PROBATE INFORMATION SHEET Upon completion, please bring

EAGLE POINT BLVD.
LAKE ELMO, MN 55042
TELEPHONE: 651.209.1155
FAX: 651.731.8004
PAUL E. OVERSON, ESQ.
STEVEN M. COODIN, ESQ.
PROBATE INFORMATION SHEET
Upon completion, please bring this form to your next scheduled appointment along
with a certified copy of the decedent’s death certificate (if possible). If extra space
is needed please provide additional pages.
PERSONAL INFORMATION OF THE DECEASED:
Name of Decedent ___________________________________________________
Street Address, City, State, Zip: ________________________________________
County of Residence: _______________
Social Security No.: ______________
Date & Place of Birth: ________________________________________________
Date & Place of Death: ______________________________________________
Date of Will: ________________
Date of Codicil: ______________________
Spouse’s Full Name: _________________________________________________
Street Address, City, State, Zip: ________________________________________
Social Security No.: ______________
Date & Place of Birth: ____________
If Applicable:
Predeceased Spouse Full Name: ________________________________________
Social Security Number: _________________
Date of Birth: ______________
Date of Death: ______________________________________________________
Former Spouse (s) address: ____________________________________________
PERSONAL REPRESENTATIVE
Name of Nominated Personal Representative: _____________________________
Street Address, City, State, Zip: ________________________________________
Social Security No.: _________________
The PID No. (if applicable): _______
Relationship to Decedent: _____________________________________________
Home Phone: ____________________ Work Phone ________________________
Cellular Phone: _____________________ Email: _________________________
CHILDREN OF DECEDENT (Please specify Biological, Step, or Adopted):
1. Name: _______________________
Date of Birth: ______________
Street Address: ________________________________________________
City, State, Zip: ________________________________________________
Social Security No.: _____________________________________________
2. Name: _______________________
Date of Birth: ______________
Street Address: ________________________________________________
City, State, Zip: ________________________________________________
Social Security No.: _____________________________________________
3. Name: _______________________
Date of Birth: ______________
Street Address: ________________________________________________
City, State, Zip: ________________________________________________
Social Security No.: _____________________________________________
4. Name: _______________________
Date of Birth: _____________
Street Address: ________________________________________________
City, State, Zip: ________________________________________________
Social Security No.: _____________________________________________
5. Name: _______________________
Date of Birth: _____________
Street Address: ________________________________________________
City, State, Zip: ________________________________________________
Social Security No.: _____________________________________________
LIST ANY PREDECEASED CHILDREN:
1. Name: _______________________
Date of Birth: ______________
Street Address: ________________________________________________
City, State, Zip: ________________________________________________
Social Security No.: _____________________________________________
2. Name: _______________________
Date of Birth: ______________
Street Address: ________________________________________________
City, State, Zip: ________________________________________________
Social Security No.: _____________________________________________
OTHER BENEFICIARIES (Siblings, etc.):
1. Name: _______________________
Date of Birth: ______________
Street Address: ________________________________________________
City, State, Zip: ________________________________________________
Social Security No.: _____________________________________________
2. Name: _______________________
Date of Birth: _____________
Street Address: ________________________________________________
City, State, Zip: ________________________________________________
Social Security No.: _____________________________________________
3. Name: _______________________
Date of Birth: ______________
Street Address: ________________________________________________
City, State, Zip: ________________________________________________
Social Security No.: _____________________________________________
4. Name: _______________________
Date of Birth: _____________
Street Address: ________________________________________________
City, State, Zip: ________________________________________________
Social Security No.: _____________________________________________
HOMESTEAD INFORMATION (Provide Deed if Possible):
Address: ___________________________________________________________
County: ____________________
Amount of Mortgage: _________________
Fair Market Value: __________________________________________________
ADDITIONAL REAL ESTATE INFORMATION (Provide Deed if Possible):
Address: __________________________________________________________
County: __________________
Amount of Mortgage: _________________
Fair Market Value: ___________________________________________________
BUSINESS ASSETS:
Name of Business: __________________________________________________
Street Address, City, State, Zip: ________________________________________
Type of Business: ___________________________________________________
Approximate Value of Business:________________________________________
Name of Person Operating Business: ____________________________________
CASH, BANK AND/OR INVESTMENT ACCOUNTS (Provide Latest
Statements):
1. Bank/Company: _______________________________________________
Type of Account: ________________Value as of DOD: _______________
Name of Joint Owner or Beneficiary: _______________________________
2. Bank/Company: _______________________________________________
Type of Account: ________________ Value as of DOD: _______________
Name of Joint Owner or Beneficiary: _______________________________
3. Bank/Company: _______________________________________________
Type of Account: _______________ Value as of DOD: _______________
Name of Joint Owner or Beneficiary: _______________________________
4. Bank/Company: ________________________________________________
Type of Account: ________________ Value as of DOD: _______________
Name of Joint Owner or Beneficiary: _______________________________
SECURITIES, STOCKS AND BONDS (Provide Latest Statements):
1. Company: ____________________________________________________
Type of Investment: ____________ Value per share as of DOD: ________
Name of Joint Owner or Beneficiary: _______________________________
2. Company: ____________________________________________________
Type of Investment: _____________ Value per share as of DOD: ________
Name of Joint Owner or Beneficiary: _______________________________
3. Company: ____________________________________________________
Type of Investment: ____________ Value per share as of DOD: ________
Name of Joint Owner or Beneficiary: _______________________________
4. Company: ____________________________________________________
Type of Investment: _____________ Value per share as of DOD: ________
Name of Joint Owner or Beneficiary: _______________________________
LIFE INSURANCE (Provide Latest Statements):
1. Name of Company: _____________________________________________
Value of Policy: _________________
Beneficiary: _______________
2. Name of Company: _____________________________________________
Value of Policy: _________________
Beneficiary: _______________
RETIREMENT ACCOUNTS/ANNUITIES (Provide Latest Statements):
1. Company: ___________________________________________________
Type of Account: _________________
Value as of DOD: __________
Name of Joint Owner or Beneficiary: _______________________________
2. Company: ____________________________________________________
Type of Account: _________________
Value as of DOD: __________
Name of Joint Owner or Beneficiary: _______________________________
3. Company: ____________________________________________________
Type of Account: _________________
Value as of DOD: __________
Name of Joint Owner or Beneficiary: _______________________________
4. Company: ____________________________________________________
Type of Account: _________________
Value as of DOD: __________
Name of Joint Owner or Beneficiary: _______________________________
PERSONAL PROPERTY:
Auto: Make and Model: _________________________ Value: ____________
Loan Amount: _________________ Debtor: _____________________
Auto: Make and Model: _________________________ Value: ____________
Loan Amount: _________________ Debtor: _____________________
Value of Furniture and Household Goods: _______________________________
Value of Wearing Apparel and Jewelry: __________________________________
Value of Other Personal Property: _______________________________________
FUNERAL EXPENSES:
Name of Funeral Home: _________________
Amount Owed: ____________
List anyone who advanced funds for funeral expenses:
Name: ___________________Amount advanced: __________________________
Name: ___________________Amount advanced: __________________________
Name: ___________________Amount advanced: __________________________
Did Decedent receive Medical Assistance Benefits? ________________________
OTHER DEBTS AND/OR CLAIMS (Credit Cards, Medical Bills, Etc.):
Name: _____________________________________________________________
Street Address: ______________________________________________________
City, State, Zip: _____________________________________________________
Amount of Claim: _______________ Reason for Claim: ____________________
Name: _____________________________________________________________
Street Address: ______________________________________________________
City, State, Zip: _____________________________________________________
Amount of Claim: ________________
Reason for Claim: _______________
Name: _____________________________________________________________
Street Address: ______________________________________________________
City, State, Zip: _____________________________________________________
Amount of Claim: ________________
Reason for Claim: _______________
Name: _____________________________________________________________
Street Address: ______________________________________________________
City, State, Zip: _____________________________________________________
Amount of Claim: ________________
Reason for Claim: _______________
TAXES:
Date real estate taxes are next due: ____________ Amount Due: _____________
When did Decedent last file income tax returns? ___________________________
Did Decedent file gift tax returns for gifts made during lifetime? ______________
Name of Accountant: _____________________ Phone:_____________________
CHECKLIST OF DOCUMENTS TO BRING TO THE FIRST MEETING
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Original Will, all Codicils, and written lists
List of names and addresses of heirs and/or Will beneficiaries
Death Certificate (if available)
Title papers for real estate (deeds, certificates of title, etc.)
All available information about Decedent’s assets and their value
All available bills and other evidence of Decedent’s outstanding obligations
Decedents last income tax return
List of questions you may have