Probate Intake Form "*" indicates required fields DemographicsName of Decedent* NAME OF DECEDENT Last Permanent Residence at Time of Death (Prior to Nursing Home or Hospital) STREET COUNTY CITY STATE ZIP Date of Birth Month Day Year Date of Death Month Day Year Social Security Number Was Decedent ever on Medicaid? Yes No Was Decedent ever on Medicare? Yes No Will DetailsLocation of Will, If Any Date of Will Month Day Year Location of Codicil, If Any Date of Codicil Month Day Year Representative DemographicsPersonal Representative (Named in Will or Proposed) NAME Last Address STREET CITY STATE ZIP Date of Birth Month Day Year Social Security Number PhoneRelationship to Decedent Beneficiaries or Heirs at LawDecedent's Spouse NAME Last Address STREET CITY STATE ZIP Date of Birth Month Day Year Social Security Number PhoneDecedent's Children (Click + to add more)NameAddressPhoneDate of Birth Add RemoveOther Beneficiaries (Click + to add more)NameAddressPhoneDate of BirthRelationship Add RemoveAssetsSafe Deposit Box Yes No Location of Safe Deposit Box Real Estate Address #1 STREET COUNTY CITY STATE ZIP How Titled DOD ValueHomestead? Yes No Add More Real Estate? Yes No Real Estate Address #2 STREET COUNTY CITY STATE ZIP How Titled DOD ValueHomestead? Yes No Real Estate Address #3 STREET COUNTY CITY STATE ZIP How Titled DOD ValueHomestead? Yes No Stocks & BondsName of Company Type of Security How Titled Location of Certificate DOD ValueName of Company Type of Security How Titled Location of Certificate DOD ValueBank AccountsBank Name Account Number How Titled DOD ValueBank Name Account Number How Titled DOD ValueBank Name Account Number How Titled DOD ValueMoney Market or Certificates of DepositName of Institution Account Number How Titled DOD ValueName of Institution Account Number How Titled DOD ValueUS Government Savings Bonds (E, EE, H)How Titled Location of Bonds To Be Cashed? Yes No If Yes, Name of Transferee DOD ValueAny Money Due to DecedentDebtor #1 NAME Last Debtor #1 Address STREET CITY STATE ZIP Terms of Obligation DOD ValueDebtor #2 NAME Last Debtor #2 Address STREET CITY STATE ZIP Terms of Obligation DOD ValueInsurance of Decedent's LifeCompany Name Policy Number Beneficiaries Named Location of Policy DOD ValueCompany Name Policy Number Beneficiaries Named Location of Policy DOD ValueAnnuitiesCompany Name Policy Number Beneficiaries Named Location of Policy DOD ValueVehiclesMake & Model Year How Titled Location of Title DOD ValueMake & Model Year How Titled Location of Title DOD ValueMake & Model Year How Titled Location of Title DOD ValueMiscellaneous Personal PropertyDebtsPlease list all debts owed by the decedent, including the amount owed, at the time of their death. (Example of debts would be credit cards, automobile loans, home loans, doctor's bills, etc. Creditor Account Number Creditor's Address: Type of Debt Amount OwedCreditor Account Number Creditor's Address: Type of Debt Amount OwedCreditor Account Number Creditor's Address: Type of Debt Amount OwedAdditional QuestionsAre Any of Decedent's Children Disabled? Yes No If yes, please list the child's name and nature of disability Documents Needed by This OfficePlease use the file upload button below to upload the following documents Death Certificate without Cause of Death (Short Form) Copy of Paid Funeral Bill with $0 Balance or Proof of Payment Copies of any Real Estate Deeds Copies of any Vehicle Titles Copies of any Bills Last Will and Testament (if one exists, original needed) File Drop files here or Select files Max. file size: 100 MB. Today's Date Month Day Year Name First Last Address STREET COUNTY CITY STATE ZIP Home PhoneCell PhoneWork PhoneEmail How Did You Hear About Us?PLEASE SELECT ONEALLEGAN COUNTY LEGAL ASSISITANCE CENTERFACEBOOKALLEGAN NEWSONLINE SEARCHREFERRED BYOTHERPlease Explain Type of CasePLEASE SELECT ONECRIMINALFAMILY LAWWILLS/TRUSTSLITIGATIONBANKRUPTCYSOCIAL SECURITYOTHERPlease Explain CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.