Probate Information Form - Ccr-J-20
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1
2IN THE CIRCUIT COURT OF FAIRFAX COUNTY
PROBATE INFORMATION FORM
PLEASE PRINT CLEARLY
Fiduciary Number: FI-_______-________________
1. Decedent’s full name exactly as it appears on the death certificate:
__________________________________________________________________________________________
2. Decedent’s full name exactly as it appears on the will & codicil(s), if such document exists:
__________________________________________________________________________________________
3.
Married
Widowed
Divorced
Never Married
4. Decedent’s residence address at death (street, city, state):
__________________________________________________________________________________________
5. Date of Death: _____________ Place of death: ______________________ Date of Birth: ________________
6. Proof of death:
Death Certificate:
other ___________________________________________________
7. Decedent died:
with a will
without a will
with a codicil
without a codicil
8. Date of will: ______________________
Date of codicil(s): ____________________________________
9. Name, address & telephone number of ALL PERSONS probating will and/or seeking appointment as:
Executor
Administrator
Other ___________________________________
A.
Name: ________________________________________________________________________________
Address: _____________________________________________________________________________________
Evening Telephone #: (
) _______________________
Day Telephone #: (
) _____________________
Employer’s Name: _____________________________________________________________________________
Work Address: ________________________________________________________________________________
B.
Name: ________________________________________________________________________________
Address: _____________________________________________________________________________________
Evening Telephone #: (
) _______________________
Day Telephone #: (
) _____________________
Employer’s Name: _____________________________________________________________________________
Work Address: ________________________________________________________________________________
C.
Name: ________________________________________________________________________________
Address: _____________________________________________________________________________________
Evening Telephone #: (
) _______________________
Day Telephone #: (
) _____________________
Employer’s Name: _____________________________________________________________________________
Work Address: ________________________________________________________________________________
D.
Name: ________________________________________________________________________________
Address: _____________________________________________________________________________________
Evening Telephone #: (
) _______________________
Day Telephone #: (
) _____________________
Employer’s Name: _____________________________________________________________________________
Work Address: ________________________________________________________________________________
J-20
November 2006
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