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
Person for whom planning desired:

______________________________________________________
First Last

Street Address: ________________________________________

City ____________________ State ____ Zip Code _____________

Telephone Numbers: Cell: __________________________________

Day: ____________________ /Night: ________________________

E-mail address: __________________________________________

Referred By: ___________________________________________

Today's Date ___________________________________________

1. Name of person filling out this interview sheet, if different than above:

____________________________________________________________

2. Current address and phone for person whom Estate Planning is sought:

____________________________________________________________

____________________________________________________________

3. Relationship of person filling out this interview sheet, if not person needing planning:

____________________________________________________________

4. Special medical or financial needs of person, spouse and dependents:

____________________________________________________________

____________________________________________________________

____________________________________________________________

ASSETS

5. Stocks, bonds and other securities. How Registered. Approximate Amount of Each. (Joint - Survivorship - P.O.D. - Trust - Custodial) If none, write none:

____________________________________________________________

____________________________________________________________

____________________________________________________________

6. Real Estate: Location and General Description - Record Owners -
How and When Acquired, Estimated Value - Mortgages, Approximate Amount of Each: If none, write none:

____________________________________________________________

____________________________________________________________

____________________________________________________________

7. Bank and Savings & Loan Association Accounts: Savings - Time Cert. - Checking - other. How registered (Joint, Survivorship, Trust, Custodial)
If none, write none:
BANK APPROXIMATE AMOUNT BENEFICIARY

____________________________________________________________

____________________________________________________________

____________________________________________________________

8. Major Personal Effects: Including Furs, Jewelry, Art, Cash on Hand and other items of Substantial Value and the Approximate Amount of Each:
If none, write none:

____________________________________________________________

____________________________________________________________

____________________________________________________________

9. Other Investments: Nature and in What Names(s) Held and the Approximate Amount of Each:
If none, write none:

____________________________________________________________

____________________________________________________________

____________________________________________________________

10. Insurance policies, pensions, retirement and death benefits:
(Identification and beneficiary) If none, write none:

COMPANY AMOUNT OF POLICY BENEFICIARY

____________________________________________________________

____________________________________________________________

____________________________________________________________

11. Safe Deposit Box: Location and How Registered: If none, write none:

____________________________________________________________

12. Liabilities More Than $2,000.00: If none, write none:

____________________________________________________________

____________________________________________________________

____________________________________________________________

13. Estimated Gross Estate:

$_________________________________________________________

14. A. 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? ________

D. Did You have/ bring a List of Assets? _________

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

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

ESTATE PLANNING
The estate may be subject to Federal Estate Taxation if the total of assets exceeds $200,000. If the 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.

[Estate Planning/Guardianship Form rev 1/18/07 Imac2}

       Kenneth Vercammen's Law office represents individuals charged with criminal, drug offenses, and serious traffic violations throughout New Jersey. Our office helps people with traffic/ municipal court tickets including drivers charged with Driving While Intoxicated, Refusal and Driving While Suspended.

       Kenneth Vercammen was the NJ State Bar Municipal Court Attorney of the Year and past president of the Middlesex County Municipal Prosecutor's Association.

       Criminal and Motor vehicle violations can cost you. You will have to pay fines in court or receive points on your drivers license. An accumulation of too many points, or certain moving violations may require you to pay expensive surcharges to the N.J. DMV [Division of Motor Vehicles] or have your license suspended. Don't give up! The Law Office of Kenneth Vercammen can provide experienced attorney representation for criminal motor vehicle violations.

       When your job or driver's license is in jeopardy or you are facing thousands of dollars in fines, DMV surcharges and car insurance increases, you need excellent legal representation. The least expensive attorney is not always the answer. Schedule an appointment if you need experienced legal representation in a traffic/municipal court matter.

       Our website www.benotguilty.com provides information on traffic offenses we can be retained to represent people. Our website also provides details on jail terms for traffic violations and car insurance eligibility points. Car insurance companies increase rates or drop customers based on moving violations.

Contact the Law Office of
 Kenneth Vercammen & Associates, P.C.
 at 732-572-0500
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.  The Law Office now accepts payment by American Express, Visa and Master Card.

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