DARRYL V. PRATT Attorney at Law Certified Public Accountant PRATTLAW A Professional Limited Liability Company ATTORNEYS & COUNSELORS AT LAW Stonebriar Financial Center 2500 Legacy Drive, Suite 228 Frisco, Texas 75034 Main (972) 712-1515 Fax (972) 712-2832 dpratt@prattlawgroup.com PROBATE QUESTIONNAIRE FORM LAST NAME OF DECEDENT (PERSON WHO DIED): SURVIVING SPOUSE S LAST NAME (IF ANY): FIRST NAME OF DECEDENT: FIRST NAME OF SURVIVING SPOUSE: MIDDLE NAME: MIDDLE NAME: JR., SR. II, III, IV? JR., SR. II, III, IV? CALLED BY ANY OTHER NAMES? CALLED BY ANY OTHER NAMES? DATE OF DEATH: DATE OF BIRTH: SSN: HOME ADDRESS: DATE OF BIRTH: SSN: HOME ADDRESS: HOME CITY: STATE: ZIP CODE: COUNTY OF RESIDENCE: DECEDENT S WORK PHONE: DECEDENT S CELL PHONE: DECEDENT S CELL PHONE: HOME PHONE: SPOUSE S WORK PHONE: SPOUSE S CELL PHONE: SPOUSE S CELL PHONE: WAS DECEDENT A U.S. CITIZEN? IF NOT, OTHER CITIZENSHIP: WAS DECEDENT BORN IN TEXAS? IF NOT, YEAR MOVED TO TEXAS:
Page 2 of 7 DECEDENT S OCCUPATION AT TIME OF DEATH? DECEDENT S BUSINESS ADDRESS? IF RETIRED, WHAT WAS DECEDENT S FORMER OCCUPATION? PLEASE LIST NAME AND ADDRESS OF DECEDENT S PHYSICIANS AT THE TIME OF HIS/HER DEATH: NAME ADDRESS 1. 2. WAS DECEDENT CONFINED IN A HOSPITAL DURING HIS/HER LAST ILLNESS? IF SO, PLEASE LIST THE NAME OF THE HOSPITAL: DID DECEDENT HAVE A SAFE DEPOSIT BOX EITHER ALONE OR JOINTLY? IF SO, PLEASE STATE THE NAME OF THE BANK WHERE THE BOX IS LOCATED: PLEASE ATTACH A LIST OF THE CONTENTS OF THE SAFE DEPOSIT BOX WAS DECEDENT A VETERAN? WHAT WAS DECEDENT S MARITAL STATUS AT DATE OF DEATH: MARRIED SINGLE LEGALLY SEPARATED WIDOW OR WIDOWER DIVORCED NAME OF FORMER SPOUSE DATE MARRIED, DATE MARRIAGE ENDED & REASON 1 2. 4.
Page 3 of 7 PLEASE LIST THE FOLLOWING FOR ALL CHILDREN BORN TO OR ADOPTED BY DECEDENT: 1. NAME ADDRESS RELATIONSHIP DATE OF BIRTH/DEATH & NAMES OF DESCENDENTS IF DECEASED 2. 4. 5. NAME AND ADDRESS OF ACCOUNTANT OR BOOKKEEPER ASSISTING WITH THE PREPARATION OF DECEDENT S FEDERAL INCOME TAX RETURNS: NAME ADDRESS DID DECEDENT OWN ANY INTEREST IN A BUSINESS, JOINT VENTURE OR PARTNERSHIP? IF SO, PLEASE DESCRIBE: APPLICANT S CONTACT INFORMATION: ADDRESS: CITY/STATE: ZIP CODE: APPLICANT S HOME PHONE: APPLICANT S CELL PHONE: APPLICANT S WORK PHONE: OTHER PHONE:
Page 4 of 7 PLEASE LIST DECEDENT S PROPERTY BELOW AND ON THE FOLLOWING PAGES. NOTE THAT DECEDENT S PROPERTY INCLUDES EVERYTHING OWNED BY DECEDENT, EITHER ALONE OR JOINTLY WITH ANOTHER, AT DEATH: A. REAL ESTATE PROPERTY A PROPERTY B 1. LOCATION: 2. LEGAL DESCRIPTION: DATE ACQUIRED: 4. HOW ACQUIRED: 5. PURCHASE PRICE: 6. HAVE SUBSTANTIAL IMPROVEMENTS BEEN MADE SINCE ACQUIRED BY DECEDENT? IF SO, DESCRIBE: 7. APPROXIMATE COSTS OF IMPROVEMENTS: 8. MINERAL AND ROYALTY INTERESTS: 9. COST OF MINERAL AND ROYALTY INTERESTS: B. PERSONAL PROPERTY 1. STOCKS AND BONDS 2. DESCRIPTION: SHARES: 4. COST: 5. NAME AND ADDRESS OF STOCK BROKER:
Page 5 of 7 6. BANK ACCOUNTS: 7. CDs: 8. CASH ON HAND: 9. CHECKING ACCOUNT NO S: NAME OF BANK: BANK ADDRESS: 10. SAVINGS ACCOUNT NO S : NAME OF BANK: BANK ADDRESS: 11. PROMISSORY NOTES: *Do not list accounts with beneficiaries appointed (Payable on Death accounts) *Do not list accounts with beneficiaries appointed (Payable on Death accounts) 12. LIFE INSURANCE: 1 DEATH BENEFITS: C. OTHER MISCELLANEOUS PROPERTY 14. AUTOMOBILES MAKE/MODEL, INCLUDING VEHICLE IDENTIFICATION NUMBER (VIN) AND VALUE: 15. HOUSEHOLD FURNISHINGS AND VALUE: 16. ANTIQUES AND OTHER ARTICLES OF INTRINSIC VALUE: 17. ACCOUNTS RECEIVABLE: 18. UNCASHED CHECKS 19. BUSINESS INTERESTS, JOINT VENTURES, PARTNERSHIPS
Page 6 of 7 20. STOCKS, BONDS, RETIREMENT ACCOUNTS, PENSION FUNDS, BONDS, PROFIT SHARING, ANNUITIES ECT. D. DEBTS SUCH DEBTS SHOULD INCLUDE ALL CHARGE ACCOUNTS, HOUSEHOLD UTILITIES, PROPERTY TAXES, INCOME TAXES, CAR NOTES, BOAT LOANS, AND ANY OTHER INDEBTEDNESS OF DECEDENT DESCRIPTION ACCOUNT NUMBER AND CREDITOR S ADDRESS AMOUNT 1. 2. IF DECEDENT HAD ADDITIONAL DEBTS, PLEASE ATTACH SHEET 16. IS THERE ANY CREDIT LIFE INSURANCE ON ANY OF THE ABOVE DEBTS? IF SO, PLEASE LIST THE ITEM NUMBERS OF ALL DEBTS COVERED BY CREDIT LIFE: Medicare took care of all medical bills (she had sick for past 2 years and Medicare had paid for everything). E. MISCELLANEOUS ITEMS IF YOU HAVE NOT ALREADY DONE SO, PLEASE SEND US THE FOLLOWING DOCUMENTS: 1. DEATH CERTIFICATE 2. COPY OF DECEDENT LAST WILL AND TESTAMENT ALL LIFE INSURANCE POLICIES EITHER INSURING DECEDENT S LIFE, AND/OR OWNED BY DECEDENT AT DATE OF HIS/HER DEATH 4. LIST OF CONTENTS OF SAFE DEPOSIT BOX 5. DEEDS TO ANY REAL ESTATE, AND RELATED LOAN DOCUMENTS, AND A COPY OF THE TITLE POLICY AND ANY CLOSING STATEMENT RELATING TO DECEDENT S PURCHASE OF THE PROPERTY 6. DECEDENT S FEDERAL INCOME TAX RETURNS FOR THE CURRENT YEAR (IF IT HAS BEEN PREPARED), AND FOR THE LAST 3 YEARS 7. CERTIFICATES OF TITLE TO ANY AUTOMOBILES, MOBILE HOMES, TRACTORS, TRAILERS, OR BOATS 8. FINANCIAL STATEMENTS AND TAX RETURNS FOR ANY BUSINESS, JOINT VENTURE OR PARTNERSHIP FOR THE CURRENT YEAR, IF ANY, AND FOR THE PAST 5 YEARS 9. COPIES OF STATEMENTS OF ACCOUNT FOR EACH OF DECEDENT S BANK ACCOUNTS AT HIS/HER DATE OF DEATH 10. COPIES OF STATEMENTS OF ACCOUNT FOR EACH OF DECEDENT S ACCOUNTS AT HIS/HER OF DEATH
Page 7 of 7 11. COPIES OF STATEMENTS OF ACCOUNT FOR ALL OF DECEDENT S DEBTS, MORTGAGES (COPY OF AMORTIZATION SCHEDULE) AND CHARGE ACCOUNTS AT HER DATE OF DEATH THANK YOU for completing our Probate Questionnaire. Please return your Questionnaire to us via email to holly@prattlawgroup.com or via fax to 972-712-2832 or via U.S. mail to 2500 Legacy Drive, Suite 228, Frisco, Texas 75034. We will contact you shortly to confirm receipt of your information.