Client Interview.pdf
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PART I - PERSONAL DATA NAME of DECEDENT:_________________________________________________________ Alias Names (if any):____________________________________________________________ Street Address:_________________________________________________________________ City:___________________________ State:____________________ Zip Code:_____________ Date of Birth:__________________________________________________________________ Place of Birth:__________________________________________________________________ Date of Death:__________________________________________________________________ Place of Death:_________________________________________________________________ Social Security Number:__________________________________________________________ Was Decedent a U.S. citizen Yes: _ No:___ If naturalized U.S. citizen, Date and Place of Naturalization:_____________________________ ______________________________________________________________________________ Location of Will, if any:__________________________________________________________ Date of Will:___________________________________________________________________ Page 1 of 7 Location of Codicils, if any:_______________________________________________________ Date of Codicils:________________________________________________________________ NAME of PERSONAL REPRESENTATIVE:______________________________________ Street Address:_________________________________________________________________ City:___________________________ State:____________________ Zip Code:_____________ Home :_______________________________Cell :__________________________________ Work :________________________________Fax :__________________________________ E-mail:_________________________________Pgr :__________________________________ Relationship to Decedent:_________________________________________________________ NAME of ALTERNATE REPRESENTATIVE:_____________________________________ Street Address:__________________________________________________
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