This simple intake questionnaire will provide us with the necessary information to properly recommend the estate planning documents which we believe would be beneficial to your needs.
Please provide a summary of assets and liabilities.
Annual Salary
Checking and Savings Accounts
Money Market Funds
Certificates of Deposit
Cash Value of Life Insurance
Death Benefit of Life Insurance
Stocks
Bonds
Mutual Funds
Annuities
IRA's (Traditional, Roth)
Retirement Plan Account (eg.: 401(k), 403(b), 457 Plans)
Pension Plan
College 529 Plan
Notes and Mortgages Payable to You
Residence
Other Real Estate in New Jersey
Other Real Estate Outside New Jersey
Automobiles
Recreational Vehicle/Boat
Jewelry, Furs, Collections
Furniture, Household Effects
Expected Inheritance
Miscellaneous Assets
Do you have any interest in any business, professional practice, patents, copyrights, oil, gas or mineral rights, or other contract rights?
Total Assets
Please provide complete contact information.
Spouse's Address
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."
Are there any special circumstances, problems, or other concerns you wish to bring to our attention?
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.
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:
Your second choice for your agent:
Your Spouse's information
Your first choice for your agent:
Your second choice for your agent:
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:
Your second choice for your agent:
Your Spouse's information
Your spouse's first choice for your agent:
Your spouse's second choice for their agent:
Disability Careworker Information
ex.: Diagnosis, difficulties, etc.
Income Information
What benefits does the disabled person receive, and in what amount?
Information of Child with Disability
Trustee Information
(For the Special Needs Trust)
This person takes on the responsibilities of the Trustee, in the event the Trustee is incapable of serving.
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.
Full legal name
Full legal name
Full legal name
Full legal name
Full legal name
Full legal name
Full legal name
Full legal name
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.
Full legal name
Full legal name
Full legal name
Full legal name
These are your beneficiaries should you, your spouse, and your children die in a common incident.
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?
ex.: a friend's recommendation, our website, etc.
Please fill in all personal information for yourself.
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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