Info Center – Wrongful Death

Name*

Address

City

State

Zip

Email Address*

Phone Number

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?

Yes No

When did the decedent die?

What was the cause of death?

Was an autopsy conducted?

Yes No

Was the decedent married or single?

Married Single

Is the decedent a minor?

Yes No

Did the decedent leave children?

Yes No

Was the decedent employed at the time of death?

Yes No

Were you dependent upon the decedent for financial support?

Yes No

Were other family members dependent upon the decedent for financial support?

Yes No

Do you have reason to believe the decedent experienced pain or suffering as a result of an incident that contributed to his/her death?

Yes No

Did an accident occur which caused the death?

Yes No

Is there any indication that the poor medical treatment contributed to cause the decedent’s death?

Yes No

Please note any other concerns:

DISCLAIMER: This web site is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship.