REV-346 EX (03-09) 3460009101 ESTATE INFORMATION SHEET FOR REGISTER’S OFFICE USE ONLY County Code Year File Number DECEDENT INFORMATION: Enter data as it will appear on all Decedent’s Social Security Number documents submitted to the Department. Date of Death Date of Birth Last Name First Name Suffix MI TYPE FILING: Fill in oval to indicate the nature of the return to be filed with the department. Probate Return Joint Assets Only Non-probate Assets Only Litigation Purposes (no other assets) LETTERS GRANTED: Fill in oval to indicate the nature of the proceedings at the Register of Wills Office. (Attach additional sheets if explanation is necessary.) Testamentary Administration No Letters Other (Please Explain.) ATTORNEY/CORRESPONDENT INFORMATION: Enter all information for the attorney or individual to receive tax information and correspondence. First Name Suffix Last Name Supreme Court I.D. # MI Telephone Number Attorney/ Correspondent’s e-mail address: First Line of Address Second Line of Address City or Post Office State ZIP Code PERSONAL REPRESENTATIVE INFORMATION: Enter all information for the personal representative(s) of the estate authorized by the Register of Wills. Executor/Administrator Social Security Number Last Name Telephone Number Suffix First Name MI First Line of Address OFFICIAL USE ONLY Second Line of Address City or Post Office TRANSACTION COUNT State ZIP Code Complete general estate information questions and indicate additional personal representatives on reverse side. PLEASE USE ORIGINAL FORM ONLY Side 1 3460009101 3460009101 American LegalNet, Inc. www.FormsWorkFlow.com 3460009201 REV-346 EX (03-09) Decedent’s Social Security Number Decedent’s Name: Co-Executor/Administrator Social Security Number Telephone Number Last Name First Name Suffix MI First Line of Address Second Line of Address City or Post Office State ZIP Code Co-Executor/Administrator Social Security Number Last Name Telephone Number First Name Suffix MI First Line of Address Second Line of Address City or Post Office State ZIP Code General Instructions: 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. Side 2 3460009201 3460009201 American LegalNet, Inc. www.FormsWorkFlow.com