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Wrongful Death Information Center

Wrongful Death Information Center

Wrongful Death Contact Form

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?
YesNo

When did the decedent die?

What was the cause of death?

Was an autopsy conducted?
YesNo

Was the decedent married or single?
MarriedSingle

Is the decedent a minor?
YesNo

Did the decedent leave children?
YesNo

Was the decedent employed at the time of death?
YesNo

Were you dependent upon the decedent for financial support?
YesNo

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

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

Did an accident occur which caused the death?
YesNo

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

Please note any other concerns:

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