Confidential Will Questionnaire

more info at http://www.njlaws.com/will_questionnaire.html
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.

PLEASE PRINT CLEARLY

1. Your Full Name:

______________________________________________________

First Last

2. IF MARRIED OR SEPARATED, complete (a) and (b) below:

(a) Spouses 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: _________________________ 7. Todays Date ____________

If referred by a person, is this a client or attorney? __________________________________

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 _____

How can we help you? What are your questions/other important info?

______________________________________________________________

_______________________________________________________________

_______________________________________________________________

[It is required by New Jersey Court Rules that all pages be filled out prior to seeing the attorney]

8. Your Sex: [ ] Male [ ] Female

9. Your Marital Status: [ ] Single [ ] Married [ ] Separated [ ] Divorced [ ] Widowed

10. Your Date of Birth: ___________________ SS # __________________

Month Day Year

11. Spouse Date of Birth: _________________ SS # __________________

Month Day Year

12. 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:

Name: _______________________ _______________________

First Last

Relationship: _______________ Address: ____________________

2. SECOND Choice of Executor:

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.

Full Name: ___________________________ _________________

First Last

Relationship: _______________ Address: ____________________
The two proposed Executors must be filled out prior to meeting the attorney. We do not recommend Joint Executors, which often cause conflicts and additional work for the Estate. It is best to select one primary person, then a secondary person.

Asset Information- Must Be Completed - If none, write none

House/Real Estate Address _________________________________________________

Estimate Total Real Estate Value: _____________ Approx mortgage ________________

Bank Accounts, Stocks, CDs and Assets: _______________________________________

Approximate Amount _______________________________________________________

Beneficiaries of Bank Accounts (if none write none) ______________________________

Other Major Assets (if none, write none): _______________________________________

Approximate Life Insurance: _________________ Beneficiary ____________________

In the Will- Who do you want to get your assets:

Beneficiary (1) _______________________ Relationship _______________

Beneficiary (2) _______________________ Relationship _______________

Beneficiary (3) _______________________ Relationship _______________
Any Specific Bequests of Money and Property:

_________________________________________________________________________

_________________________________________________________________________

[ ] A. MARRIED PERSONS WITH CHILD(REN) OR GRANDCHILD(REN).

KENNETH  VERCAMMEN & ASSOCIATES, PC
ATTORNEY AT LAW
2053 Woodbridge Ave.
Edison, NJ 08817
(Phone) 732-572-0500
 (Fax)    732-572-0030
website: www.njlaws.com