Estate Planning Questionnaire Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.INTRODUCTION: The following Questionnaire may seem imposing and unnecessarily lengthy; however, much of the requested information may not apply. The requested information is necessary to comply with the requirements of the probate court and to prepare an accurate estate tax return. The following information will be treated as strictly confidential. Please do not hesitate to call us if you have any questions regarding the Questionnaire. Decedent's Full Name *FirstMiddleLastDate of Death *Date of Birth *Social Security Number *Occupation or Former Occupation *Was the Decedent Retired?NoYesDomicile at Time of Death *Year Domicile was Established *Marital Status *SingleMarriedSeparatedDivorcedIf Widow(er), Name of Deceased Spouse *FirstLastDate of Death of Deceased SpouseIs there a valid will? *YesNoPERSONAL REPRESENTATIVE INFORMATION: Name of Executor/ Personal Representative *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone Number *Social Security Number *BENEFICIARY INFORMATION: SPOUSE: NameFirstLastAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of BirthSocial Security NumberCHILDREN: NameFirstLastAddress Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of BirthSocial Security NumberNameFirstLastAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of BirthSocial Security NumberNameFirstLastAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of BirthSocial Security NumberName FirstLastAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of BirthSocial Security NumberGRANDCHILDREN (if beneficiary): Name FirstLastAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of BirthSocial Security NumberName FirstLastAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of BirthSocial Security NumberAny beneficiary children or grandchildren information not listed above:Other individuals/organizations who benefit from the Estate:ASSETS OF THE DECEDENT Real and tangible personal property located outside of Pennsylvania: Held in decedent's name alone: List details for each one.Held jointly with others (names of joint owners):List details for each one.Pennsylvania real estate: Held in decedent's name alone:List details for each one.Held jointly with others (names of joint owners):List details for each one.Please upload a copy of the recorded Deed, a copy of the most recent tax bill, and a copy of any recent appraisals. Click or drag a file to this area to upload. Stocks and bonds: Please provide a complete description of stocks, including the number of shares, common or preferred. For bonds, please provide the face amount of each bond, interest rate, and maturity date. If held in a brokerage account, please provide a copy of the statement for the month of death. Held in decedent's name alone:List details for each one.Held jointly with others (names of joint owners):List details for each one.Add details for any other stocks or bonds.Were any accounts Transfer on Death (TOD)?YesNoUpload any relevant documents. Click or drag a file to this area to upload. Cash, bank accounts, notes and mortgages Please provide a list of all bank accounts, promissory notes, mortgages payable to the decedent and cash on hand. Please provide a copy of bank statements for the month of death, and a copy of the promissory note or mortgage and amortization schedule, if any. If not available, please provide the names(s) on account, the name and address of the bank, and account number. Held in decedent's name alone:List details for each one.Held jointly with others (names of joint owners):List details for each one.Upload any relevant documents. Click or drag a file to this area to upload. Life insurance on the decedent's life and life insurance owned by the decedent on the life of another Please provide the name of the insurance company, address, policy number, amount, and named beneficiary. If the insurance company sends a Form 712 - Life Insurance Statement upon payment of the claim, please attach a copy. Upload any relevant documents. Click or drag a file to this area to upload. Tangible personal property (automobiles, personal effects, household furnishings, boats, etc.) Upload any relevant documents. Click or drag a file to this area to upload. Other miscellaneous property If you answer "yes" to any of the following questions, please submit full details. Did decedent own an interest in a partnership or unincorporated business?YesNoDid decedent own any jewelry, stamp collections, coin collections, etc. having either artistic or intrinsic value?YesNoHas anyone (surviving spouse, children, etc.) received any money or property as a result of the decedent's death (i.e., death benefit, unpaid salary or vacation pay, bonus, award, etc.)?YesNoDid the decedent have a safe deposit box?YesNoDid the decedent at the time of death have any power, beneficial interest or trusteeship in a trust that was not created by the decedent?YesNoWas the decedent a trustee or beneficiary of any trust whether created by him/her or another person?YesNoDid decedent create any trusts during his/her lifetime? If yes, please provide details and a copy of the trust.YesNoUpload any relevant documents. Click or drag a file to this area to upload. Transfers during decedent's life If you answer "yes" to any of the following questions, please submit full details. Did the decedent make any gifts or fund any 529 plans within the last five years?YesNoDid the decedent ever file Federal Gift Tax Returns? If so, please provide copy.YesNoUpload any relevant documents. Click or drag a file to this area to upload. Powers of Appointment Did the decedent ever possess, exercise, or release a power of appointment?YesNoAnnuities If you answer "yes" to any of the following questions, please provide the name of payor, contract number, copy of the contract, the named beneficiary, most recent statement, etc. Was the decedent receiving an annuity or pension at the time of his/her death (other than social security)?YesNoIs anyone else entitled to receive payments under the annuity or pension?YesNoWas the decedent a beneficiary or participant of any pension or profit-sharing plan at the time of his or her death?YesNoDid the decedent have any IRA accounts?YesNoUpload any relevant documents. Click or drag a file to this area to upload. LIABILITIES OF THE DECEDENT Debts of the decedent, mortgages, and liens were outstanding at the time of death. Provide the name and address of the creditor, account number, and amount. Debts (real estate taxes, utility bills, income tax liabilities, credit cards, home improvements, etc.):Mortgages, notes and liens:Funeral expenses (burial costs, payments to clergy, flowers, reception, etc.) Administration expenses (Executor's out-of-pocket expenses, accountant, etc.) Upload any relevant documents. Click or drag a file to this area to upload. PLEASE ALSO INCLUDE COPIES OF THE FOLLOWING ITEMS, IF AVAILABLE: 1. Certified copies of death certificate. 2. Copy of recorded deeds. 3. Copy of most recent tax bill showing assessed value. 4. Copy of the decedent's last income tax return. 5. Copy of any trust agreements. 6. Copy of any partnership agreements. 7. Copy of any real or personal property appraisals. 8. Copy of any gift tax returns. 9. Copy of personal property/excise tax bills. 10. Copy of promissory notes and amortization schedules. 11. Copy of bank and brokerage statements. 12. Copy of annuity contracts. 13. Copy of citizenship papers of spouse, if any. 14. Copy of all statements from life insurance companies. 15. Copy of the will. Upload files here. Click or drag a file to this area to upload. Submit Call Us 888-357-3197 Address 33 Robinhood DrEtters, PA, 17319-9321, US Send a Message Name Email Address Message Submit