How are you related to the decedent (the person who passed away)?
Have you been appointed as the personal representative or executor of the decedent’s estate?
When did the decedent die?
What was the cause of death?
Was an autopsy conducted?
Was the decedent married or single?
Is the decedent a minor?
Did the decedent leave children?
Was the decedent employed at the time of death?
Were you dependent upon the decedent for financial support?
Were other family members dependent upon the decedent for financial support?
Do you have reason to believe the decedent experienced pain or suffering as a result of an incident that contributed to his/her death?
Did an accident occur which caused the death?
Is there any indication that the poor medical treatment contributed to cause the decedent’s death?
Please note any other concerns:
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