Estate Planning Questionnaire

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 Information Prepared

How did you hear about us?

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Your Personal Information

Please fill in all personal information for yourself.

Full Legal Name

Birth Date

Gender

Social Security Number

We take your privacy very seriously. This website is secure.

Occupation

Preferred method of final arrangements

I am a Veteran

I have a spouse

Date of Marriage

Prior Marriage

Former Spouse's Full Legal Name

Date of Divorce

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Living Children

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Who referred you?

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

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

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Your Spouse's Information

Spouse's Full Legal Name

Spouse's Birth Date

Spouse's Gender

Spouse's Social Security Number

We take your privacy very seriously. This website is secure.

Spouse's Occupation

Spouse's preferred method of final arrangements

My spouse is a Veteran

Prior Marriage

Former Spouse's Full Legal Name

Date of Divorce

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Your Spouse's Information

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Gifts and Distribution

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

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

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

Do you wish to provide for your children equally?

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

Death Before Distribution

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?

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Contingent Beneficiaries

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

Full Legal Name

Age

Full Mailing Address

Best Phone Number

Best Email Address

Add Another Beneficiary

Full Legal Name

Age

Full Mailing Address

Best Phone Number

Best Email Address

Add Another Beneficiary

Full Legal Name

Age

Full Mailing Address

Best Phone Number

Best Email Address

Should the above-mentioned individual(s) predecease should their share be distributed to their descendants?

If not, then to whom?

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

Full Legal Name

Age

Full Mailing Address

Best Phone Number

Best Email Address

Add Another Beneficiary

Full Legal Name

Age

Full Mailing Address

Best Phone Number

Best Email Address

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Charitable Beneficiaries

I would like to designate charitable beneficiaries.

Full Legal Name

City

State

Zip Code

Best Phone Number

Best Email Address

If applicable, specific distribution left to charity

Special purpose for selecting this beneficiary?

Add Another Beneficiary

Full Legal Name

City

State

Zip Code

Best Phone Number

Best Email Address

If applicable, specific distribution left to charity

Special purpose for selecting this beneficiary?

Add Another Beneficiary

Full Legal Name

City

State

Zip Code

Best Phone Number

Best Email Address

If applicable, specific distribution left to charity

Special purpose for selecting this beneficiary?

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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

Identify your desired Successor Executor

Full legal name

Street Address

City

State

Zip Code

Add an Alternate/Successor Executor

Identify your Alternate/Successor Executor

Full legal name

Street Address

City

State

Zip Code

Identify your spouse's desired Successor Executor

Full legal name

Street Address

Full legal name

City

Full legal name

State

Full legal name

Zip Code

Full legal name

Add an Alternate/Successor Executor

Identify your spouse's Alternate/Successor Executor

Full legal name

Street Address

City

State

Zip Code

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.

My spouse and I appoint each other as our Primary Trustees

Identify your desired Successor Trustee

Full legal name

Street Address

City

State

Zip Code

Add an Alternate/Successor Trustee

Identify your Alternate/Successor Trustee

Full legal name

Street Address

City

State

Zip Code

Identify your spouse's desired Successor Trustee

Full legal name

Full Mailing Address

Add an Alternate/Successor Trustee

Identify your spouse's Alternate/Successor Trustee

Full legal name

Street Address

City

State

Zip Code

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Executors and Trustees

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Assets

Please provide a summary of assets and liabilities.

Spousal Assets Column Not Applicable

Joint Assets Column Not Applicable

Annual Salary

Self - Annual Salary

Spouse - Annual Salary

Joint - Annual Salary

Checking and Savings Accounts

Self - Checking & Savings

Spouse - Checking & Savings

Joint - Checking & Savings

Money Market Funds

Self - Money Market Funds

Spouse - Money Market Funds

Joint - Money Market Funds

Certificates of Deposit

Self - Certificates of Deposit

Spouse - Certificates of Deposit

Joint - Certificates of Deposit

Cash Value of Life Insurance

Self - Cash Value of Life Insurance

Spouse - Cash Value of Life Insurance

Joint - Cash Value of Life Insurance

Death Benefit of Life Insurance

Self - Death Benefit of Life Insurance

Spouse - Death Benefit of Life Insurance

Joint - Death Benefit of Life Insurance

Stocks

Self - Stocks

Spouse - Stocks

Joint - Stocks

Bonds

Self - Bonds

Spouse - bonds

Joint - Bonds

Mutual Funds

Self - Mutual Funds

Spouse - Mutual Funds

Joint - Mutual Funds

Annuities

Self - Annuities

Spouse - Annuities

Joint - Annuities

IRA's (Traditional, Roth)

Self - IRA

Spouse - IRA

Joint - IRA

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

Self - Retirement Plan Account

Spouse - Retirement Plan Account

Joint - Retirement Plan Account

Pension Plan

Self - Pension Plan

Spouse - Pension Plan

Joint - Pension Plan

College 529 Plan

Self - College 529 Plan

Spouse - College 529 Plan

Joint - College 529 Plan

Notes and Mortgages Payable to You

Self - Notes and Mortgages

Spouse - Notes and Mortgages

Joint - Notes and Mortgages

Residence

Self - Residence

Spouse - Residence

Joint - Residence

Other Real Estate in New Jersey

Self - Other Real Estate in NJ

Spouse - Other Real Estate in NJ

Joint - Other Real Estate in NJ

Other Real Estate Outside New Jersey

Self - Other Real Estate Outside NJ

Spouse - Other Real Estate Outside NJ

Joint - Other Real Estate Outside NJ

Automobiles

Self - Automobile

Spouse - Automobile

Joint - Automobile

Recreational Vehicle/Boat

Self - Rec Vehicle/Boat

Spouse - Rec Vehicle/Boat

Joint - Rec Vehicle/Boat

Jewelry, Furs, Collections

Self - Jewelry, Furs, Collections

Spouse - Jewelry, Furs, Collections

Joint - Jewelry, Furs, Collection

Furniture, Household Effects

Self - Furniture, Household Effects

Spouse - Furniture, Household Effects

Joint - Furniture, Household Effects

Expected Inheritance

Self - Expected Inheritance

Spouse - Expected Inheritance

Joint - Expected Inheritance

Miscellaneous Assets

Self - Misc Assets

Spouse - Misc Assets

Joint - Misc Assets

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

Spouse - Interests

Joint - Interests

Total Assets

Self - Total Assets

Spouse - Total Assets

Joint - Total Assets

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Special Needs Trust Information

Information of Child with Disability

Full Legal Name

Street Address

City

State

Zip Code

Social Security Number

What is the child’s diagnosis?

Would you like to set up a Special Needs Trust?

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

Street Address

City

State

Zip Code

Primary Telephone Number

Relationship to Beneficiary

Add an Alternate Trustee

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

Full Legal Name

Street Address

City

State

Zip Code

Primary Telephone Number

Relationship to Beneficiary

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Income Information for Special Needs Trust

Disability Careworker Information

Full Legal Name

Primary Telephone Number

Please Specify Disability

ex.: Diagnosis, difficulties, etc.

State the amount to be put in the Trust

State from where the money is derived from

Income Information

Disability Benefits

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

First Choice: Full Legal Name

Street Address

City

State

Zip Code

Your second choice for your agent:

Second Choice: Full Legal Name

Street Address

City

State

Zip Code

Your Spouse's information

Your spouse's first choice for your agent:

Name my spouse as my first Agent choice

First Choice: Full Legal Name

Street Address

City

State

Zip Code

Your spouse's second choice for their agent:

Second Choice: Full Legal Name

Street Address

City

State

Zip Code

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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

First Choice: Full Legal Name

Street Address

City

State

Zip Code

Your second choice for your agent:

Second Choice: Full Legal Name

Street Address

City

State

Zip Code

Your Spouse's information

Your first choice for your agent:

Name my spouse as my first Agent choice

First Choice: Full Legal Name

Street Address

City

State

Zip Code

Your second choice for your agent:

Second Choice: Full Legal Name

Street Address

City

State

Zip Code

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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

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

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Gifts and Distribution

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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

Street Address

City

State

Zip Code

Best Phone Number

Best Email Address

I am appointing a Co-Guardian

Full Legal Name

Street Address

City

State

Zip Code

Best Phone Number

Best Email Address

Add Another Co-Guardian, or Alternate/Successor Guardian

Full Legal Name

Street Address

City

State

Zip Code

Best Phone Number

Best Email Address

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Living Children

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Primary Beneficiaries

Full Legal Name

Age

City of Residence

State of Residence

Add Another Beneficiary

Full Legal Name

Age

City of Residence

State of Residence

Add Another Beneficiary

Full Legal Name

Age

City of Residence

State of Residence

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Additional Considerations

Do you possess any firearms?

Please describe.

Are you currently storing any genetic or reproductive material?

Please describe.

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

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General Contact Information

Please provide complete contact information.

My spouse and I reside at the same address.

Address Line 1

Address Line 2

City

County

State

Zip Code

Spouse's Address

Address Line 1

Address Line 2

City

County

State

Zip Code

You are resident(s) of New Jersey.

Residence Phone Number

Mobile Phone Number

Business Phone Number

Primary Email Address

Secondary or Business Email Address

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End of Estate Planning Questionnaire

Enter your email

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.

Summary

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Preparing for Your Appointment

Your Personal Information

Living Children

Who referred you?

Your Spouse's Information

Your Spouse's Information

Gifts and Distribution

Contingent Beneficiaries

Charitable Beneficiaries

Executors and Trustees

Executors and Trustees

Assets

Special Needs Trust Information

Income Information for Special Needs Trust

Healthcare Power of Attorney

Financial Power of Attorney

Special Circumstances or Concerns

Gifts and Distribution

Guardianship

Living Children

Primary Beneficiaries

Additional Considerations

General Contact Information

End of Estate Planning Questionnaire

Summary

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