Confidential Estate Administration Survey Form

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  
Street Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
Email Address
Your Relationship to Decedent
Part 1: DECEDENT INFORMATION
Full Name  
Street Address
City
State
Zip
Country
Date of Birth
Date of Death
Social Security #
Part 2: WILL, CODICIL
Location of Will, if any  
Date of Will
Location of Codicil, if any
Date of Codicil
Personal Representative Named in Will
Full Name  
Street Address
City
State
Zip
Home Phone with area code
Work Phone with area code
Cell Phone with area code
Email Address
Relationship to Decedent
Alternate Personal Representative Named in Will
Full Name  
Street Address
City
State
Zip
Home Phone with area code
Work Phone with area code
Cell Phone with area code
Email Address
Relationship to Decedent
Part 3: BENEFICIARIES OR HEIRS AT LAW
DECEDENT'S SPOUSE
Full Name  
Street Address
City
State
Zip Code
Home Phone with area code
Work Phone with area code
Cell Phone with area code
Social Security #
Email Address  
DECEDENT'S CHILDREN
Full Name  
Street Address
City
State
Zip
Home Phone with area code
Work Phone with area code
Cell Phone with area code
Social Security #
Date of Birth, If Minor
Email Address
Full Name
Street Address
City
State
Zip
Home Phone with area code
Work Phone with area code
Cell Phone with area code
Social Security #
Date of Birth, If Minor
Email Address
Full Name
Street Address
City
State
Zip
Home Phone with area code
Work Phone with area code
Cell Phone with area code
Social Security #
Date of Birth, If Minor
Email Address
Full Name
Street Address
City
State
Zip
Home Phone with area code
Work Phone with area code
Cell Phone with area code
Social Security #
Date of Birth, If Minor
Email Address
Full Name
Street Address
City
State
Zip
Home Phone with area code
Work Phone with area code
Cell Phone with area code
Social Security #
Date of Birth, If Minor
Email Address
Full Name
Street Address
City
State
Zip
Home Phone with area code
Work Phone with area code
Cell Phone with area code
Social Security #
Date of Birth, If Minor
Email Address  
OTHER BENEFICIARIES
Full Name  
Street Address
City
State
Zip
Home Phone with area code
Work Phone with area code
Cell Phone with area code
Social Security#
Date of Birth, If Minor
Email Address
Relationship to Decedent
Full Name
Street Address
City
State
Zip
Home Phone with area code
Work Phone with area code
Cell Phone with area code
Social Security#
Date of Birth, If Minor
Email Address
Relationship to Decedent
Full Name
Street Address
City
State
Zip
Home Phone with area code
Work Phone with area code
Cell Phone with area code
Social Security#
Date of Birth, If Minor
Email Address
Relationship to Decedent
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
SAFE DEPOSIT BOX   Yes No
If yes, location
Who has access?
REAL ESTATE
Street Address  
City
State
Zip
Country
Date of Death Value $
How Titled
Homestead? Yes No
Street Address
City
State
Zip
Country
Date of Death Value $
How Titled
Homestead? Yes No
Street Address
City
State
Zip
Country
Date of Death Value $
How Titled
Homestead? Yes No
BROKERAGE ACCOUNTS
Broker Name  
Account #
How Titled
Date of Death Value $
Broker Name
Account #
How Titled
Date of Death Value $
Broker Name
Account #
How Titled
Date of Death Value $
Broker Name
Account #
How Titled
Date of Death Value $
Stocks (those held individually, not with a broker)
Company Name  
Number of Shares
How Titled
Location of Stock Certificates
Company Name
Number of Shares
How Titled
Location of Stock Certificates
Company Name
Number of Shares
How Titled
Location of Stock Certificates
Company Name
Number of Shares
How Titled
Location of Stock Certificates
Bonds (those held individually, not with a broker)
Company or Government Agency  
How Titled
Value of Bond
Location of Bond
Company or Government Agency
How Titled
Value of Bond
Location of Bond
Company or Government Agency
How Titled
Value of Bond
Location of Bond
Company or Government Agency
How Titled
Value of Bond
Location of Bond
U.S. Government Bonds (E, EE, H)
How Titled  
Location of Bonds
Date of Death Value $
To be cashed? Yes No
If yes, name of Transferee
How Titled
Location of Bonds
Date of Death Value $
To be cashed? Yes No
If yes, name of Transferee
How Titled
Location of Bonds
To be cashed? Yes No
If yes, name of Transferee
Date of Death Value $
Money Market Accounts, Certificates of Deposit
Name of Institution  
Account #
Date of Death Value $
How Titled
Name of Institution
Account #
Date of Death Value $
How Titled
Name of Institution
Account #
Date of Death Value $
How Titled
Bank Accounts
Bank Name  
Account #
Date of Death Value $
How Titled
Bank Name
Account #
Date of Death Value $
How Titled
Bank Name
Account #
Date of Death Value $
How Titled
Mortgages and Notes (Receivables)
Mortgagor  
Street Address
City
State
Zip
Terms of Obligation
Date of Death Value $
Mortgagor
Street Address
City
State
Zip
Terms of Obligation
Date of Death Value $
Mortgagor
Street Address
City
State
Zip
Terms of Obligation
Date of Death Value $
Insurance on Decedent’s Life
Company Name  
Policy #
Date of Death Value $
Beneficiaries Named
Location of Policy
Company Name
Policy #
Date of Death Value $
Beneficiaries Named
Location of Policy
Company Name
Policy #
Date of Death Value $
Beneficiaries Named
Location of Policy
Annuities
Company Name  
Policy #
Date of Death Value $
Beneficiaries Named
Location of Policy
Company Name
Policy #
Date of Death Value $
Beneficiaries Named
Location of Policy
Company Name
Policy #
Date of Death Value $
Beneficiaries Named
Location of Policy
Vehicles, Recreational Vehicles, Mobile Homes
Model  
Year
Date of Death Value $
How Titled
Location of Title
Model
Year
Date of Death Value $
How Titled
Location of Title
Model
Year
Date of Death Value $
How Titled
Location of Title
Part 5: Creditors
Name of Creditor  
Street Address
City
State
Zip
Account #
Amount Owed $
Name of Creditor
Street Address
City
State
Zip
Account #
Amount Owed
Name of Creditor
Street Address
City
State
Zip
Account #
Amount Owed
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.
 
Would you please tell us how you heard about the Karp Law Firm?
 
Please also refer to the “Checklist of Estate Administration Items”