Please type up & fill out completely and email back. Typing name and details is necessary. Save as word doc or text with your name. Don't save as pdf or handwrite. Your accuracy and completeness in responding will help me best help you. This form is extremely important. All sections and information must be filled out prior to discussing with the attorney. Should not be handwritten since computer will scan and computer cannot read handwritten info. After we receive we call to discuss. KENNETH VERCAMMEN & ASSOCIATES, PC ATTORNEY AT LAW 2053 Woodbridge Ave Edison, NJ 08817 (Phone) 732-572-0500
Please be sure to check all appropriate boxes. If "NONE", please state "NONE". If "NOT APPLICABLE", please state "N/A" rev 9/10 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. Address: ______________________ Your Street Address: City State Zip Code 4. Telephone Numbers: Cell: _____________________ other # _________
5. E-mail address: _________
6. Referred By: __________ [Or how did you hear about us? _____ 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, type Claim number & member ID. [Metlife Hyatt, ARAG Legal, UAW] ________________, _________
7 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 How can we help you? What are your questions/other important information that need to be addressed?
____________________________________________ [It is required that all pages be filled out prior to discussing with the attorney] 8. Your Marital Status: [ ] Single [ ] Married [ ] Widowed [ ] Separated [ ] Divorced 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. Most people select their SPOUSE as primary Executor, followed by the child who lives closest to your home. Type Spouse unless you don’t want spouse. 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: _______________
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 discussing with the attorney. We do not recommend Joint Executors, which cause conflicts and additional work for the Estate. It is best to select one primary person, then another person as a Second Executor. Needs to be over age 21.
Asset Information- Must Be Completed - If none, type “none”.
House/Real Estate Address _______________
Other Real Estate Address _____________
Estimate Total Real Estate Value: _____________ mortgage balance ____
We don't need specifics or current amounts, just estimate of total: Bank Accounts, Stocks, CDs and Assets: _______________________
Approximate Amount ____________________________
Direct Beneficiaries of Accounts - If none TYPE "none" ____________________
Other Major Assets - If none, TYPE "none" _____________________________
Approximate Life Insurance: ___________ Beneficiary _______ No account numbers needed; Assets are not listed in a Will since assets change Is total more or less than $12,500,000 ? ____________ In the Will- Who do you want to get your assets & who gets if beneficiary died:
Beneficiary (1) _____________ Relationship _________
Beneficiary (2) ____________ Relationship _______
Beneficiary (3) ______________ Relationship _______ It is required that major assets and beneficiaries be filled out prior to discussing with 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. No account numbers needed. Any Specific Bequests of Money and Property: [type if detailed] _______________________________________________ [ ] 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, TYPE NONE. If there is child you intentionally want to leave out of the Will, please type their full name and age in CAPS. No reason needed. Also, if any other family member needs to be excluded, type name in CAPS.
III. GUARDIAN(S) OF MINOR CHILD(REN) or Trustees of Trust for children [Skip this section if you have NO minor children and DO NOT want a trust. There are substantial additional fees for preparation of a stand-alone funded Trust, minimum $3,000] 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 Trustee 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. This cannot be your spouse. Provide the following information about the person(s) you select to be Guardian(s)/Trustee(s) for minors. In the event my spouse predeceases me, I name as GUARDIAN(S)/ TRUSTEE(S):
1. PRIMARY Choice of GUARDIAN / TRUSTEE:
Full Name: _______________________________________
Relationship: ______________________________________
2. SECOND Choice 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. The Will Q 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 or there are reasons why an Adult should not receive money outright? Please answer in detail ___________________________ Are you or any of your Beneficiaries 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 TYPE 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 $11,700,000 and you desire estate planning to avoid or reduce your Federal 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 accommodation ahead of time. WILLS: T 1- Parents with minor children and trust for children 22,25,30 ___________ T 2- Parents no spouse ____________ T 3- Unmarried ____________ T 4- Parents without trust ____________ T 5- Spouse Trust Will $ for spouse to go in Trust? [2nd marriage or protect assets from Medicaid] _____
PAYMENT WILL BE MADE BY: (Please check one) Check, Credit Card (Visa, Mastercard, American Express) or Cash Checks are payable to Vercammen PC If Legal plan, need claim numbers or case # __ Payment is required for Will, Power of Attorney and other document prior to any documents being drafted if not a legal plan. The Law Office works remote. We prepare the documents and email documents to clients for reading and execution. Minimum fee for Last Will and Testament preparation is $350 each unless paid by a legal plan. Husband and wife $700. There is only one form needed for a husband and wife. NJ does not have joint Wills. We charge a $200 consultation fee, which is credited to the preparation of the Will or other document. This $200 fee is non-refundable even if the documents are not prepared. If there are any changes to a draft form 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 preparation 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 is not a Will. | 
