Estate Planning interview in NJ

"CONFIDENTIAL WILL QUESTIONNAIRE"  by KENNETH VERCAMMEN & ASSOCIATES, complete details at http://www.njlaws.com/will_Questionnaire.html
ATTORNEY AT LAW
2053 Woodbridge Ave
Edison, NJ  08817
(Phone) 732-572-0500
(Fax) 732-572-0030
 Please fill out completely and fax or mail back. This form is extremely important. Your accuracy and completeness in responding will help me best represent you. All sections and information must be filled out prior to sitting down with the attorney.
 Please be sure to check all appropriate boxes. If "NONE", please state "NONE".
If "NOT APPLICABLE", please state "N/A" or none.
PLEASE PRINT CLEARLY
1.  Your Full Name: _____________________________________________

2. IF MARRIED OR SEPARATED, complete (a) and (b) below:
(a) Spouse's Full Name:

______________________________________________________
First                                 Last

3.  Your Street Address: ____________________________________

City _______________________ State ____  Zip Code ______________
            
4. Telephone Numbers:              

Cell: _______________________________    ________________________
                                      
Day: ____________________/Night: ________________________

5. E-mail address: _______________________________________

6. Referred By: ___________________________________________
 If referred by a person, is this a client or attorney?  If you heard about the law office on the internet, which search engine?  What search terms did you use?

7. Today's Date ____________________

       We recommend a Durable Power of Attorney in the event of your physical
or mental disability to help you with financial affairs?
                 Yes ________  No ________

        We recommend a Living Will telling hospitals and doctors not to prolong your life by artificial means, i.e. Terri Schiavo; Karen Quinlan?    
        Yes ________  No ________
Confidential Will Q                Rev 3/24/14
How can we help you? What are your questions/other important information?

_______________________________________________________________________

_______________________________________________________________________
[It is required by Court Rules that all pages be filled out in person's own handwriting prior to seeing the attorney]
8. Your Marital Status: [  ] Single   [  ]  Married  [  ]  Separated    [  ] Divorced [  ]  Widowed
     [  ] Domestic Partner

9.  Your Day/Month  of birth:  ___________________
    

10.  Spouse Day/Month of birth:  _________________
                          
11. If you are the parent or legal guardian of a minor child or minor children, please check here.  [   ]
2.  ESTATE EXECUTOR
 The person charged with administering/Probating your estate, paying taxes and/or other debts, preserving, managing, and distributing estate assets and property is called an Executor. This person should be one in whom you have trust and confidence. Your SPOUSE is usually named as primary Executor, followed by the child who lives closest to your home.
 Please provide the following information about the person you wish to name to serve in this capacity.
1. PRIMARY Choice of Executor/Personal Representative in Power of Attorney:

Name: _________________________  ______________________________
            First                                              Last

Relationship: _______________ Address: ________________________

2. SECOND Choice of Executor/Personal Representative in Power of Attorney:
 This individual will serve in the event that the primary executor/personal representative is not alive at the time of your death, or is unable to serve.

Name: _________________________  ______________________________
            First                                              Last

Relationship: _______________  Address: _____________________________
   The two proposed Executors must be filled out prior to meeting the attorney.