The Karp Law Firm, P.A.
Palm Beach Gardens, Florida 561.625.1100
Boynton Beach, Florida 561.752.4550
Port St. Lucie, Florida 772.343.8411
Fax 561,625.0060 |
Your Name |
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Street Address |
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City |
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State |
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Zip |
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Home Phone |
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Work Phone |
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Cell Phone |
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Email Address |
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Your Relationship to Decedent |
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Part 1: DECEDENT INFORMATION |
Full Name |
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Street Address |
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City |
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State |
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Zip |
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Country |
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Date of Birth |
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Date of Death |
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Social Security # |
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Part 2: WILL, CODICIL |
Location of Will, if any |
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Date of Will |
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Location of Codicil, if any |
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Date of Codicil |
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Personal Representative Named in Will |
Full Name |
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Street Address |
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City |
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State |
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Zip |
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Home Phone with area code |
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Work Phone with area code |
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Cell Phone with area code |
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Email Address |
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Relationship to Decedent |
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Alternate Personal Representative Named in Will |
Full Name |
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Street Address |
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City |
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State |
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Zip |
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Home Phone with area code |
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Work Phone with area code |
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Cell Phone with area code |
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Email Address |
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Relationship to Decedent |
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Part 3: BENEFICIARIES OR HEIRS AT LAW |
DECEDENT'S SPOUSE |
Full Name |
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Street Address |
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City |
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State |
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Zip Code |
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Home Phone with area code |
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Work Phone with area code |
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Cell Phone with area code |
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Social Security # |
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Email Address |
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DECEDENT'S CHILDREN |
Full Name |
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Street Address |
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City |
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State |
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Zip |
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Home Phone with area code |
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Work Phone with area code |
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Cell Phone with area code |
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Social Security # |
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Date of Birth, If Minor |
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Email Address |
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Full Name |
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Street Address |
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City |
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State |
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Zip |
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Home Phone with area code |
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Work Phone with area code |
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Cell Phone with area code |
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Social Security # |
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Date of Birth, If Minor |
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Email Address |
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Full Name |
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Street Address |
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City |
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State |
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Zip |
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Home Phone with area code |
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Work Phone with area code |
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Cell Phone with area code |
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Social Security # |
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Date of Birth, If Minor |
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Email Address |
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Full Name |
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Street Address |
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City |
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State |
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Zip |
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Home Phone with area code |
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Work Phone with area code |
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Cell Phone with area code |
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Social Security # |
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Date of Birth, If Minor |
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Email Address |
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Full Name |
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Street Address |
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City |
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State |
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Zip |
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Home Phone with area code |
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Work Phone with area code |
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Cell Phone with area code |
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Social Security # |
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Date of Birth, If Minor |
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Email Address |
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Full Name |
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Street Address |
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City |
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State |
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Zip |
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Home Phone with area code |
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Work Phone with area code |
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Cell Phone with area code |
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Social Security # |
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Date of Birth, If Minor |
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Email Address |
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OTHER BENEFICIARIES |
Full Name |
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Street Address |
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City |
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State |
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Zip |
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Home Phone with area code |
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Work Phone with area code |
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Cell Phone with area code |
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Social Security# |
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Date of Birth, If Minor |
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Email Address |
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Relationship to Decedent |
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Full Name |
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Street Address |
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City |
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State |
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Zip |
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Home Phone with area code |
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Work Phone with area code |
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Cell Phone with area code |
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Social Security# |
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Date of Birth, If Minor |
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Email Address |
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Relationship to Decedent |
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Full Name |
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Street Address |
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City |
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State |
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Zip |
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Home Phone with area code |
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Work Phone with area code |
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Cell Phone with area code |
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Social Security# |
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Date of Birth, If Minor |
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Email Address |
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Relationship to Decedent |
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Part 4: ASSETS |
Note: When providing answers to “How Titled,” indicate if the asset was:
- Solely owned by decedent
- In the decedent’s trust
- Jointly owned with right of survivorship
- Owned with another person(s), indicating whom
- Any other form of ownership
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SAFE DEPOSIT BOX |
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Yes
No |
If yes, location |
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Who has access? |
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REAL ESTATE |
Street Address |
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City |
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State |
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Zip |
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Country |
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Date of Death Value $ |
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How Titled |
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Homestead? |
Yes
No |
Street Address |
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City |
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State |
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Zip |
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Country |
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Date of Death Value $ |
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How Titled |
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Homestead? |
Yes
No |
Street Address |
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City |
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State |
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Zip |
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Country |
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Date of Death Value $ |
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How Titled |
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Homestead? |
Yes
No |
BROKERAGE ACCOUNTS |
Broker Name |
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Account # |
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How Titled |
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Date of Death Value $ |
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Broker Name |
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Account # |
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How Titled |
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Date of Death Value $ |
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Broker Name |
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Account # |
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How Titled |
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Date of Death Value $ |
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Broker Name |
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Account # |
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How Titled |
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Date of Death Value $ |
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Stocks (those held individually, not with a broker) |
Company Name |
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Number of Shares |
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How Titled |
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Location of Stock Certificates |
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Company Name |
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Number of Shares |
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How Titled |
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Location of Stock Certificates |
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Company Name |
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Number of Shares |
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How Titled |
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Location of Stock Certificates |
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Company Name |
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Number of Shares |
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How Titled |
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Location of Stock Certificates |
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Bonds (those held individually, not with a broker) |
Company or Government Agency |
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How Titled |
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Value of Bond |
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Location of Bond |
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Company or Government Agency |
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How Titled |
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Value of Bond |
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Location of Bond |
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Company or Government Agency |
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How Titled |
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Value of Bond |
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Location of Bond |
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Company or Government Agency |
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How Titled |
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Value of Bond |
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Location of Bond |
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U.S. Government Bonds (E, EE, H) |
How Titled |
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Location of Bonds |
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Date of Death Value $ |
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To be cashed? |
Yes
No |
If yes, name of Transferee |
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How Titled |
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Location of Bonds |
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Date of Death Value $ |
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To be cashed? |
Yes
No |
If yes, name of Transferee |
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How Titled |
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Location of Bonds |
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To be cashed? |
Yes
No |
If yes, name of Transferee |
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Date of Death Value $ |
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Money Market Accounts, Certificates of Deposit |
Name of Institution |
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Account # |
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Date of Death Value $ |
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How Titled |
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Name of Institution |
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Account # |
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Date of Death Value $ |
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How Titled |
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Name of Institution |
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Account # |
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Date of Death Value $ |
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How Titled |
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Bank Accounts |
Bank Name |
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Account # |
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Date of Death Value $ |
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How Titled |
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Bank Name |
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Account # |
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Date of Death Value $ |
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How Titled |
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Bank Name |
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Account # |
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Date of Death Value $ |
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How Titled |
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Mortgages and Notes (Receivables) |
Mortgagor |
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Street Address |
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City |
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State |
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Zip |
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Terms of Obligation |
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Date of Death Value $ |
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Mortgagor |
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Street Address |
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City |
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State |
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Zip |
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Terms of Obligation |
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Date of Death Value $ |
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Mortgagor |
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Street Address |
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City |
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State |
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Zip |
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Terms of Obligation |
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Date of Death Value $ |
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Insurance on Decedent’s Life |
Company Name |
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Policy # |
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Date of Death Value $ |
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Beneficiaries Named |
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Location of Policy |
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Company Name |
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Policy # |
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Date of Death Value $ |
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Beneficiaries Named |
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Location of Policy |
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Company Name |
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Policy # |
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Date of Death Value $ |
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Beneficiaries Named |
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Location of Policy |
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Annuities |
Company Name |
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Policy # |
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Date of Death Value $ |
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Beneficiaries Named |
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Location of Policy |
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Company Name |
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Policy # |
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Date of Death Value $ |
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Beneficiaries Named |
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Location of Policy |
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Company Name |
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Policy # |
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Date of Death Value $ |
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Beneficiaries Named |
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Location of Policy |
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Vehicles, Recreational Vehicles, Mobile Homes |
Model |
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Year |
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Date of Death Value $ |
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How Titled |
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Location of Title |
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Model |
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Year |
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Date of Death Value $ |
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How Titled |
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Location of Title |
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Model |
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Year |
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Date of Death Value $ |
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How Titled |
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Location of Title |
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Part 5: Creditors |
Name of Creditor |
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Street Address |
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City |
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State |
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Zip |
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Account # |
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Amount Owed $ |
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Name of Creditor |
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Street Address |
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City |
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State |
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Zip |
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Account # |
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Amount Owed |
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Name of Creditor |
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Street Address |
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City |
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State |
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Zip |
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Account # |
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Amount Owed |
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Part 6: Other Information/Your Questions and Concerns |
Please use this area to list any information you believe is relevant, or specific questions you wish to
address during your consultation. |
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Would you please tell us how you heard about the Karp Law Firm? |
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Please also refer to the “Checklist of Estate Administration Items” |
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