Matter

Barulich Dugoni & Suttmann Law Group Inc. Estate Administration Questionnaire

Who referred you to our office?
Relationship to you
With whom at Barulich Dugoni Law Group will you be meeting?

Client Contact Information

*First Name		Middle Name
*Last Name		Birthdate	[ 5/22/2019 ]
Place of Birth		Citizenship Country (non-US)
SSN		Phone
Fax		Home Phone
Mobile		Email
Primary Email Type		Email 2
Email 2 Type		Best Contact Method
Gender		Representative Type

Address Information

Mailing Street		Other Street
Mailing City		Other City
Mailing State/Province		Other State/Province
Mailing Zip/Postal Code		Other Zip/Postal Code
Mailing Country		Other Country
Mailing Address Type		Other Address Type

Estate Admin Details

DOD/Date of Incapacity	[ 5/22/2019 ]	Was decedent a US Citizen?
Decedent's country of citizenship		Address of safe deposit entity
Safe deposit box number		Title on safe deposit box
Summary of contents in safe deposit box		Received property from another decedent?
Form 706 tax return filed?		Misc death benefits from whom?
Pension benefits from whom?		Decedent's domicile same as residence?
When was decedents domicile established?		Was real property transferred to child?
Decedent own property outside the state?

Heirs and Beneficiaries

	First Name	Middle Name	Last Name	Birthdate	Relation to Decedent	Address	Phone	SSN
1				[ 5/22/2019 ]

Professional Advisors

Accountant

Accountant Name
Mailing Street
Mailing City
Mailing State/Province
Mailing Zip/Postal Code
Phone
Email

Financial Advisor

Financial Advisor Name
Mailing Street
Mailing City
Mailing State/Province
Mailing Zip/Postal Code
Phone
Email

Life Insurance Agent

Life Insurance Agent Name
Mailing Street
Mailing City
Mailing State/Province
Mailing Zip/Postal Code
Phone
Email

Asset Information

Cash Accounts (Checking, Saving, Market Accounts, CDs)

Description	Asset type	Current Fair Market Value	How Title is Held

Investment Accounts (Stocks, Bonds, Mutual Funds)

Description	Asset type	Current Fair Market Value	How Title is Held

Retirement Accounts (IRAs, Pensions, 401k, etc.)

Description	Asset type	Current Fair Market Value	How Title is Held

Business Interests (Corporations, Partnerships, LLCs)

Description	Asset type	Current Fair Market Value	How Title is Held

Personal Property

Items that you feel are of substantial value, such as cars, boats, collectibles, jewelry and so on.

Description	Current Fair Market Value	How Title is Held

Promissory Notes

Description	Current Fair Market Value	How Title is Held

Hide Section - Real Estate

Real Estate

Property Address	Is Principal Residence	Current Fair Market Value	Mortgage Balance	How Title is Held

Hide Section - Life Insurance and Annuities

Life Insurance and Annuities

Company/Policy Number	Death Benefit	Person Insured	Policy Owner	Beneficiaries	Type of Policy (Term/Perm)

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