LexaGuard Legacy Law Group

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Here are a few tips before you begin:

1. Watch Click Here this video Do not overthink this! These are only preliminary questions to get you thinking. These are NOT final decisions. All answers will be reviewed with a qualified attorney and can be changed.

2. Please allow 15-20 minutes to complete this questionnaire. You can save and come back to the questionnaire as needed.

3. Our online questionnaire cannot account for every scenario, so we suggest you fill it out the best you can. We can always make changes to your drafts once you’ve submitted the application.

Please provide Decedent information below.

First Name *

Middle Name *

Last Name *

Email *

Password *

Cell *

Decendent Details
Decendent Details

Date Of Birth *

Date Of Death *

Social Security Number *

Also known as(optional)

Are you married? *

✓

Yes

✓

No

Suffix(optional)

✓

Jr

✓

Sr

✓

II

✓

III

✓

Other

Gender

✓

Male

✓

Female

PERMANENT RESIDENCE AT TIME OF DEATH

Full Address: *

Address Line 1 *

Address Line 2

City *

State *

County *

Zip Code *

Was Decedent Ever on Medicaid? *

✓

Yes

✓

No

Was Decedent Ever on Medicare? *

✓

Yes

✓

No

Location of Will

LOCATION OF WILL

DATE OF WILL *

LOCATION OF CODICIL, IF ANY

DATE OF CODICIL *

PERSONAL REPRESENTATIVE

Full Name *

Address *

City *

State *

Zip Code *

Date Of Birth *

Social Security *

Telephone *

Relationship To Decendent *

BENEFICIARIES OR HEIRS AT LAW

decedentspouse

Spouse Name *

Address *

City *

State *

Zip Code *

Date Of Birth *

Social Security *

Telephone *

DECEDENT'S CHILDREN:

Child Name *

Address *

City *

State *

Zipcode *

Telephone *

Date Of Birth *

OTHER BENEFICIARIES (INCLUDE LIVING SIBILINGS AND LIVING PARENTS):

Beneficiary Name *

Address *

City *

State *

Zip Code *

Date Of Birth *

Telephone *

Relationship To Decendent *

ASSETS

Safe Deposit Box *

✓

Yes

✓

No

Location *

Real Estate

Address *

City *

State *

Zip Code *

County *

DOD Value *

How Titled *

HomeStead *

✓

Yes

✓

No

Stocks And Bonds

Name Of Company *

Type Of Security *

How Titled *

Location Of Certificate *

Date Of Death Value *

Bank Accounts

Bank Name *

Account Number *

How Titled *

Date Of Death Value *

Money Market Accounts Or Certificates of Deposit

Name Of Institution *

Account Number *

How Titled *

Date Of Death Value *

U.S. GOVERNMENT Savings Bonds (E, EE, H)

How Titled *

Location Of Bonds *

To Be Cashed *

✓

Yes

✓

No

If Yes, Name Of Transferee

Date Of Death Value *

Mortgages And Notes

Mortgagor *

Address *

City *

State *

Zipcode *

Terms Of Obligation *

Date Of Death Value *

Insurance On Decedent's Life

Company Name *

Policy # *

Beneficiaries Name *

Location Of Policy *

Date Of Death *

Annuities

Company Name *

Policy # *

Beneficiary Named *

Location Of Policy *

Date Of Death Value *

Vehicles

Model *

Year *

How Titled *

Location Of Title *

Date Of Death Value *

Miscellaneous Personal Property *

DEBTS

Please 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 # *

Creditor's Address *

Type Of Debt *

Amount Owed *

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