407-647-PLAN (7526)

REQUEST A CONSULTATION

CALL US: 407-647-PLAN (7526)

Billing Address:

Zip:

Client Date of Birth:

Client’s Cell #

Client’s Home #

Client’s Email Address:

Name of Decreased/Grantor
(Spell name exactly as listed on Will and/or Trust)

Date of Death:

Place of Death
(City/ State)

Relationship to Client:

Was Deceased/ Grantor?:
MarriedWidowedSingle

Spouse’s Name:

Date of Marriage

Spouse’s Date of Birth

Do you have an original short form Death Certificate?:

Did the deceased/ grantor have a:

WillTrustPower of Attorney

Are you the Personal Representative. Trustee of the Decedents’s estate/trust?

Did the deceased/ grantor own property in other counties?

Did the deceased/ grantor own property in other states?

Bank Name & Bank Branch

Do you have access to the safe deposit box?

Whom may we thank for referring you?

I. Date of Will

Date of Trust

Relationship:

Phone:

Date of Birth:

SSN#:

Relationship:

Phone:

Date of Birth:

SSN#:

Relationship:

Phone:

Date of Birth:

SSN#:

Relationship: 4

Phone:

Date of Birth:

SSN#:

State

County

Street Address

Was this property the homestead property?

Is there an outstanding mortgage on this property? Amount $

Was this property titled jointly with anybody else? Name:

What is the Fair Market Value of this property? $

State

County

Street Address

Was this property the homestead property?

Is there an outstanding mortgage on this property?

Was this property titled jointly with anybody else? Name:

What is the Fair Market Value of this property? $

Cash & Bank Deposits

Securities -Stocks, Bonds, Certificate of Deposits

Retirement Plans (Pensions, IRAs, 40lks, etc.)

Life Insurance Policies

Annuities

Notes Payable to Decedent/Grantor

Partnership, Business or Other Interest

Vehicles -Autos, Boats, Motorcycles/ATVs, Jet Skis, etc.

Antiques/Collectable

Jewelry

Please state approximate value: $

Furniture/China

Please state approximate value: $

Other (Coins, etc.)

Please state approximate value: $

Credit Cards

o Visa
o MasterCard
o Discover
o American Express
o Department Store- Sears, JC Penney, Macy's, Lowe's, Home Depot, etc

(Please bring most recent copy of each and every credit card statement.)

Mortgages