Probate Intake Form (New Version) Probate Intake Form (New Version)Intake Agent's Name- Select -Fabricio FallasJay MappusJoseph RiosJoy JenkingJuan Carlos SalasRangel MorganMaria Gabriela FonsecaOrganization- Select -McDonald Worley Law FirmCase Type- Select -ProbateLead Source- Select -ArcherProbate ProNational Probate PartnersE and W - Your Adoption LayerESTATE OF _Client's First NameClient's Last NameClient's Phone NumberTo do probate with us we require a $2,500 retainer fee to start the case. We do bill hourly though so it could be a little more depending on how the case goes. Shall we proceed? Yes NoWhat is your email address?In which state did the decedent pass away?- Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificIs there a Will? Yes No Don't KnowYes - There is a WillDo you have the original will? Yes NoHas it been over 4 years since Decedent died? Yes NoIf yes, why wasn’t it done within 4 years?We can still file an application but we will need intestate heirs to sign a consent or have them served. Shall we proceed? Yes NoThank you (Mr./Ms. Last Name) for reaching out but after reviewing your information, unfortunately, we will not be able to assist at the time. However, you may contact your local Bar association for further assistance.Is an independent executor named in the Will? Yes NoIs an executor named in the Will? Yes NoAre you the executor named in the Will? Yes No If not, why isn’t the executor named applying?What is your relationship to the Decedent?What are the last 4 digits of your social security number?What are the last 4 digits of your Drivers License number?What is your marital Status: Married Divorced Widowed SingleWhat is your birth date?Is the decedent a minor?- Select -YesNoWhat's the last 3 digits of the decedent security social number?What's the last 3 digits of the decedent driver license?Client's AddressStreetCityStateZip CodeHow many beneficiaries are listed in the will?- Select -12345678910Beneficiary 1Name: Street Address: City: State: Zip: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Beneficiary 2Name: Street Address: City: State: Zip: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Beneficiary 3Name: Street Address: City: State: Zip: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Beneficiary 4Name: Street Address: City: State: Zip: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Beneficiary 5Name: Street Address: City: State: Zip: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Beneficiary 6Name: Street Address: City: State: Zip: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Beneficiary 7Name: Street Address: City: State: Zip: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Beneficiary 8Name: Street Address: City: State: Zip: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Beneficiary 9Name: Street Address: City: State: Zip: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Beneficiary 10Name: Street Address: City: State: Zip: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Could you please send me a copy of the will? Yes NoNo - There is no WillDo all the heirs agree to you being appointed the Independent Administrator of the estate and able to sign a waiver and consent? Yes No Don't KnowThen we will have to do a dependent administration. Each heir will have to be served. Also, the court will require a bond. The bond amount will be based off the value of Decedent’s assets. You would have to pass a credit check. A dependent administration means the court must approve everything we do. It’s a longer and more expensive process. Shall we proceed? Yes NoWhat is your relationship to the Decedent? What are the last 4 digits of your social security number?What are the last 4 digits of your Drivers License number?Is the decedent a minor?- Select -YesNoWhat are the last 3 digits of the DECEDENT Social Security Number?What are the last 3 digits of the DECEDENT Driver License?What is your marital Status: Married Divorced Widowed SingleWhat is your birth date?Clients's AddressStreetCityStateZip CodeWas Decedent married at the time of death? Yes NoDid Decedent have children? Yes NoAre any of Decedent’s children minors? Yes NoHow many heirs (decedent’s children & spouse) are there?- Select -123456789101112131415Heir 1Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 2Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 3Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 4Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 5Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 6Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 7Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 8Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 9Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 10Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 11Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 12Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 13Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 14Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Heir 15Name: Full Address: Relationship to Decedent: Marital Status: Date of Birth: Place of Birth: Phone Number: Email: Name of the other parent (if necessary):Was the decedent ever married? Yes No"If the Decedent was not married and didn’t have children, then the heirs will be the parents. If the parents are deceased, then the heirs would be Decedent’s siblings."How many times was the decedent married?- Select -12345Spouse 1Name: Was Decedent married to this person at time of death? Date of marriage: Date & place of termination if the marriage was terminated: Email address:: Phone number:Spouse 2Name: Was Decedent married to this person at time of death? Date of marriage: Date & place of termination if the marriage was terminated: Email address:: Phone number:Spouse 3Name: Was Decedent married to this person at time of death? Date of marriage: Date & place of termination if the marriage was terminated: Email address:: Phone number:Spouse 4Name: Was Decedent married to this person at time of death? Date of marriage: Date & place of termination if the marriage was terminated: Email address:: Phone number:Spouse 5Name: Was Decedent married to this person at time of death? Date of marriage: Date & place of termination if the marriage was terminated: Email address:: Phone number:Did the decedent own other assets than this lawsuit?- Select -NoYesAssetsWas the estate worth less than $50,000? Yes NoDo you know if the decedent received Medicaid benefits on or after March 1, 2005? Yes No"Since the Estate is worth $50,000 or less, it qualifies for the Small Estate Affidavit. We will need 2 disinterested witnesses to sign the Small Estate Affidavit. Note: If Decedent was not married and didn’t have children, then the heirs will be the parents. If the parents are deceased, then the heirs would be Decedent’s siblings."Would you like to add an emergency contact? Yes NoFirst NameLast NameRelationship to you:Phone/MobileCould you please send me a copy of the death certificate? Yes No(Vocatum Agent - For outbound calls only.) Can you tell me what caller ID your phone is displaying for our call?Is your phone a cell or landline phone? Cell Phone Landline PhoneLead Status- Select -Send email of Lead ti firmSend retainer contractSend printed retainer contractRetainer sent by textAdminNew leadRejectedDisqualifiedVery quality leadIntake NotesTriple Intake Status- Select -Retainer sentLanguage- Select -EnglishSpanishCreolePortugueseOther (see intake notes)Submit
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