Name
Address
City
State
Zip
Email Address
Phone Number
Business Phone
Cellular or Pager
Relationship to decedent
Decedent's date and place of birth
Date of death
Place of death
Residence at the time of death
Marital status
ChildrenYes No
If yes, provide names, ages, and addresses
Children from outside a marriageYes No
Prior marriages?Yes No
Was there a will?Yes No
Checking $
Savings $
Cash $
Bonds $
Stocks $
CD's $
Household Goods/Furnishings $
Automobile $
Other (list) $
Home $
Vacation Home $
Rental Property $
Land $
Mortgage $
Credit Cards $
Medical Expenses $
Other $
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Robert W. York & Associates 7212 North Shadeland Ave., Suite 150 Indianapolis, IN 46250 Map & Directions E-mail the Firm Phone: 317-842-8000 Toll-Free: 888-309-0784