questions on this form because we need a lot of information to properly file
and complete a Probate. Do your best, but don’t worry if some of the information you need to
complete this form is not available to you. Please call us at if you have any questions or concerns
about completing this form.

1. PERSONAL DATA

Name of DECEDENT:
Alias Names (if any):
Date of Birth:
Place of Birth:
Date of Death:
Place of Death:
SSN:
                                                         Yes         No
US Citizen?
If Naturalized U.S. Citizen,
date and place of
Naturalization:
Veteran?                                                 Yes         No
Home Address:
Home City, State, Zip:
Location of Will, if any:
Date of Will:
Location of Codicils, if any:
Date of Codicils:




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                                                 Name:
                                                 Relationship:
                                                 Phone - Home:
                                                                  Cell:
                                                                  Work:
Name/Info of PERSONAL
REPRESENTATIVE:                                                   Fax:
                                                                  Pager:
                                                 Email:
                                                 Address:
                                                 City, State,
                                                 Zip:

                                                 Name:
                                                 Relationship:
                                                 Phone - Home:
                                                                  Cell:
                                                                  Work:
Name/Info of ALTERNATE
REPRESENTATIVE:                                                   Fax:
                                                                  Pager:
                                                 Email:
                                                 Address:
                                                 City, State,
                                                 Zip:

2. BENEFICIARIES or HEIRS AT LAW

                                               Name:
                                               Phone - Home:
                                                            Cell:
Name/Info of SPOUSE/
                                                            Work:
DOMESTIC PARTNER:
                                                            Fax:
                                                            Pager:
                                               Email:
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                                               Address:
                                               City, State, Zip:
                                               Date of Birth:
Name/Info of SPOUSE/                           Social Security
DOMESTIC PARTNER                               Number:
(continued):                                   Date and Place of
                                               Marriage/Domestic
                                               Partnership:
                                                                                   Living
                                               Status of Spouse:                   Deceased
                                                                                   Under Conservatorship

CHILDREN:

1) Name:                                                                         Age:
Address:                                                                         Birthdate:
City, State, Zip:                                                                Living:        Yes    No
Phone:                                                                           Married:       Yes    No
Other parent of child, if not
decedent’s surviving spouse/partner:

2) Name:                                                                         Age:
Address:                                                                         Birthdate:
City, State, Zip:                                                                Living:        Yes    No
Phone:                                                                           Married:       Yes    No
Other parent of child, if not
decedent’s surviving spouse/partner:

3) Name:                                                                         Age:
Address:                                                                         Birthdate:
City, State, Zip:                                                                Living:        Yes    No
Phone:                                                                           Married:       Yes    No
Other parent of child, if not
decedent’s surviving spouse/partner:

4) Name:                                                                         Age:
Address:                                                                         Birthdate:
City, State, Zip:                                                                Living:        Yes    No
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Phone:                                                                           Married:     Yes   No
Other parent of child, if not
decedent’s surviving spouse/partner:

5) Name:                                                                         Age:
Address:                                                                         Birthdate:
City, State, Zip:                                                                Living:      Yes   No
Phone:                                                                           Married:     Yes   No
Other parent of child, if not
decedent’s surviving spouse/partner:

6) Name:                                                                         Age:
Address:                                                                         Birthdate:
City, State, Zip:                                                                Living:      Yes   No
Phone:                                                                           Married:     Yes   No
Other parent of child, if not
decedent’s surviving spouse/partner:

OTHER DEPENDENTS, if any:

1) Name:                                                                         Age:
Address:                                                                         Birthdate:
City, State, Zip:

2) Name:                                                                         Age:
Address:                                                                         Birthdate:
City, State, Zip:

GRANDCHILDREN:

1) Name:                                                                         Age:
Parents:                                                                         Birthdate:

2) Name:                                                                         Age:
Parents:                                                                         Birthdate:



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3) Name:                                                                         Age:
Parents:                                                                         Birthdate:

4) Name:                                                                         Age:
Parents:                                                                         Birthdate:

5) Name:                                                                         Age:
Parents:                                                                         Birthdate:

6) Name:                                                                         Age:
Parents:                                                                         Birthdate:

7) Name:                                                                         Age:
Parents:                                                                         Birthdate:

8) Name:                                                                         Age:
Parents:                                                                         Birthdate:

Please list the names of decedent's parents, brothers and sisters, whether they are living,
and if so, list their city and state of residence:

1) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


2) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


3) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


4) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


5) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:

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6) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


7) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


8) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:

Please list, as well, the names of the surviving spouse/partner’s parents, brothers and
sisters, whether they are living, and if so, list their city and state of residence:

1) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


2) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


3) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


4) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


5) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


6) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


7) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:


8) Name:                                                                         Relationship:
Living:           Yes          No           If living, City/State of Residence:

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Please provide the following information regarding decedent’s former marriages, if any:

1) Name:
Living:           Yes          No           Date of Divorce or Death:


2) Name:
Living:           Yes          No           Date of Divorce or Death:


3) Name:
Living:           Yes          No           Date of Divorce or Death:

3. DECEDENT’S DESIGNEES
TRUSTEE (i.e. the person who will be responsible for the long-term management of
property for the surviving spouse, children or other beneficiaries):

Name of Trustee:
Address:
City, State, Zip:
Home Phone:
Work Phone:
1st Alternate
Trustee:
2nd Alternate
Trustee:
3rd Alternate
Trustee:

GUARDIAN OF MINOR CHILDREN (i.e. the person who will take physical care of any
minor children should both parents die):

Name of Guardian:
Address:
City, State, Zip:
Home Phone:
Work Phone:
1st Alternate
Guardian:

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2nd Alternate
Guardian:
3rd Alternate
Guardian:

4. ASSETS

Describe decedent’s property. If known, indicate whether the property is separate
property, the surviving spouse's/partner's separate property, or community property. If
not, state the name(s) which appear on the title, if known, and state whether the property is
held with right of survivorship, if known.

CASH & ACCOUNTS WITH FINANCIAL INSTITUTIONS (include cash, traveler's
checks, money orders, and accounts with commercial banks, savings banks, credit unions,
etc.):

CASH:
                   Cash on Hand: $
            Traveler’s Checks: $
                  Money Orders: $

ACCOUNTS:

1) Name of Financial Institution:
Account Title:
Account Number:
                                                                       Checking      Savings   Money Market
Type of Account:
                                                                       CD            Other:
Current Account Balance:
                                                                  $
(as of        ):

2) Name of Financial Institution:
Account Title:
Account Number:
                                                                       Checking      Savings   Money Market
Type of Account:
                                                                       CD            Other:
Current Account Balance:
                                                                  $
(as of        ):

3) Name of Financial Institution:
Account Title:
Account Number:


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                                                                       Checking      Savings   Money Market
Type of Account:
                                                                       CD            Other:
Current Account Balance:
                                                                  $
(as of        ):

4) Name of Financial Institution:
Account Title:
Account Number:
                                                                       Checking      Savings   Money Market
Type of Account:
                                                                       CD            Other:
Current Account Balance:
                                                                  $
(as of        ):

5) Name of Financial Institution:
Account Title:
Account Number:
                                                                       Checking      Savings   Money Market
Type of Account:
                                                                       CD            Other:
Current Account Balance:
                                                                  $
(as of        ):

6) Name of Financial Institution:
Account Title:
Account Number:
                                                                       Checking      Savings   Money Market
Type of Account:
                                                                       CD            Other:
Current Account Balance:
                                                                  $
(as of        ):

REAL ESTATE (include any real property on which decedent and/or decedent's surviving
spouse/partner are an owner, joint owner or have an interest in any manner, including
property purchased in recreational developments and time-shares.):

1) Street Address of
Property:
County/State of Property:
Legal Description (if
necessary, attach a copy to
this questionnaire):
Current Fair Market Value
                                                 $
(as of         ):
Mortgage Company and                             Company:
Account Number (if any):                         Account #:

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Mortgage Balance
                                                 $
(as of       ):
Other Liens Against
Property:
Current Net Equity In
                                                 $
Property:

2) Street Address of
Property:
County/State of Property:
Legal Description (if
necessary, attach a copy to
this questionnaire):
Current Fair Market Value
                                                 $
(as of         ):
Mortgage Company and                             Company:
Account Number (if any):                         Account #:
Mortgage Balance
                                                 $
(as of         ):
Other Liens Against
Property:
Current Net Equity In
                                                 $
Property:

3) Street Address of
Property:
County/State of Property:
Legal Description (if
necessary, attach a copy to
this questionnaire):
Current Fair Market Value
                                                 $
(as of         ):
Mortgage Company and                             Company:
Account Number (if any):                         Account #:
Mortgage Balance
                                                 $
(as of         ):
Other Liens Against
Property:
Current Net Equity In
                                                 $
Property:




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MINERAL INTERESTS (include any property in which the parties own the mineral
estate, separate and apart from the surface estate, such as oil and gas leases; also include
royalty interests, working interests, and producing and non-producing oil and gas wells):

1) Name of Mineral Interest/
Lease/Well:
Type of Interest:
County/State of Location:
Legal Description (if
necessary, attach a copy to
this questionnaire):
Name of Producer/
Operator:
Current Value
                                                 $
(as of         ):

2) Name of Mineral Interest/
Lease/Well:
Type of Interest:
County/State of Location:
Legal Description (if
necessary, attach a copy to
this questionnaire):
Name of Producer/
Operator:
Current Value
                                                 $
(as of         ):

3) Name of Mineral Interest/
Lease/Well:
Type of Interest:
County/State of Location:
Legal Description (if
necessary, attach a copy to
this questionnaire):
Name of Producer/
Operator:
Current Value
                                                 $
(as of         ):




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BROKERAGE /MUTUAL FUND ACCOUNTS:

1) Name of Brokerage Firm/Mutual
Fund:
Name of Account (and
Subaccounts, if any):
Account Title:
Account Number (and Numbers of
Subaccounts, if any):
Value (as of         ):          $

2) Name of Brokerage Firm/Mutual
Fund:
Name of Account (and
Subaccounts, if any):
Account Title:
Account Number (and Numbers of
Subaccounts, if any):
Value (as of         ):          $

3) Name of Brokerage Firm/Mutual
Fund:
Name of Account (and
Subaccounts, if any):
Account Title:
Account Number (and Numbers of
Subaccounts, if any):
Value (as of        ):           $

4) Name of Brokerage Firm/Mutual
Fund:
Name of Account (and
Subaccounts, if any):
Account Title:
Account Number (and Numbers of
Subaccounts, if any):
Value (as of         ):          $

5) Name of Brokerage Firm/Mutual
Fund:
Name of Account (and
Subaccounts, if any):
Account Title:
Account Number (and Numbers of
Subaccounts, if any):
Value (as of         ):          $

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STOCKS, BONDS & OTHER SECURITIES (include securities not in a brokerage
account, mutual fund or retirement fund):

1) Name of Security:
Number of Shares:
                                                                  Common Stock     Preferred Stock
Type:
                                                                  Bond      Other:
Certificate Numbers:
In Possession Of:
Name of Exchange On Which
Listed:
Current Market Value
                                                             $
(as of        ):

2) Name of Security:
Number of Shares:
                                                                  Common Stock     Preferred Stock
Type:
                                                                  Bond      Other:
Certificate Numbers:
In Possession Of:
Name of Exchange On Which
Listed:
Current Market Value
                                                             $
(as of        ):

3) Name of Security:
Number of Shares:
                                                                  Common Stock     Preferred Stock
Type:
                                                                  Bond      Other:
Certificate Numbers:
In Possession Of:
Name of Exchange On Which
Listed:
Current Market Value
                                                             $
(as of        ):

4) Name of Security:
Number of Shares:
                                                                  Common Stock     Preferred Stock
Type:
                                                                  Bond      Other:
Certificate Numbers:
In Possession Of:


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Name of Exchange On Which
Listed:
Current Market Value
                                                             $
(as of      ):

5) Name of Security:
Number of Shares:
                                                                  Common Stock     Preferred Stock
Type:
                                                                  Bond      Other:
Certificate Numbers:
In Possession Of:
Name of Exchange On Which
Listed:
Current Market Value
                                                             $
(as of        ):

CLOSELY HELD BUSINESS INTERESTS (include sole proprietorships, professional
practices, corporations, partnerships, limited liability companies and partnerships, joint
ventures and other nonpublicly traded business entities):

1) Name of Business:

Address/City/State/Zip:

Type of Business Organization:
Percentage of Ownership:
Number of Shares Owned (if
applicable):
Value (as of       ):                                        $

2) Name of Business:
Address/City/State/Zip:
Type of Business Organization:
Percentage of Ownership:
Number of Shares Owned (if
applicable):
Value (as of       ):                                        $

3) Name of Business:
Address/City/State/Zip:
Type of Business Organization:

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Percentage of Ownership:
Number of Shares Owned (if
applicable):
Value (as of       ):                                        $

BUSINESS PERSONAL PROPERTY (i.e., patents, copyrights, trademarks, royalties, etc.):

1) Item Identification:
Location:
Value:                                   $

2) Item Identification:
Location:
Value:                                   $

3) Item Identification:
Location:
Value:                                   $

4) Item Identification:
Location:
Value:                                   $

5) Item Identification:
Location:
Value:                                   $

6) Item Identification:
Location:
Value:                                   $

7) Item Identification:
Location:
Value:                                   $

8) Item Identification:
Location:
Value:                                   $



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RETIREMENT BENEFITS (including Defined Contribution Plans, Defined Benefit Plans,
IRA's, SEP's, KEOGH's, Nonqualified Plans and Government Benefits such as civil
service, teacher, railroad, state and local, etc.):

1) Name of Plan:
Name and Address of Plan                      Name:
Administrator:                                Address:
                                                IRA/SEP/KEOUGH/Defined Contribution Plan
                                                Defined Benefit Plan
Type:
                                                Government Benefit:
                                                Other:
Employee:
Employer:
Starting Date of
                                                                                  Percentage Vested:
Creditable Service:
Account Title:
Account Number:
Payee of Survivor
Benefits:
Designated Beneficiary:
Current Account Balance
                                              $
(as of       ):

2) Name of Plan:
Name and Address of Plan                      Name:
Administrator:                                Address:
                                                IRA/SEP/KEOUGH/Defined Contribution Plan
                                                Defined Benefit Plan
Type:
                                                Government Benefit:
                                                Other:
Employee:
Employer:
Starting Date of
                                                                                  Percentage Vested:
Creditable Service:
Account Title:
Account Number:
Payee of Survivor
Benefits:
Designated Beneficiary:
Current Account Balance
                                              $
(as of       ):




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3) Name of Plan:
Name and Address of Plan                      Name:
Administrator:                                Address:
                                                IRA/SEP/KEOUGH/Defined Contribution Plan
                                                Defined Benefit Plan
Type:
                                                Government Benefit:
                                                Other:
Employee:
Employer:
Starting Date of
                                                                                  Percentage Vested:
Creditable Service:
Account Title:
Account Number:
Payee of Survivor
Benefits:
Designated Beneficiary:
Current Account Balance
                                              $
(as of       ):

LIFE INSURANCE:

1) Life Insurance Company Name:
Policy Number:
Name of Owner:
Name of Insured:
Designated Beneficiary:
Date of Issue:
                                                                  Term
Type of Insurance:                                                Whole Life      Face Amount:    $
                                                                  Universal
                                                                                     Monthly
Amount of Premiums:                                          $                       Quarterly
                                                                                     Semi-Annually
Cash Surrender Value
                                                             $
(as of       ):

2) Life Insurance Company Name:
Policy Number:
Name of Owner:
Name of Insured:
Designated Beneficiary:
Date of Issue:
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                                                                  Term
Type of Insurance:                                                Whole Life      Face Amount:   $
                                                                  Universal
                                                                                    Monthly
Amount of Premiums:                                          $                      Quarterly
                                                                                    Semi-Annually
Cash Surrender Value
                                                             $
(as of       ):

3) Life Insurance Company Name:
Policy Number:
Name of Owner:
Name of Insured:
Designated Beneficiary:
Date of Issue:
                                                                  Term
Type of Insurance:                                                Whole Life      Face Amount:   $
                                                                  Universal
                                                                                    Monthly
Amount of Premiums:                                          $                      Quarterly
                                                                                    Semi-Annually
Cash Surrender Value
                                                             $
(as of       ):

4) Life Insurance Company Name:
Policy Number:
Name of Owner:
Name of Insured:
Designated Beneficiary:
Date of Issue:
                                                                  Term
Type of Insurance:                                                Whole Life      Face Amount:   $
                                                                  Universal
                                                                                    Monthly
Amount of Premiums:                                          $                      Quarterly
                                                                                    Semi-Annually
Cash Surrender Value
                                                             $
(as of       ):




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ANNUITIES:

1) Company Name:
Policy Number:
Name of Owner:
Name of Annuitant:
Designated Beneficiary:
Date of Issue:
Type of Annuity:                                                                  Face Amount: $
                                                                                     Monthly
Amount of Premiums:                              $                                   Quarterly
                                                                                     Semi-Annually
Cash Surrender Value
                                                 $
(as of       ):

2) Company Name:
Policy Number:
Name of Owner:
Name of Annuitant:
Designated Beneficiary:
Date of Issue:
Type of Annuity:                                                                  Face Amount: $
                                                                                     Monthly
Amount of Premiums:                              $                                   Quarterly
                                                                                     Semi-Annually
Cash Surrender Value
                                                 $
(as of       ):

3) Company Name:
Policy Number:
Name of Owner:
Name of Annuitant:
Designated Beneficiary:
Date of Issue:
Type of Annuity:                                                                  Face Amount: $
                                                                                     Monthly
Amount of Premiums:                              $                                   Quarterly
                                                                                     Semi-Annually
Cash Surrender Value
                                                 $
(as of       ):


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4) Company Name:
Policy Number:
Name of Owner:
Name of Annuitant:
Designated Beneficiary:
Date of Issue:
Type of Annuity:                                                                       Face Amount: $
                                                                                          Monthly
Amount of Premiums:                              $                                        Quarterly
                                                                                          Semi-Annually
Cash Surrender Value
                                                 $
(as of       ):

MOTOR VEHICLES, BOATS, AIRPLANES, CYCLES, ETC. (including mobile homes,
trailers, and recreational vehicles):

1) Year:                     Make:                                                      Model:
Name on Certificate of Title:
In Possession Of:
Vehicle Identification
Number:
Name of Creditor, if loan
against vehicle:
Current Balance                                                                   Current Net Equity
                                                 $                                                     $
(as of           ):                                                               in Vehicle:

2) Year:                     Make:                                                      Model:
Name on Certificate of Title:
In Possession Of:
Vehicle Identification
Number:
Name of Creditor, if loan
against vehicle:
Current Balance                                                                   Current Net Equity
                                                 $                                                     $
(as of           ):                                                               in Vehicle:

3) Year:                     Make:                                                      Model:
Name on Certificate of Title:
In Possession Of:
Vehicle Identification
Number:
Name of Creditor, if loan
against vehicle:
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Current Balance                                                                   Current Net Equity
                                                 $                                                     $
(as of          ):                                                                in Vehicle:

4) Year:                     Make:                                                      Model:
Name on Certificate of Title:
In Possession Of:
Vehicle Identification
Number:
Name of Creditor, if loan
against vehicle:
Current Balance                                                                   Current Net Equity
                                                 $                                                     $
(as of           ):                                                               in Vehicle:

5) Year:                     Make:                                                      Model:
Name on Certificate of Title:
In Possession Of:
Vehicle Identification
Number:
Name of Creditor, if loan
against vehicle:
Current Balance                                                                   Current Net Equity
                                                 $                                                     $
(as of           ):                                                               in Vehicle:

OTHER MISCELLANEOUS PROPERTY (including household furniture, furnishings,
and fixtures, electronics and computers, antiques, artwork, collections, sporting goods,
firearms, jewelry and other personal items, livestock, etc.):

1) Description of Asset:
Owner:
Current Value:                              $

2) Description of Asset:
Owner:
Current Value:                              $

3) Description of Asset:
Owner:
Current Value:                              $

4) Description of Asset:
Owner:
Current Value:                              $

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5) Description of Asset:
Owner:
Current Value:                              $

6) Description of Asset:
Owner:
Current Value:                              $

7) Description of Asset:
Owner:
Current Value:                              $

8) Description of Asset:
Owner:
Current Value:                              $

9) Description of Asset:
Owner:
Current Value:                              $

10) Description of Asset:
Owner:
Current Value:                              $

11) Description of Asset:
Owner:
Current Value:                              $

12) Description of Asset:
Owner:
Current Value:                              $

13) Description of Asset:
Owner:
Current Value:                              $




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Updated 8/8/2012
SAFE DEPOSIT BOXES:

1) Name of Depository:
Box Number:
Names of Persons with
Access to Contents:



Items in Safe Deposit
Box:




2) Name of Depository:
Box Number:
Names of Persons with
Access to Contents:



Items in Safe Deposit
Box:




3) Name of Depository:
Box Number:
Names of Persons with
Access to Contents:



Items in Safe Deposit
Box:




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Updated 8/8/2012
INDICATE DOCUMENTS TO BRING TO INTERVIEW:

      1. Prior and present Wills and any codicils

      2. Death certificate

      3. Paid funeral bills

      4. Trust instruments in which client is grantor, trustee or beneficiary

      5. Income tax return (most recent)

      6. Gift tax returns (all)

      7. Texas intangible tax return (most recent)

      8. Financial statements prepared by accountant

      9. Financial information submitted to lending institutions

      10. Real and personal property tax bills

      11. Deeds to property

      12. Mortgages

      13. Vehicle titles

      14. Copies of any bills and creditors' addresses

      15. Government, municipal, and corporate bonds
    16. Life and health insurance policies and annuities and summary of current owner
 and beneficiary provisions
    17. Savings account passbooks, statements relating to certificates of deposit, money
 market certificates and liquid daily asset accounts
      18. Stockholder or partnership agreements

      19. Pension and profit-sharing plans and summary of current benefits

      20. Leases

      21. Instruments under which client has any interest or power of appointment

      22. Prenuptial, postnuptial or separation agreements

      23. Judgments of dissolution of marriage

      24. Court orders or agreements under which client is obligated to provide support

      25. Wills of other family members, if pertinent
      26.

                                                                  Page 24 of 24
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Updated 8/8/2012

								
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