KENNETH VERCAMMEN & ASSOCIATES, PC
ATTORNEY AT LAW
2053 Woodbridge Ave
Edison, NJ 08817
(Phone) 732-572-0500
(Fax) 732-572-0030
"CONFIDENTIAL WILL QUESTIONNAIRE"
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: _____________________________________________
2. IF MARRIED OR SEPARATED, complete (a) and (b) below. If married no need to fill out separate forms unless you want different Executors
Spouse's Full Name: ___________________________________ _______
First Last
3. Your Street Address: ____________________________________
City _______________________ State ____ Zip Code ______________
4. Telephone Numbers:
Cell: _______________________________ other # _____________________
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, what search terms did you use? If Legal plan, write Claim number. [Hyatt, UAW] _______
7. Today's Date ____________________
We recommend a DurablePowerofAttorneyin the event of your physical
or mental disability to help you with financial affairs?
Yes ________ No ________
We recommend a Living Willtelling hospitals and doctors not to prolong your life by artificial means, i.e. Terri Schiavo; Karen Quinlan?
Yes ________ No ________
Confidential Will Q Rev 5/4/19
How can we help you? What are your questions/other important information that need to be addressed?
_______________________________________________________________________
_______________________________________________________________________
[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
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. 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 _________________________________________
Other Real Estate Address _________________________________________
Estimate Total Real Estate Value:_____________ mortgagebalance _________
Bank Accounts, Stocks, CDs and Assets:_______________________________
Approximate Amount______________________________________________
Direct Beneficiaries of Accounts -If none write "none"____________________
Other Major Assets -If none, write "none"_____________________________
Approximate Life Insurance:_________________ Beneficiary_____________
Is total more or less than $11,500,000 ? ____________
In the Will- Who do you want to get your assets:
Beneficiary (1) _______________________ Relationship_______________
Beneficiary (2) _______________________ Relationship_______________
Beneficiary (3)_______________________ Relationship_______________
It is required that major assets and beneficiaries be filled out prior to seeing the attorney. A best guess. Also, list who receives assets if a beneficiary dies prior to you if that person’s share does not go to their children.
Any Specific Bequests of Money and Property:
______________________________________________________________
[ ] A. MARRIED PERSONS WITH CHILD(REN) OR GRANDCHILD(REN).
Generally most married people provide that, upon their death, property will be distributed as follows:
1. Your estate (all property and assets not owned jointly with another person) will be distributed to your surviving spouse.
2. If your spouse predeceases you, then your estate will be divided in equal shares among all of your living children, If any child shall predecease you, then that child's share to their children (grandchildren).
Names of Children: ______________________________ Age: _____
____________________________________________ Age: _____
LIST THE NAMES AND AGES OF ALL CHILDREN EVEN IF THEY ARE OLDER THAN EIGHTEEN. IF NO CHILDREN, WRITE NONE.If no minor children, skip page 5.
III. GUARDIAN(S) OF MINOR CHILD(REN) or Trustees of Trust
[Skip this section if you have NO minor children and DO NOT want a trust. There are substantial additional fees for preparation of a Trust, minimum $2,500 for stand alone trusts]
The surviving parent of a minor child is ordinarily entitled to be the GUARDIAN of that child. In the case of simultaneous death of you and your spouse, or if you are a single parent, you should appoint a Guardian for your minor child. It is advisable, prior to the completion of this Questionnaire, to make sure that your proposed Guardian(s) is (are) willing to serve as Guardian(s). In addition, the Guardian will also hold the monies for the minor children UNLESS you direct us otherwise. In your Will you can have any adult serve as Trustee of monies for minor children.
Provide the following information about the person(s) you select to be Guardian(s)/Trustee(s). In the event my spouse predeceases me, I name as GUARDIAN(S)/ TRUSTEE(S):
1. PRIMARYChoice of GUARDIAN / TRUSTEE:
Full Name: _______________________________________
Relationship: ______________________________________
2. SECONDChoice of GUARDIAN / TRUSTEE:
Full Name: _______________________________________
Relationship: _____________________________________
[ ] B. MARRIED PERSONS WITH NO CHILD(REN) OR GRANDCHILD(REN).
Generally most married people with no child(ren) or grandchild(ren) provide that upon their death their property will be distributed as follows:
1. Your estate (all property and assets not owned jointly with another person) will be distributed to your surviving spouse, but
2. If your spouse predeceases you, then your estate will be distributed to your living parent, or equally to your living parents.
3. But should both of your parents predecease you, then your estate will distributed equally to your brothers and sisters or equally to the children of a predeceased brother or sister.
Please check B above only if you wish your property distributed precisely and exactly as indicated in section B, 1 through 3, above.
Additional information on Wills, Probate and Elder Law available at www.njlaws.com. This interview form online at http://www.njlaws.com/will_questionnaire.html
[ ] C. DIVORCED OR WIDOWED PERSONS WITH CHILD(REN) OR GRANDCHILD(REN). Generally, most divorced or widowed persons with child(ren) or grandchild(ren) provide that upon their death property will be distributed as follows: 1. Your estate (all property and assets not owned jointly with another person) will be distributed in equal shares to all of your living child(ren).
2. But if one or more of your children predeceases you, that deceased child's share will be distributed to his or her child(ren), your grandchild(ren) in equal shares
[ ] D. ALTERNATE PLAN OF DISTRIBUTION - You may list specific gifts to individuals and/or divide your estate among several individuals by listing percentages to each, making sure that the percentages total 100%. You may add additional sheets if necessary or use the back of this form. There are additional Will preparation fees if there are gifts, called specific bequests.
Are there any beneficiaries with special needs, or receiving SSI or SDD? Please answer in detail ___________________________
Are you or any of your Beneficiaries are not United States citizens? _______
If not US citizen, extra taxes may apply.
Do you have any religious wishes on burial? ___, Are you a USA Veteran or Elks member?_
PLEASE WRITE DOWN ANY QUESTIONS YOU HAVE HERE or anything else important that we should be aware. Use back of this page for additional important information or type a list:
______________________________________________________________
______________________________________________________________
If your assets exceed $5,000,000 and you desire estate planning to avoid or reduce your estate tax or require a Trust to protect a spouse or children, please advise Mr. Vercammen. A Standard Will is not designed to address estate tax issues. We do not do Medicaid Nursing Home Planning. The law office building has four steps in the front so please advise us if you need assistance.
WILLS:
T 1- Parents with minor children and trust for children ____________
T 2- Parents no spouse ____________
T 3- Unmarried ____________
T 4- Parents without trust ____________
T 5- Spouse Trust Will $ for spouse to go in Trust ? [2ndmarriage
or protect assets from Medicaid _____
PAYMENT WILL BE MADE BY: (Please circle one)
Check, Credit Card (Visa, Mastercard, American Express) or Cash
Checks are payable to Vercammen PC
Payment is required for Will, Power of Attorney and other document preparation at the first consult and prior to any documents being drafted. Minimum fee for Last Will and Testament preparation is $300 each. We charge a $150.00 consultation fee, which is credited to the preparation of the Will or other document. This $150.00 fee is non-refundable even if the documents are not prepared. If there are any changes to a draft Will, Power of Attorney, or other document, there will be a minimum charge of $75.00 per revision. The Will needs to be signed within 21 days of initial consult or an additional fee of $100.00 will be charged. Due to complexity and need to re-title assets, Fees for stand alone Trusts are minimum $3,000.
This form was filled out by: sign name _________________________
