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:
______________________________________________________
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 _______________
It
is required by New Jersey Court Rules that assets and beneficiaries be filled
out prior to seeing the attorney
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 childs share to their children (grandchildren).
Names
of Children: ______________________________ Age: ______
______________________________
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 4.
III.
GUARDIAN(S) OF MINOR CHILD(REN)
[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]
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.
PRIMARY Choice of GUARDIAN / TRUSTEE:
Full
Name: _______________________________________
Relationship:
______________________________________
2.
SECOND Choice of GUARDIAN / TRUSTEE:
Full
Name: _______________________________________
Relationship:
_____________________________________
Are
there any beneficiaries with special needs, or receiving SSI or SDD? Please
answer in detail
________________________________________
[ ]
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 njwillsprobatelaw.com
[ ]
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 childs 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.
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:
_______________________________________________________________
_______________________________________________________________
ESTATE
PLANNING
Your
estate may be subject to Federal Estate Taxation if the total of your assets
exceeds $2,000,000. If your assets exceed $2,000,000 and you desire estate
planning to avoid or reduce your estate tax or require a Trust to protect a
spouse, please advise Mr. Vercammen. A Standard Will is not designed to address
estate tax issues. We do not do Tax Planning or Medicaid Planning.
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- Unified Credit Trust over $1 million? ____________
PAYMENT
WILL BE MADE BY: (Please circle one)
Check,
Credit Card (Visa, Mastercard, American Express) or Cash
Payment
is required for Will, Power of Attorney and other document preparation at the
first consult and prior to any documents being drafted. 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.
This
form was filled out by:
_________________________________________
sign
name
For more information, go to http://njwillsprobatelaw.com/will_questionnaire.html?id=1047&a=
For more information, go to http://njwillsprobatelaw.com/will_questionnaire.html?id=1047&a=
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