Wayne Gutman Law PLLC – Probate Intake Worksheet

Your Information (the Applicant)

The person contacting us — typically the surviving spouse, adult child, or named executor

First Name *

Middle Name

Last Name *

Date of Birth

Phone Number *

Email Address *

Home Address

City

State

ZIP Code

Preferred Contact Method *

Best Time to Reach You

Your Relationship to the Decedent *

How Did You Hear About Us?

Decedent Information

Information about the person who passed away

Tip: Names should match exactly what appears on the decedent's driver's license or death certificate. Email a digital copy of the death certificate to wayne@waynegutmanlaw.com.

First Name *

Middle Name

Last Name *

Suffix (Jr., Sr., III)

Other Names Used

SSN (last 4 digits)

Date of Birth

Date of Death *

Age at Death

City of Death *

County of Death

State of Death

Decedent's Last Home Address

City / County / State / ZIP

Marital Status at Time of Death *

Number of Certified Death Certificates Obtained

Surviving Spouse Full Name

Surviving Spouse Phone

Was Decedent Ever Previously Married?

Yes No Unknown

If Yes — Prior Spouse Name(s) & How Ended

Heirs, Beneficiaries & Family

All heirs must be identified for the Harris County probate application

Harris County Probate Courts require names, relationships, and addresses of all distributees (heirs or beneficiaries) in the application. List all children even if not named in the Will.

Did the Decedent Have Any Children? *

Yes No

List All Children

Full Name	Date of Birth	Relationship	Address / State	Living?	Minor?

Are All Heirs in Agreement to Proceed with Probate?

Yes No — dispute Uncertain

If Dispute — Briefly Describe

Did Decedent Have Living Parents?

Yes No

Did Decedent Have Living Siblings?

Yes No Unknown

Were There Minor Grandchildren?

Yes No

Has Anyone Begun Removing Assets from the Estate?

Yes No

Debts & Liabilities

Required to determine eligibility for simplified procedures

Does the Estate Have Unpaid Debts? *

Outstanding Mortgage on Real Property?

Yes No Unknown

Did Decedent Receive Medicaid Benefits?

Yes No Unknown

Known Creditors or Lawsuits Against Estate?

Yes No Unknown

Describe Known Debts / Creditors

Electronic Signature & Certification

By signing below, I certify that the information provided on this intake worksheet is true and accurate to the best of my knowledge. I understand that providing false or misleading information may affect the outcome of my probate matter. Submitting this form does not create an attorney-client relationship; that relationship is established only upon execution of a signed Engagement Agreement with Wayne Gutman Law PLLC.

Draw Your Signature Below *

Sign here using your mouse or finger

No signature yet

Printed Full Name *

Date Signed

Your information will be sent securely to wayne@waynegutmanlaw.com. We will contact you within 1 business day.

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✓ Form Submitted Successfully

Thank you! We have received your Probate Intake Worksheet and will contact you at the email and phone number you provided within 1 business day.

If you have urgent questions, please call or email us directly at wayne@waynegutmanlaw.com.