CLIENT DATA FORM FOR ADMINISTRATION OF AN ESTATE Please complete this questionnaire. It is important that you complete ALL items so that we have the information needed to draft your documents. If a question does not apply to you, write N/A in the appropriate blank. If you need more space, use extra sheets and specify the question you are referring to. If you need assistance in answering a question, call our office. All information will be held in strict confidence. DATE_____________________________ CLIENT INFORMATION 1. Name:___________________________________________ Date of birth ___________, Social Security No. _________________and ____male/___female To your knowledge, did the decedent leave a Will? ___No ___Yes (Dated:____________________) Are you named as the first Executor/Executrix? ___Yes ___No If No, name the first Executor/Executrix__________________________________________________ Is this person willing and able to serve? ___Yes ___No ___Don't know Are you named as a successor Executor/Executrix? ___Yes ___No What was your relationship to the Decedent?_______________________________________________ DECEDENT INFORMATION Full name:________________________________________________________________ ___male/___female Any other name(s) Decedent may have used:_____________________________________ Decedent's date of birth ____________ and Social Security No._________________________________ 2. Residence: ___________________________________________ How long?_____________________________ City: ____________________________, County ______________________, State_______ How long did Decedent live at this address?____________________________________________________ Place of death:______________________________________________________________ City County State Date of Death: _____________ Physician(s): ____________________________________________________ Was Decedent a Military Veteran? ___No ___Yes If Yes, list branch of military __________________________________and dates of service_________ Was Decedent employed? ___No ___Yes If Yes, list employer and address_______________________________________________________________ ________________________________________________________________________________________________ 3. Was Decedent was married at the time of his/her death? ___No ___Yes If Yes, give the name and address of spouse Name_______________________________________________________ Address:____________________________________________________________________ Date of Marriage Place of Marriage __________________________ _________________________________________ Date Texas Domicile was established__________________________________ Is spouse pregnant? ___No ___Yes Was there a pre-marital agreement? ___No ___Yes Was there a post-nuptial agreement? ___No ___Yes Please give the name of each prior spouse, if any, and the date the marriage ended: Name of ex-spouse_________________________________ Date of marriage__________________________________ Date marriage ended_________________________ Name of ex-spouse_________________________________ Date of marriage__________________________________ Date marriage ended_________________________ 4. If the Decedent had children, please give the following information: FULL NAME______________________________________________ ___Son ___Daughter Address_________________________________________________________________________ County____________________ Date of Birth_____________________________ ___Single ___Married ___Children FULL NAME______________________________________________ ___Son ___Daughter Address_________________________________________________________________________ County_________________ Date of Birth________________________________ ___Single ___Married ___Children FULL NAME______________________________________________ ___Son ___Daughter Address_________________________________________________________________________ County____________________ Date of Birth_____________________________ ___Single ___Married ___Children FULL NAME______________________________________________ ___Son ___Daughter Address_________________________________________________________________________ County____________________ Date of Birth_____________________________ ___Single ___Married ___Children FULL NAME______________________________________________ ___Son ___Daughter Address_________________________________________________________________________ County____________________ Date of Birth_____________________________ ___Single ___Married ___Children FULL NAME______________________________________________ ___Son ___Daughter Address_________________________________________________________________________ County____________________ Date of Birth_____________________________ ___Single ___Married ___Children WERE THERE ANY CHILDREN BORN TO OR ADOPTED BY THE DECEDENT AFTER THE DATE OF THE WILL? ___Yes ___No If Yes, list their names and dates of birth FULL NAME______________________________________________ ___Son ___Daughter Address_________________________________________________________________________ County____________________ Date of Birth_____________________________ ___Single ___Married ___Children FULL NAME______________________________________________ ___Son ___Daughter Address_________________________________________________________________________ County____________________ Date of Birth_____________________________ ___Single ___Married ___Children 5. If Decedent had any children under the age of eighteen (18), state the full name, address and relationship (if any) of the person listed to act as their custodian. Name_____________________________________________ Relationship_________________ Address_______________________________________________________________________ State______________ County_____________________________ Were there any other beneficiaries listed in Decedent's Will? ___Yes ___No FULL NAME__________________________________________________________________ RELATIONSHIP____________________________ ADDRESS_____________________________________________________________________________________________________________ FULL NAME__________________________________________________________________ RELATIONSHIP____________________________ ADDRESS_____________________________________________________________________________________________________________ FULL NAME__________________________________________________________________ RELATIONSHIP____________________________ ADDRESS_____________________________________________________________________________________________________________ FULL NAME__________________________________________________________________ RELATIONSHIP____________________________ ADDRESS_____________________________________________________________________________________________________________ Did Decedent's Will specifically EXCLUDE any one? ___Yes ___No If Yes, who? 6. List the following information: a. Real estate owned in whole or in part by the Decedent:_________________________________________ ADDRESS__________________________________________________________________ LEGAL DESCRIPTION________________________________________________________ ___Separate property ___Community Property Value $______________________ ___Mortgaged ___Leased ___Insurance ___Mineral Rights ___Other_______________ ADDRESS__________________________________________________________________ LEGAL DESCRIPTION________________________________________________________ ___Separate property ___Community Property Value $______________________ ___Mortgaged ___Leased ___Insurance ___Mineral Rights ___Other_______________ ADDRESS__________________________________________________________________ LEGAL DESCRIPTION________________________________________________________ ___Separate property ___Community Property Value $______________________ ___Mortgaged ___Leased ___Insurance ___Mineral Rights ___Other_______________ b. Savings accounts, Checking Accounts, Certificates of Deposits, Money Market Accounts, Pension Plans, Profit Sharing Plans, 401(K) Plans, or other plans or accounts: TYPE___________________________________________________ LOCATION_______________________________ ACCOUNT NUMBER_________________________________________ VALUE_______________________________ TYPE___________________________________________________ LOCATION_______________________________ ACCOUNT NUMBER_________________________________________ VALUE_______________________________ TYPE___________________________________________________ LOCATION_______________________________ ACCOUNT NUMBER_________________________________________ VALUE_______________________________ TYPE___________________________________________________ LOCATION_______________________________ ACCOUNT NUMBER_________________________________________ VALUE_______________________________ TYPE___________________________________________________ LOCATION_______________________________ ACCOUNT NUMBER_________________________________________ VALUE_______________________________ TYPE___________________________________________________ LOCATION_______________________________ ACCOUNT NUMBER_________________________________________ VALUE_______________________________ c. Stocks, Bonds, Securities or other investment information:________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ d. Social Security, Disability, Veteran's Benefits, or Pension Plan income: r Social Security $_______________ per month r Disability $_______________ per month r Veteran's Benefits $_______________ per month r Pension Plan income $_______________ per month 7. List life insurance information: a. Cash surrender value of any life insurance policies $___________ b. Death value of any life insurance policies $___________ c. Cash surrender value of life insurance on spouse $___________ d. Death value of life insurance policy on spouse $___________ e. Retirement Benefits or Annuities $___________ f. Retirement or Death Benefits from sources other than employment $___________ Other: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________  TO BE COMPLETED ONLY BY ATTORNEY: ___Muniment of Title ___Small Estate Affidavit ___Probate Will w/Letters (Independent) ___Letters of Administration (Dependent) ___Declare Heirship w/o Administration ___Administration w/Will Attached (Dependent) ___Other ___Determination of Heirship w/in Administration