JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Heirs' Property Application for Services Form
This form will determine if you are eligible for assistance from Mississippi Center for Justice
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Date
*
MM
/
DD
/
YYYY
Last Name
*
Your answer
First name
*
Your answer
Your Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Personal Telephone
*
Your answer
Work Telephone
Your answer
Email
Your answer
Birthday
*
MM
/
DD
/
YYYY
Age
*
Your answer
Race
*
Black
White
Hispanic
Asian
Other
Prefer not to say
Gender
*
Female
Male
Prefer not to say
Other:
Do you currently have a will?
*
Yes
No
If you answered "no" for the previous question, will you allow MCJ to prepare a simple will for purposes of naming your heirs or beneficiaries?
Yes
No
Clear selection
Property Information
Property address / legal description or parcel number
*
Your answer
County
*
Your answer
Do you currently live on this land?
*
Yes
No
Do any other heirs live on this land?
*
Yes
No
If you answered "yes" above, how many other heirs live on this property?
Your answer
How many family members are involved with this property?
*
Your answer
How many acres are involved?
*
Your answer
Name on the original deed
*
Your answer
Your relationship to the name on the deed
*
Your answer
Did the person whose name is on the deed have a will?
*
Yes
No
Was this property probated?
*
Yes
No
I don't know
If this property was probated, do you live in a mobile or modular home?
Yes
No
Clear selection
Is this property in need of major housing repairs?
*
Yes
No
Maybe
Previous Legal Representation
Have you or another heir previously applied for services with Mississippi Center for Justice?
*
Yes
No
Do you have an attorney representing you now or have you had one represent you in the past regarding the property in question?
*
Yes
No
Have you spoken to an attorney about the property in the past three years?
*
Yes
No
If you spoke to an attorney, please name the attorney
Your answer
If you no longer have that attorney, do you have a termination letter?
Yes
No
Clear selection
To your knowledge, is any other heir or family member currently represented by an attorney in connection with this property?
*
Yes
No
To your knowledge, is there now or has there ever been a lawsuit filed regarding this property?
*
Yes
No
Income Information
How many people live in your household?
*
Your answer
Please list all income-earners in your household, their relationship to you, their age, and their annual income.
*
Your answer
What is the total annual income in your household?
*
Your answer
Check all sources of this income
*
Job Wages
Social Security
Disability
Child Support
Retirement
Unemployment
SSI / SSDI
Other:
Required
Employers that provide job wages toward your household income
Your answer
Do you have funds or savings available to you that are outside of your income and would allow you to hire an attorney?
*
Yes
No
If yes, what is the value of these funds or savings?
Your answer
What assistance are you seeking in reference to this property after a clear title is obtained?
*
Your answer
Do you understand that if your case is accepted, there will be no attorney's fees. However, you will be responsible for the expenses associated with filing your case?
*
Yes
No
How did you hear about Mississippi Center for Justice?
*
Your answer
Please enter your name to confirm that you agree with the contents of this completed application and understand that Mississippi Center for Justice has the right to request documentation to verify this information
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
