CONFIDENTIAL ESTATE ADMINISTRATION SURVEY

- We recognize that this information is of a personal nature. Information you provide to this office will be treated confidentially and will not be revealed to anyone outside of this office without your permission.
- Click “submit” when finished. (This form does NOT allow you to partially complete it and return to the form to enter additional information. If that is your preference, please use the PDF fillable option.)
Today's Date
Your Name (for legal documents)*
Street Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
Email*
Your Relationship to Decedent:
PART 1: GENERAL INFORMATION
Decedent’s Full Name
Street Address
City
State
Zip
County
Date of Death
Month
Day
Year
Date of Birth
Month
Day
Year
PART 2: DOCUMENTS
WILL AND CODICIL (if any)
Location of Will
Date of Will
Month
Day
Year
Location of Codicil
Date of Codicil
Month
Day
Year
Personal Representative Named in Will
Full Name
Street Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
Email
Relationship to Decedent
Alternate Personal Representative Named in Will
Full Name
Street Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
Email
Relationship to Decedent
TRUST (if any)
Location of Trust
Date of Trust
Month
Day
Year
Successor Trustee Named in Trust
Full Name
Street Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
Email
Relationship to Decedent
Alternate Successor Trustee Named in Trust
Full Name
Street Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
Email
Relationship to Decedent

Company	Shares #	Owner (Decedent Only / Decedent’s Trust / Decedent & Spouse / Owned with another person(s) / Any other form of ownership)	Location of Stock Certificates

Company or Gov’t. Agency	Owner (Decedent Only / Decedent’s Trust / Decedent & Spouse / Owned with another person(s) / Any other form of ownership)	Value $	Location of Bond

Owner (Decedent Only / Decedent’s Trust / Decedent & Spouse / Owned with another person(s) / Any other form of ownership)	Location Of Bond	Date of Death Value$	Beneficiary, If Any

PART 1: GENERAL INFORMATION

Institution	Beneficiary (Spouse / Trust / Other )	Date of Death Value $

Broker Name	Owner (Decedent Only / Decedent’s Trust / Decedent & Spouse / Owned with another person(s) / Any other form of ownership)	Date of Death Value $

Bank Name	Owner (Decedent Only / Decedent’s Trust / Decedent & Spouse / Owned with another person(s) / Any other form of ownership)	Date of Death Value$