Name of Applicant (Client):
Address:
City, State, Zip:
County:
Phone:
Email:
Last 4 of Social Security No
Last 4 of Driver's License
Other State if not Texas:
Name of Deceased:
Place of Birth
Date of Death
Place of Death
Last 4 of TX Driver's Lic. or ID
Last 4 of Social Security No.
Name of Spouse:
Address, City, State, County:
Date of Marriage
Place of Marriage
Prior Spouse #1 Name:
Date of Marriage
Place of Marriage
Date of Divorce
Place of Divorce
Prior Spouse #2 Name:
Date of Marriage
Place of Marriage
Date of Divorce
Place of Divorce
Prior Spouse #3 Name:
Date of Marriage
Place of Marriage
Date of Divorce
Place of Divorce
Beneficiary #1 Name:
Address
City, State, Zip
County
Phone number
E-mail
Relationship to the Deceased:
Beneficiary #2 Name:
Address
City, State, Zip
County
Phone number
E-mail
Relationship to the Deceased:
Beneficiary #3 Name:
Address
City, State, Zip
County
Phone number
E-mail
Relationship to the Deceased
Beneficiary #4 Name
Address
City, State, Zip
County
Phone number
E-mail
Relationship to the Deceased
Beneficiary #5 Name
Address
City, State, Zip
County
Phone number
E-mail
Relationship to the Deceased
Deceased Beneficiary #1 Name:
Date of Death
Deceased Beneficiary #2 Name:
Date of Death
Witness #1 Name
Phone number
Address
City, State, Zip
E-mail
Relationship to the Deceased
How long did they know the Decedent?
Witness #2 Name
Phone number
Address
City, State, Zip
E-mail
Relationship to the Deceased
How long did they know Decedent?
Real Estate Address & County
Approximate Value
Real Estate Address & County
Approximate Value
Real Estate Address & County
Approximate Value
Real Estate Address & County
Approximate Value
Mineral Rights Location & County
Approximate Value
Mineral Rights Location & County
Approximate Value
Mineral Rights Location & County
Approximate Value
Name of Bank
Type of Acct. (Checking or Savings)
Checking
Savings
LAST 4 of ACCT#
Approximate Balance
Name of Bank
Type of Acct. (Checking or Savings)
Checking
Savings
LAST 4 of ACCT#
Approximate Balance
Name of Bank
Type of Acct. (Checking or Savings)
Checking
Savings
LAST 4 of ACCT#
Approximate Balance
Name of Bank
Type of Acct. (Checking or Savings)
Checking
Savings
LAST 4 of ACCT#
Approximate Balance
Name of Bank
Type of Acct. (Checking or Savings)
Checking
Savings
LAST 4 of ACCT#
Approximate Balance
Name of Bank
Type of Acct. (Checking or Savings)
Checking
Savings
LAST 4 of ACCT#
Approximate Balance
IRA's (Name of Institution)
Type and LAST 4 of ACCT#
Approximate Balance
IRA's (Name of Institution)
Type and LAST 4 of ACCT#
Approximate Balance
IRA's (Name of Institution)
Type and LAST 4 of ACCT#
Approximate Balance
IRA's (Name of Institution)
Type and LAST 4 of ACCT#
Approximate Balance
Investments (Name of Institution)
Type and LAST 4 OF ACCT#
Approximate Balance
Investments (Name of Institution)
Type and LAST 4 OF ACCT#
Approximate Balance
Investments (Name of Institution)
Type and LAST 4 OF ACCT#
Approximate Balance
Stocks, Bonds, Etc.
Type and LAST 4 OF ACCT#
Approximate Balance
Stocks, Bonds, Etc.
Type and LAST 4 OF ACCT#
Approximate Balance
Stocks, Bonds, Etc.
Type and LAST 4 OF ACCT#
Approximate Balance
Make
Model
Year
Color
Condition
17 Digit VIN
Approximate Value
Make
Model
Year
Color
Condition
17 Digit VIN
Approximate Value
Make
Model
Year
Color
Condition
17 Digit VIN
Approximate Value
Make
Model
Year
Color
Condition
17 Digit VIN
Approximate Value
Make
Model
Year
Color
Condition
17 Digit VIN
Approximate Value
Household Goods. Personal Items and Furnishings (you do not need to itemize, please estimate the total amount based on GARAGE SALE VALUES)
Approximate Total Value of Estate
Share On: