Estate Information Sheet {REV-346}

3460015105 FORREGISTER'SOFFICEUSEONLY 1 DECEDENTINFORMATION: Enterdataasitwillappearonall Decedent's Social Security Number ESTATEINFORMATION SHEET REV-346 EX (11-15) County Code Year File Number documentssubmittedtotheDepartment. Date of Death Date of Birth Last Name Suffix First Name MI 2 TYPEFILING: Fillinovaltoindicatethenatureofthereturntobefiledwiththedepartment. Probate Return Joint Assets Only Non-probate Assets Only 3 LETTERSGRANTED: Fillinovaltoindicatethenatureoftheproceedings attheRegisterofWillsOffice. (Attachadditionalsheetsifexplanationisnecessary.) Administration No Letters Testamentary Other (Please Explain.) Litigation Purposes (no other assets) 4 ATTORNEY/CORRESPONDENTINFORMATION: Enterallinformationfortheattorneyorindividualtoreceivetax Last Name Supreme Court I.D. # information andcorrespondence. First Name Suffix MI Telephone Number Attorney/ Correspondent's e-mail address: First Line of Address Second Line of Address City or Post Office State ZIP Code 5 PERSONALREPRESENTATIVEINFORMATION: Enterallinformationforthepersonalrepresentative(s)oftheestate authorizedbytheRegisterofWills. Suffix First Name Executor/Administrator Last Name MI First Line of Address OFFICIALUSEONLY Second Line of Address TRANSACTIONCOUNT City or Post Office State ZIP Code Telephone Number Completegeneralestateinformationquestionsandindicateadditionalpersonalrepresentativesonreverseside. PLEASEUSEORIGINALFORMONLY Side1 3460015105 3460015105 American LegalNet, Inc. www.FormsWorkFlow.com 3460015205 REV-346 EX (11-15) Decedent's Name: Decedent's Social Security Number Co-Executor/Administrator Last Name Suffix First Name MI First Line of Address Second Line of Address City or Post Office State ZIP Code Telephone Number Co-Executor/Administrator Last Name Suffix First Name MI First Line of Address Second Line of Address City or Post Office State ZIP Code Telephone Number GeneralInstructions: This form should be filed with the Register of Wills of the county of which the decedent was a resident at death. Please be aware the correspondent identified will receive all correspondence from the department. It is the responsibility of the personal representative to notify the department if the correspondent contact information changes. The department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The department uses the Social Security number to identify the decedent and personal representatives of the estate. The commonwealth may also use the information in exchange-of-tax-information agreements with federal and local taxing authorities. State law prohibits commonwealth personnel from disclosing confidential tax information except for official purposes. Side2 3460015205 3460015205 American LegalNet, Inc. www.FormsWorkFlow.com