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
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| Your Name |
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| Street Address |
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| City |
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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 |
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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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