Probate
Inheritance Estate Interview
PLEASE
PRINT
YOUR
NAME _________________________________________________
ADDRESS
___________________________________________________
CITY
___________________________ STATE ____ ZIP _____________
CELL
(____)____________________ TODAYS DATE ____/_____/______
PHONE-DAY
(____)________________ NIGHT (____)________________
E-MAIL
___________________________________________
Decedents
Name ___________________________________
Date
of Death (mm/dd/yy) ___ ___ /___ ___ /___ ___ ___ ___
Your
relation to the person who passed away: _______________________
Referred
By: ______________________________________
[Probate-Inherit Quest Macbook.doc
rev 4/10/08]
*All Pages and Information must be filled out prior to seeing the
Attorney. This information is required by the Surrogates Office and the
Inheritance Tax Bureau.
Date of Will? (mm/dd/yy) ___ ___ /___ ___ /___ ___ ___
___
(If no will, write no will)
Location
of original Will ____________________
Indicate if Surrogate Probate letters
were issued and where issued: __________
Executor/
Administrator if not person filing out this form ____________
*The
following questions are required by the Surrogates Office and the Inheritance
Tax Bureau to be answered. Please answer all these questions to the best of
your knowledge so we can best help you. If none, write none.
Decedents S.S. No.
___ ___ ___ /___ ___ /___ ___ ___ ___
County
of Residence ________________________________
SCHEDULE
A REAL PROPERTY If none, write none
1.
Street and Number _____________________________________
Town:
____________________
Lot:
___ Block: ____ County: ____________________
Title/Owner
of Record: _______________
Full
Market Value of Property: $________ Mortgage Balance: $_________
Tax Assessor
Assessed Value: $____________________
Any
other Real Estate: $______________________
SCHEDULE
B-1: BANK ACCOUNTS/BROKERAGE ACCOUNTS
2) SCHEDULE B-1: STOCK
3) SCHEDULE B-1:
INVESTMENT BONDS
4) SCHEDULE B-1: ALL OTHER PROPERTY
BANK ACCOUNTS/BROKERAGE
ACCOUNTS
SCHEDULE B (1) BANK ACCOUNTS, STOCK, CD, OTHER ASSETS
All Other
Personal Property Owned Individually or Jointly; Market Value, Indicate the
Manner of Registration at Date of Death. If none, write none for each line. Use
back of page if you need more space, or attach a list of assets.
Bank
Accounts - Individually or Jointly Owned Date of Death Value
Name
of Bank, Acct. # _____________ $_____________
___________________________________________
$_____________
___________________________________________ $_____________
Stock
(A)
Number of Shares
(B) Name of Stock - Registered Owners(s)
(C) State of Inc.
(D)
Date of Death Per Share Value
(E) Total Market Value
(F) Decedents Equity
Name
of Stock Co., Acct. # ________________ $_____________
___________________________________________
$_____________
INVESTMENT
BONDS
(A) Bonds - Individually or Jointly Owned
(B) Date of Death Value
(C)
Decedents Equity*
___________________ $_____________
___________________
$_____________
___________________ $_____________
SCHEDULE B (1) - ALL OTHER
PROPERTY
RESIDENT DECEDENT
Cars _______________________________________
$_____________
Other assets over $10,000 ______________________ $_____________
___________________________________________
$_____________
___________________________________________ $_____________
___________________________________________
$_____________
___________________________________________ $_____________
___________________________________________
$_____________
SCHEDULE
B CLOSELY HELD BUSINESSES
RESIDENT DECEDENT
SCHEDULE B (2) CLOSELY HELD BUSINESSES
Proprietorship,
Partnership, Joint Venture and/or Closely Held Corporation in which the
Decedent Held Any Interest, Market Value at Date of Death [attach details]If
none, write none. ________________ $_____________
SCHEDULE
D EXPENSES
Estimated Expenses for Funeral $ ____________________
Probate
Administration $ ____________________
Counsel
Fees: $ ____________________
Executors or Administrators Commissions $
____________________
Other Administration Expenses (list individually),
attach receipts.
Expense _________________ $ ____________________
Expense
_________________ $ ____________________
Expense _________________ $
____________________
Expense _________________ $ ____________________
Expense
_________________ $ ____________________
Expense _________________ $
____________________
SCHEDULE E BENEFICIARIES
In case of Intestacy, the
parentage of all collateral heirs (such as nieces, nephews, cousins, etc.) must
be set forth. The relationship of step-parent, step-child, step-brother or
step-sister must be so stated.
BENEFICIARIES
AND ADDRESSES
(State full names and addresses of all who have an interest,
vested, contingent or otherwise, in estate)
HEIRS
AT LAW/
NEXT OF KIN: RELATIONSHIP: ADDRESS: APPROX. AGE: % INTEREST:
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Any
specific bequests/gifts in will? _____________________________
_________________________________________________________
(NOTE:
LIST CHILDREN OF DECEASED NEXT OF KIN - /ALSO GIVE AGE OF ANY MINORS)
State
full names of all beneficiaries who died before or after decedents death:
____________________________
1.
The Inheritance Tax Bureau will require certain documents. Please attach a
photocopy (not original) of the decedents Will, Death Certificate, codicils,
trusts, and last full years Federal Income Tax Return. This is required by the
Surrogates Office (Tax Bureau). We will also need photocopies of the Deed and
Tax Bill to submit to the Inheritance Tax Bureau.
SUMMARY
1.
Real Property - Schedule A $_______________
2. All Other Assets - Schedule B(1)
$_______________
3. Closely Held Businesses - Schedule B $_______________
4.
Transfers prior to death - Schedule C $_______________
5. Gross Estate . .
Total Lines 1 thru 4 $_______________
6. Deductions/Expenses . . . - Schedule D
$_______________
7. Net Estate . Total - Line 5, minus Line 6 $_______________
8.
Contingent Amount Included in Line 7 $_______________
9. Balance of Estate
(Line 7, minus Line 8) $_______________
Are any questions in Schedule C
answered yes? Yes __ No ___
Have or will you file or are you required to file
a Federal Estate Tax Return for estates over $2,000,000? Yes __ No ___
Has or
will any disclaimer been filed? If so, attach copy Yes __ No ___
If the
decedent died after December 31, 2001, did the decedents taxable estate plus
adjusted taxable gifts for Federal estate tax purposes under the provision of
the Internal Revenue Code in effect on December 31, 2001 exceed $675,000? Yes
__ No ___ If yes, by how much $ ___ ___ ___
How
can we help you? What questions do you have? Is there anything else important:
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
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clients: When you come into the office would you like:
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entitled to receive our Free Email Newsletter featuring updates in Probate,
Traffic Law, and Personal Injury/ Insurance. Thank you.
SCHEDULE C TRANSFERS
(THESE
QUESTIONS ARE REQUIRED BY THE INHERITANCE TAX BUREAU (DIVISION OF TAXATION)
1.
Did decedent, within three years of death, transfer property, valued at $500.00
or more, without receiving full financial consideration therefore? ___ Yes ___
No
2.
Did decedent, at any time, transfer property, reserving (in whole or in part)
the use, possession, income, or enjoyment of such property? ___ Yes ___ No
3.
Did decedent, at any time, transfer property on terms requiring payment of
income to decedent from a source other than such property? ___ Yes ___ No
4.
Did decedent, at any time, transfer property, the beneficial enjoyment of which
was subject to change because of a reserved power to alter, amend, or revoke,
or which could revert to decedent under terms of transfer or by operation of
law? ___ Yes ___ No
If answer to any of the above questions is Yes, set forth a
description of property transferred, the fair market value at date of death,
dates of transfers, and to whom transferred. Submit copy of trust deed or,
agreement, if any. (If transfers are claimed to be untaxable, also submit
detailed statement of facts on which such claim is based, proof as to decedents
physical condition and copy of death certificate.)
5.
Was decedent a participant in any pension plan that provided for payment to
another of an annuity or lump sum on or after death? ___ Yes ___ No
6.
Did decedent purchase or in any manner participate in any contract or plan
providing for payment of an annuity or lump sum on or after death to another,
except life insurance contracts payable to a designated beneficiary? ___ Yes
___ No
(Matured endowment policies, claim settlement certificates,
supplementary contracts, annuity contracts and refunds thereunder and interest
income certificates even though issued by an insurance company are not
considered life insurance contracts.)
7.
Was a single premium life insurance policy issued on decedents life in
conjunction with an annuity contract? ___ Yes ___ No
If answer to questions 5,
6 or 7 is Yes, attach photostatic copies of all such contracts, plans, and
policies.
8.
Were any accumulated dividends due on any contract of insurance? (If yes, list
below) ___ Yes ___ No
For
each transfer, set forth Date of Transfer; Description of Property, Both Real
and Personal: Actual Consideration if Any; Names and Relationship to Decedent
of Donees, Assignees, Transferees, etc.
___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Market
Value at Date of Death __________________________
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