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Applicant Information

Name
Address
City
State
Zip Code
Date of Birth
Date of Death
WILL
1. Yes
2. No
Will Dated
WILL Number of Pages
Asset Description # 1
List assets in decedents name only. Do Not List accounts/policies with survivorship, payable on death, or beneficiary. Do Not include sensitive information including identifiable numbers.
Estimated Value
Asset Description # 2
List assets in decedents name only. Do Not List accounts/policies with survivorship, payable on death, or beneficiary. Do Not include sensitive information including identifiable numbers.
Estimated Value
Asset Description # 3
List assets in decedents name only. Do Not List accounts/policies with survivorship, payable on death, or beneficiary. Do Not include sensitive information including identifiable numbers.
Estimated Value
Asset Description # 4
List assets in decedents name only. Do Not List accounts/policies with survivorship, payable on death, or beneficiary. Do Not include sensitive information including identifiable numbers.
Estimated Value
Real Estate # 1
Provide all the addresses of real estate decedent's name.
Jointly Held
1. Yes
2. No
Real Estate # 2
Provide all the addresses of real estate decedent's name.
Jointly Held
1. Yes
2. No
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HEIRS AT LAW # 1
Age
Relationship
Address
HEIRS AT LAW # 2
Age
Relationship
Address
HEIRS AT LAW # 3
Age
Relationship
Address
HEIRS AT LAW # 4
Age
Relationship
Address
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature

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