http://www.njlaws.com/will_questionnaire.html?id=1352&a=

Confidential Will Questionnaire

11/8/11 10:04 AM

Kenneth Vercammen & Associates A Law Office with Experienced Attorneys for Your New Jersey Legal Needs 2053 Woodbridge Ave. Edison NJ 08817 732-572-0500 1-800-655-2977 Personal Injury and Criminal on Weekends 732-261-4005

Princeton Area 68 South Main St. Cranbury, NJ 08512

By Appointment Only Toll Free 800-655-2977

Confidential Will Questionnaire CLICK HERE TO OPEN THIS DOCUMENT IN MICROSOFT WORD "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".

Search Website

FOR POTENTIAL CLIENTS TO CONTACT US DURING NONBUSINESS HOURS, PLEASE FILL OUT THE FORM. Name:

Cell Phone:

E-Mail Address

If "NOT APPLICABLE", please state "N/A".

PLEASE PRINT CLEARLY

If You Do Not Include a Complete EMail Address, Verizon will not Forward Your Contact Form to the Law Office.

1. Your Full Name:

Details of the Case

______________________________________________________ First Last

Agree

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

By typing " agree" into the box you are confirming that you wish to send your information to the Law Office of Kenneth Vercammen

______________________________________________________ First Last 3. Your Street Address: ____________________________________ City ____________________ State ____ Zip Code ______________

Change Image Write the characters in the image above Submit

Clear

4. Telephone Numbers: Cell: _____________________________________ ________________________ Day: ____________________/Night: ________________________ http://www.njlaws.com/will_questionnaire.html?id=1352&a=

Kenneth Vercammen was the Page 1 of 8

Confidential Will Questionnaire

5. E-mail address: _______________________________________

11/8/11 10:04 AM

Middlesex County Bar Municipal Court Attorney of the Year

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: ____________________

http://www.njlaws.com/will_questionnaire.html?id=1352&a=

Page 2 of 8

Confidential Will Questionnaire

11/8/11 10:04 AM

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.

http://www.njlaws.com/will_questionnaire.html?id=1352&a=

Page 3 of 8

Confidential Will Questionnaire

11/8/11 10:04 AM

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. http://www.njlaws.com/will_questionnaire.html?id=1352&a=

Page 4 of 8

Confidential Will Questionnaire

11/8/11 10:04 AM

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 njlaws.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 http://www.njlaws.com/will_questionnaire.html?id=1352&a=

Page 5 of 8

Confidential Will Questionnaire

11/8/11 10:04 AM

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

Receive free NJ Laws Email newsletter with current laws and cases

New Article of the Week

GO

Meet with an experienced Attorney to handle your important legal needs.

Please call the office to schedule a confidential "in Office" consultation.

Attorneys are not permitted to provide legal advice by email.

Since 1985, KENNETH VERCAMMEN has worked as a personal injury attorney, working for injury victims and their families. By taking a hard-hitting, aggressive approach toward the insurance companies, KENNETH VERCAMMEN and our co-counsel have consistently obtained outstanding results for many injured clients over the years I am proud to have worked on cases in various capacities, small and large. While obviously prior results cannot guarantee the outcome of future cases, I can guarantee that you case will receive the same degree of dedication and hard work that went into each of these prior cases.

In direct contrast to the hard-hitting approach we take toward the insurance companies is the “soft” approach we take toward our clients. I am proud of my compassionate staff as I am of the outstanding financial results they have achieved. For many years, I have watched them treat our clients with patience, dignity and respect. I would have it no other way.

Many years ago, I attended a seminar sponsored by the American Bar Association on Law Practice Management. This was to help insure that each of our clients is always treated like a person -- not a file! We recognize that you are innocent victims and that you have placed your trust in us. Please understand that we understand what you are going through. Feel comforted that we are here to help you.

If you retain KENNETH VERCAMMEN to represent you, we will give you the same advice we give each of our clients -- concentrate on your life, you family and your health. We will take care of everything else. Leave all of the work and worry about your legal rights to us. Trust us. Believe in us. Have faith in us as your attorneys.

Understand that we will always to do what we believe is best for you and your case. Helping you is our job. In fact, it is our only job -- guiding injury victims like you through one of the most difficult times of your lives, with care and concern -- while fighting aggressively to the limits of the law to obtain compensation and justice for each of you!

Print our Personal Injury Questionnaire on our Website, Fill it out and Fax back, so we can determine if we can help you obtain an injury settlement. We would welcome an opportunity to prove to you what we have proven to thousands of injured clients -- that you can feel comfortable and secure in the fact that KENNETH VERCAMMEN Trial Attorney We Fight To Win. When you have been injured in an accident or collision, you are worried about who is going to pay your medical bills, lost wages, and other damages. The last thing you want is to be taken advantage of by an insurance company. If you don’t protect your rights, you may not be able to make a claim.

Insurance companies have attorneys and adjusters whose goal is to pay you as little as they can. You need a http://www.njlaws.com/will_questionnaire.html?id=1352&a=

Page 6 of 8

Confidential Will Questionnaire

11/8/11 10:04 AM

New Jersey personal injury lawyer to fight for you. I am dedicated to helping your recover as much money as possible under the law.

You need an attorney who will work hard to protect your rights, maximize your insurance settlement and minimize the hassles of dealing with the insurance companies. You need an experienced and aggressive New Jersey trial lawyer with PROVEN RESULTS who will fight for you. Having an experienced personal injury lawyer can make the difference between getting what you deserve and getting nothing.

Without the threat of a lawyer who is willing to go to trial and seek a big jury verdict, why would an insurance company pay you what your claim is really worth? Lawsuits can be expensive, and many people do not have the money to pursue their claim. In every case, I advance all costs associated with pursuing your case and I do not ask you for a penny until we recover from the other side.

I am an experienced aggressive trial lawyer and a 3rd degree Black Belt. I am not afraid to take your case to trial if that is what it takes to maximize the amount of money your recover for your personal injury. I offer one-onone service, and I will not hand your case off to an inexperienced lawyer or a paralegal.

Reduce the stress of making a claim.

Personal injury accidents can turn your life upside down. Making a personal injury claim can be difficult and time consuming. Once I take your case, you can stop worrying about dealing with the insurance companies and focus on recovering from your injuries. I take care of all of the paperwork, phone calls, and negotiations, so you can get on with your life. p.s. For those clients who are afraid or reluctant to go to Court, KENNETH VERCAMMEN also offers a special -- “For Settlement Only” -- program. This means that if we are unable to settle with the insurance company, we will not go any further -- unless you want us to. You have my personal assurance that there will be absolutely no pressure and no obligation.

We handle personal injury cases on a contingency fee basis.

This means: YOU DON’T OWE ME A LEGAL FEE UNLESS I RECOVER MONEY FOR YOU. Call our office to schedule a "confidential" appointment 732-572-0500 Kenneth A. Vercammen is the Managing Attorney at Kenneth Vercammen & Associates in Edison, NJ. He is a New Jersey trial attorney has devoted a substantial portion of his professional time to the preparation and trial of litigated matters. He has appears in Courts throughout New Jersey each week on personal injury matters, Criminal /Municipal Court trials, and contested Probate hearings.

Mr. Vercammen has published over 125 legal articles in national and New Jersey publications on criminal, elder law, probate and litigation topics. He is a highly regarded lecturer on litigation issues for the American Bar Association, NJ ICLE, New Jersey State Bar Association and Middlesex County Bar Association. His articles have been published in noted publications included New Jersey Law Journal, ABA Law Practice Management Magazine, and New Jersey Lawyer. He is the Editor in Chief of the American Bar Association Tort and Insurance Committee Newsletter.

Admitted In NJ, NY, PA, US Supreme Court and Federal District Court.

Contact the Law Office of Kenneth Vercammen & Associates, P.C. at 732-572-0500 http://www.njlaws.com/will_questionnaire.html?id=1352&a=

Page 7 of 8

Confidential Will Questionnaire

11/8/11 10:04 AM

for an appointment.

The Law Office cannot provide legal advice or answer legal questions over the phone or by email. Please call the Law office and schedule a confidential "in office" consultation . .

Disclaimer This web site is purely a public resource of general New Jersey information (intended, but not promised or guaranteed to be correct, complete, or up-to-date). It is not intended be a source of legal advice, do not rely on information at this site or others in place of the advice of competent counsel. The Law Office of Kenneth Vercammen complies with the New Jersey Rules of Professional Conduct. This web site is not sponsored or associated with any particular linked entity unless specifically stated. The existence of any particular link is simply intended to imply potential interest to the reader, inclusion of a link should not be construed as an endorsement.

Š 2011 Kenneth Vercammen & Associates, P.C.

http://www.njlaws.com/will_questionnaire.html?id=1352&a=

Page 8 of 8