Kenneth Vercammen & Associates, P.C.
2053 Woodbridge Ave.
Edison, NJ 08817
(732) 572-0500
www.njlaws.com

Thursday, October 16, 2014

Estate Planning


GUARDIANSHIP INTERVIEW FORM
         Please fill out completely and fax or mail back. This form is extremely important. Your accuracy and completeness in responding will help us best represent you.  Please read our website article to help you understand how guardianships are handled


       ALL THE PAGES AND SECTIONS OF THIS FORM MUST BE COMPLETED PRIOR TO SEEING THE ATTORNEY.  WRITE YOUR SPECIFIC QUESTIONS AT THE END OF THE LAST PAGE.  PLEASE HELP YOURSELF TO THE FREE INFORMATION BROCHURES IN THE RECEPTION AREA.

PLEASE PRINT CLEARLY
Your Full Name:  [Person Filling out Form]


______________________________________________________
First                                          Last


Street Address: ________________________________________            


City ____________________ State ____  Zip Code _____________
              

Telephone Numbers:  Cell:  __________________________________

                                                                                      
Day: ____________________    Night: ________________________


E-mail address: __________________________________________

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

Today's Date ___________________________________________

1. Name of person for whom you seek Guardianship: ________________
 Guardianship Questionnaire   rev 8/16/12
2.   Current address and phone for incapacitated person whom Guardianship is sought:

____________________________________________________________
        
        
____________________________________________________________
                                                 
3.      Your relationship to person: _________________________________

4. Incapacitated person is of the age of ________________., DOB _______

5. The other kin of  Incapacitated person  are:
___________________, relationship _______________, residing at:  ___________________,
___________________, relationship _______________, residing at:  _________________,
___________________, relationship ______________, residing at: ____________________

6. Name, address and fax number of Doctor 1 who will sign Affidavit that person is incapacitated:

____________________________________________________________

____________________________________________________________

7. Name, address and fax number of Doctor 2 who will sign Affidavit that person is incapacitated:

____________________________________________________________

____________________________________________________________

8.  Is there a Will?  _____           Did you bring a photocopy?  ____

         B.  Is there a Power of Attorney?  _____  Did you bring a copy?  ____

         C.  Do You Have a Copy of the Deed?    ________


ASSETS
         The court rules require details of assets be set forth in a Guardianship case.

SCHEDULE “A” REAL PROPERTY  If none, write none



1. Street and Number _____________________________________




Town: ____________________




Lot: ___ Block:  ____ County: ____________________



Title/Owner of Record: _______________


Tax Assessor Assessed Value: $____________________




Full Market Value of Property:  $____________________ 

Mortgage Balance: $______________________



Any other Real Estate: $______________________


SCHEDULE “B (1)”   BANK ACCOUNTS, STOCK, CD, OTHER ASSETS
         All Other Personal Property Owned Individually or Jointly; Market Value, Indicate the Manner of Registration at Date of Death.
         If none, write none for each line

Bank Accounts/ Brokerage Accounts - Name of Bank, Acct. # ___________________________________________   $_________

__________________________________________    $_________

___________________________________________   $_________
__________________________________________    $_________
Stock - Name of Stock Co., Acct. # ________________  $_________
___________________________________________   $_________

Investment Bonds., Acct. #                                               $_________
___________________________________________   $_________

Cars _______________________________________   $_________
Other assets over $10,000 ______________________  $_________
___________________________________________  $_________
___________________________________________  $_________
___________________________________________  $_________


         Liabilities More Than $2,000:   If none, write none

____________________________________________________________

____________________________________________________________

Estimated Gross Estate:  $__________________________________
           

Set forth several specific acts of incompetency by the alleged incapacitated person: 

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________


      PLEASE USE THIS PAGE TO WRITE YOUR SPECIFIC QUESTIONS FOR THE ATTORNEY: 

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

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