Preparing for Your Appointment

Thank you for expressing interest in an estate plan. Once we have a completed questionnaire, the firm will be in a better position to recommend the estate planning documents which we believe would be beneficial to your needs.

The single most important item in estate planning is accurate and complete information. An estate plan is only as good as the information upon which it is based. This includes both personal and financial information. To this end, we ask you to complete this confidential questionnaire to the best of your ability.

If you cannot provide all the requested information, do not put off your appointment, it is better to begin the process and complete gathering the information along the way. Please be sure all names are spelled correctly.

Feel free to call our office with questions regarding the questionnaire as they may arise.

The attorneys at Sussan, Greenwald & Wesler, look forward to assisting you with your Estate Planning needs. Thank you for all us to serve you. If you have any questions, please feel free to contact your attorney at (609) 409-3500.

The information contained in this questionnaire is, and shall remain, confidential and privileged. Please provide as much of all following information as is practical.

Date of Consultation

Date Information Prepared(Required)

How did you hear about us?(Required)

Your Personal Information

Full Legal Name(Required)

Birth Date(Required)

Gender(Required)

Occupation(Required)

Preferred method of final arrangements(Required)

select...BurialCremation

I am a Veteran

Yes

I have a spouse

Yes

Date of Marriage(Required)

Prior Marriage

Yes

Date of Divorse(Required)

Former Spouse's Full Legal Name(Required)

Your Spouse's Information

Full Legal Name(Required)

Birth Date(Required)

Gender(Required)

Occupation(Required)

Spouse's preferred method of final arrangements(Required)

select...BurialCremation

My Spouse is a Veteran

Yes

Prior Marriage

Yes

Former Spouse's Full Legal Name(Required)

Date of Divorse(Required)

General Contact Information

My spouse and I reside at the same address.

Yes

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Spouse's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

You are resident(s) of New Jersey.

Yes

Residence Phone Number(Required)

Mobile Phone Number(Required)

Business Phone Number(Required)

Primary Email Address(Required)

Secondary or Business Email Address(Required)

Living Children

Do you have any living children that you would like to include?(Required)

select...YesNo

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Full Legal Name(Required)

Date of Birth(Required)

Gender(Required)

Age(Required)

Best Phone Number(Required)

Best Email Address(Required)

Same address as:(Required)

select...YouYour SpouseNeither

Address(Required)

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

This person has a child, or children, of their own

Yes

Add Another Child

Yes

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child2

Full Legal Name(Required)

Date of Birth(Required)

Gender(Required)

Age(Required)

Best Phone Number(Required)

Best Email Address(Required)

Same address as:(Required)

select...YouYour SpouseNeither

Address(Required)

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

This person has a child, or children, of their own

Yes

Add Another Child

Yes

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child3

Full Legal Name(Required)

Date of Birth(Required)

Gender(Required)

Age(Required)

Best Phone Number(Required)

Best Email Address(Required)

Same address as:(Required)

select...YouYour SpouseNeither

Address(Required)

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

This person has a child, or children, of their own

Yes

Add Another Child

Yes

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child4

Full Legal Name(Required)

Date of Birth(Required)

Gender(Required)

Age(Required)

Best Phone Number(Required)

Best Email Address(Required)

Same address as:(Required)

select...YouYour SpouseNeither

Address(Required)

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

This person has a child, or children, of their own

Yes

Add Another Child

Yes

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child5

Full Legal Name(Required)

Date of Birth(Required)

Gender(Required)

Age(Required)

Best Phone Number(Required)

Best Email Address(Required)

Same address as:(Required)

select...YouYour SpouseNeither

Address(Required)

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

This person has a child, or children, of their own

Yes

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Guardianship

A Guardian is an individual appointed to care for the well-being of minor children in the event both parents of the child become deceased. This individual will be entrusted to make decisions on behalf of the minor child much in the same way a parent would. You can name an individual, or multiple individuals who may act as "Co-Guardians."

Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Email Address(Required)

Best Phone Number(Required)

I am appointing a Co-Guardian

Yes

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gua2

Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Email Address(Required)

Best Phone Number(Required)

Add Another Co-Guardian, or Alternate/Successor Guardian

Yes

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gua2

Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Email Address(Required)

Best Phone Number(Required)

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Gifts and Distribution

Do you wish to leave gifts to your children outright, or in trust?(Required)

select...OutrightTrust

At what age(s) do you want the recipient(s) named in your trust to have access to the money?(Required)

At what age(s), if any, would you like the trust to terminate?(Required)

Do you wish to provide for your children equally?(Required)

select...YesNo

Please specify any special preferences for distribution of property among designated heirs.(Required)

Death Before Distribution(Required)

select...Distribute property among my other childrenDistribute property among the deceased's children

If your child were to predecease you, or die before reaching the age for distribution of property from a trust, would you like his or her share to be distributed equally among your other children, or would you like his or her share to go to his or her children?

Contingent Beneficiaries

These are your beneficiaries should you, your spouse, and your children die in a common incident.

Full Legal Name(Required)

Age(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Phone Number(Required)

Best Email Address(Required)

Add Another Beneficiary

Yes

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bene2

Full Legal Name(Required)

Age(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Phone Number(Required)

Best Email Address(Required)

Add Another Beneficiary

Yes

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ben3

Full Legal Name(Required)

Age(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Phone Number(Required)

Best Email Address(Required)

Should the above-mentioned individual(s) predecease should their share be distributed to their descendants? If not, then to whom?(Required)

select...YesNo

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Other Beneficiaries – if you would like to provide another individual(s) not previously listed

Full Legal Name(Required)

Age(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Phone Number(Required)

Best Email Address(Required)

Add Another Beneficiary

Yes

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Full Legal Name(Required)

Age(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Phone Number(Required)

Best Email Address(Required)

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Charitable Beneficiaries

I would like to designate charitable beneficiaries.

Yes

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char1

Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Phone Number(Required)

Best Email Address(Required)

If applicable, specific distribution left to charity(Required)

Special purpose for selecting this beneficiary?(Required)

Add Another Beneficiary

Yes

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bene2

Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Phone Number(Required)

Best Email Address(Required)

If applicable, specific distribution left to charity(Required)

Special purpose for selecting this beneficiary?(Required)

Add Another Beneficiary

Yes

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be3

Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best Phone Number(Required)

Best Email Address(Required)

If applicable, specific distribution left to charity(Required)

Special purpose for selecting this beneficiary?(Required)

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Special Circumstances or Concerns

Are there any special circumstances, problems, or other concerns you wish to bring to our attention?

Concerns(Required)

Are there any specific items of personal property (such as jewelry, automobiles and heirlooms) that you wish to leave to named individuals? Please note, you may also leave a separate writing for items of personal property.

Specific Instructions(Required)

Executors and Trustees

The Executor of your Will is the individual who will be responsible for seeing that all debts of the estate are paid from the estate. This person will then facilitate distribution of estate assets according to your Will.

My spouse and I appoint each other as our Primary Executors

Yes

Identify your desired Successor Executor - Full legal name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Add an Alternate/Successor Executor

Yes

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Identify your Alternative/Successor Executor - Full legal name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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The Trustee is an individual responsible for handling trust assets for minor children, if both parents are deceased. The trustee, if he or she is not also the guardian of minor children, will work with the Guardian in the event the Guardian requests a distribution from the trust for the benefit of minor children. The Trustee is responsible for keeping a balanced account of all trust account activity.

Identify your desired Successor Trustee - Full legal name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Add an Alternate/Successor Trustee

Yes

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Identify your Alternative/Successor Trustee - Full legal name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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Assets - Please provide a summary of assets and liabilities.

Spousal Assets Column Not Applicable

Yes

Joint Assets Column Not Applicable

Yes

Annual Salary

Self - Annual Salary(Required)

Spouse - Annual Salary(Required)

Joint - Annual Salary(Required)

Checking and Savings Accounts

Self - Checking & Savings(Required)

Spouse - Checking & Savings(Required)

Joint - Checking & Savings(Required)

Money Market Funds

Self - Money Market Funds(Required)

Spouse - Money Market Funds(Required)

Joint - Money Market Funds(Required)

Certificates of Deposit

Self - Certificates of Deposit(Required)

Spouse - Certificates of Deposit(Required)

Joint - Certificates of Deposit(Required)

Cash Value of Life Insurance

Self - Cash Value of Life Insurance(Required)

Spouse - Cash Value of Life Insurance(Required)

Joint - Cash Value of Life Insurance(Required)

Death Benefit of Life Insurance

Self - Death Benefit of Life Insurance(Required)

Spouse - Death Benefit of Life Insurance(Required)

Joint - Death Benefit of Life Insurance(Required)

Stocks

Self - Stocks(Required)

Spouse - Stocks(Required)

Joint - Stocks(Required)

Bonds

Self - Bonds(Required)

Spouse - Bonds(Required)

Joint - Bonds(Required)

Mutual Funds

Self - Mutual Funds(Required)

Spouse - Mutual Funds(Required)

Joint - Mutual Funds(Required)

Annuities

Self - Annuities(Required)

Spouse - Annuities(Required)

Joint - Annuities(Required)

IRA's (Traditional, Roth)

Self - IRAs(Required)

Spouse - IRAs(Required)

Joint - IRAs(Required)

Retirement Plan Account (eg.: 401(k), 403(b), 457 Plans)

Self - Retirement Plan Account(Required)

Spouse - Retirement Plan Account(Required)

Joint - Retirement Plan Account(Required)

Pension Plan

Self - Pension Plan(Required)

Spouse - Pension Plan(Required)

Joint - Pension Plan(Required)

College 529 Plan

Self - College 529 Plan(Required)

Spouse - College 529 Plan(Required)

Joint - College 529 Plan(Required)

Notes and Mortgages Payable to You

Self - Notes and Mortgages(Required)

Spouse - Notes and Mortgages(Required)

Joint - Notes and Mortgages(Required)

Residence

Self - Residence(Required)

Spouse - Residence(Required)

Joint - Residence(Required)

Other Real Estate in New Jersey

Self - Other Real Estate in New Jersey(Required)

Spouse - Other Real Estate in New Jersey(Required)

Joint - Other Real Estate in New Jersey(Required)

Other Real Estate Outside New Jersey

Self - Other Real Estate Outside NJ(Required)

Spouse - Other Real Estate Outside NJ(Required)

Joint - Other Real Estate Outside NJ(Required)

Automobiles

Self - Automobiles(Required)

Spouse - Automobiles(Required)

Joint - Automobiles(Required)

Recreational Vehicle/Boat

Self - Recreational Vehicle/Boat(Required)

Spouse - Recreational Vehicle/Boat(Required)

Joint - Recreational Vehicle/Boat(Required)

Jewelry, Furs, Collections

Self - Jewelry, Furs, Collections(Required)

Spouse - Jewelry, Furs, Collections(Required)

Joint - Jewelry, Furs, Collections(Required)

Furniture, Household Effects

Self - Furniture, Household Effects(Required)

Spouse - Furniture, Household Effects(Required)

Joint - Furniture, Household Effects(Required)

Expected Inheritance

Self - Expected Inheritance(Required)

Spouse - Expected Inheritance(Required)

Joint - Expected Inheritance(Required)

Miscellaneous Assets

Self - Miscellaneous Assets(Required)

Spouse - Miscellaneous Assets(Required)

Joint - Miscellaneous Assets(Required)

Do you have any interest in any business, professional practice, patents, copyrights, oil, gas or mineral rights, or other contract rights? If so, please state the current value of your interest(s).

Self - Interests(Required)

Spouse - Interests(Required)

Joint - Interests(Required)

Total Assets

Self - Total Assets(Required)

Spouse - Total Assets(Required)

Joint - Total Assets(Required)

Additional Considerations

Do you possess any firearms?(Required)

select...YesNo

Please describe.(Required)

Are you currently storing any genetic or reproductive material?(Required)

select...YesNo

Please describe.(Required)

Are you an organ donor on your driver's license?(Required)

select...YesNo

Special Needs Trust Information

Would you like to set up a Special Needs Trust?(Required)

select...YesNo

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Information of Child with Disability

Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

What is the child’s diagnosis?(Required)

Trustee Information

(For the Special Needs Trust)

The Trustee is an individual responsible for handling trust assets for the disabled child,if both parents are deceased.

Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Primary Telephone Number(Required)

Relationship to Beneficiary(Required)

Add an Alternate Trustee(Required)

Yes

This person takes on the responsibilities of the Trustee, in the event the Trustee is incapable of serving.

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Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Primary Telephone Number(Required)

Relationship to Beneficiary(Required)

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Income Information for Special Needs Trust

Disability Careworker Information

Full Legal Name(Required)

Primary Telephone Number(Required)

Please Specify Disability(Required)

ex.: Diagnosis, difficulties, etc.

State the amount to be put in the Trust(Required)

State from where the money is derived from(Required)

Income Information

Disability Benefits(Required)

What benefits does the disabled person receive, and in what amount?

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Healthcare Power of Attorney

A Healthcare Power of Attorney is a legal document that can help ensure your preferences for various medical treatments are followed, should you become unable to make your own healthcare decisions. The person you select to take on this responsibility is known as an Agent, and a spouse is most often named as first choice.

Your advance directive only goes into effect if your physician has evaluated you and determined that you are unable to understand your diagnosis, treatment options, or the possible benefits and harms of the treatment options.

Your first choice for your agent:

Name my spouse as my first Agent choice

Yes

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1st choice

First Choice: Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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Your second choice for your agent:

Second Choice: Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Financial Power of Attorney

A Financial Power of Attorney is a legal document that appoints someone to make financial decisions for you, should you become incapable of making these decisions for yourself. The person you select to take on this responsibility is known as an Agent, and a spouse is most often named as first choice. Your first choice for your agent:

Name my spouse as my first Agent choice

Yes

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First Choice: Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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Your second choice for your agent:

Second Choice: Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Who referred you?

We'd love to know — how were you referred to us?(Required)

ex.: a friend's recommendation, our website, etc.

End of Estate Planning Questionnaire

Enter your email(Required)

Thank you for completing the Estate Planning Questionnaire!

Following your submission, you should receive a confirmation email with the information provided attached as a pdf. If you do not receive it, please check your junk mail. We look forward to speaking with you regarding your Estate Planning. If you have any questions, feel free to contact us at our office (609) 409-3500.

Thank you for your confidence. We look forward to meeting with you.

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