Do you need a will? Please print out and review the following estate questionaire so that you may evaluate your estate planing needs. Give us a call or send us an email message.

For New Jersey Wills Only. Call 1 888- NJPILAW

ESTATE PLANNING QUESTIONNAIRE

GENERAL INFORMATION

1. Full Name____________________________________________________

Other names used, if any_________________________________________

2. Current Age_____________ Date of Birth__________________

3. Citizenship______________

4. Do you intend to remain a permanent resident of this state?________(yes or no)

5. Current permanent address_________________________________________

(street address)

_________________________________________

(city, state, zip code)

6. Home telephone number _____________________

7. Business telephone number ___________________

8. State of your health at this time________________

9. Have you previously executed a will or established any trusts __________

(yes or no)

10. Your marital status______(married or single); Date of marriage _________

11. Prior marriages________(yes or no)

12. Spouse's full name_____________________________________

Other names used, if any________________________________

13. Spouse's age______________ Date of Birth_________________

14. Spouse's citizenship________________

15. Spouse's current address and telephone number, if different from your own_____________________________________________________

16. State of spouse's health at this time___________________

17. Was your spouse previously married ________(yes or no)

18. Do you have an antenuptial or postnuptial agreement with your spouse ______(yes or no). If so, please attach a copy.

PRIOR MARRIAGES

19. The following information should be completed for each prior marriage for you and your spouse (use additional pages if necessary)

(a) Name and address of previous spouse ________________________________

______________________________________________________________

(b) Date, place and length of marriage___________________________________

(c) How was marriage terminated_______________________________________

(d) Do circumstances of termination of prior marriage place any restrictions or limitations on disposition of your (spouse's) estate_________(yes or no)

If yes, specify nature of limitation. Attach a copy of the divorce or other settlement agreement.

CHILDREN & GRANDCHILDREN OF YOU AND SPOUSE

20. Children of present marriage: Name, sex, age, residence and marital status.

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

21. Adopted children: Name, sex, age, residence, date of adoption and marital status.

_______________________________________________________________

_______________________________________________________________

22. Children of prior marriage(s): Name, sex, age, parentage, residence and marital status___________________________________________________________

________________________________________________________________

23. Grandchildren: Name, sex, age, parentage, residence and marital status_____________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

OTHER RELATIVES OF YOU AND SPOUSE

24. Parents of you:

Father's name and age:______________________________________

Address:__________________________________________________

_________________________________________________________

Living_______ Deceased_________

Mother's name and age:______________________________________

Address:__________________________________________________

_________________________________________________________

Living______ Deceased_________

25. Parents of Spouse:

Father's name and age:_______________________________________

Address:__________________________________________________

_________________________________________________________

Living______ Deceased__________

Mother's name and age:______________________________________

Address:__________________________________________________

_________________________________________________________

Living_______ Deceased__________

26. Other relatives (included in Will). Brothers, sisters, grandparents, aunts, uncles, nieces, nephews, etc.______________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

27. Special medical or financial needs of self, spouse and dependents___________

_______________________________________________________________

_______________________________________________________________

FINANCIAL INFORMATION (use separate schedules)

Assets/Liabilities/Gross Estate

28. Please attach a list of all assets and values by general categories (cash, securities, receivables, interests in businesses, automobiles, interest in retirement plans, residences, other real estate, etc.) and whether assets are owned by you, your spouse or jointly.(utilize attached work sheets)

29. Insurance policies (itemize, including following information for each policy):

Policy Number__________________ Insurer______________________

Type of Policy________________________(e.g., medical, disability, whole life annuity)

Date acquired______________ Cash value $______________

Face amount $_____________ Owner___________________

Beneficiaries____________________________________________

Source of payment of premiums_____________________________

Options, if any___________________________________________

30. Expectancies: inheritances, gifts_____________________________

_______________________________________________________

_______________________________________________________

31. Safe Deposit Box:

Location________________________________________________

Box number______________

How held________________ (specify, e.g., separately or jointly)

Description and value of contents____________________________

32. Debts and Other Obligations. Please attach a list of all debts and obligations including the categories (mortgages, business loans, car loans, credit cards, etc.), the amount due and the payment schedule.

33. Estimated Gross Estate $________________________________________

DISPOSITION OF ESTATE

Indicate the person or entity who would be beneficiary under your will and describe each desired bequest to such beneficiary:

34. To Spouse:___________________________________________________

____________________________________________________________

____________________________________________________________

and, if spouse does not survive you:_______________________________

____________________________________________________________

35. To:____________________________Relationship and address - age if under 18

__________________________________________________________

__________________________________________________________

__________________________________________________________

and, if beneficiary above does not survive you:_____________________

__________________________________________________________

__________________________________________________________

36. To:____________________________Relationship and address-age if under 18

_________________________________________________________

_________________________________________________________

_________________________________________________________

and, if beneficiary above does not survive you:____________________

_________________________________________________________

_________________________________________________________

37. To:____________________________Relationship and aaddress-age if under 18

_________________________________________________________

_________________________________________________________

_________________________________________________________

and, if beneficiary above does not survive you:____________________

_________________________________________________________

_________________________________________________________

38. (a) Do you wish trusts established for provisions regarding gifts or bequests to

minors or incompetents? _____Yes ______No

If yes, state age at which you want trust terminated and principal

distributed to beneficiary _________________________________________

_____________________________________________________________

_____________________________________________________________

(i.e. entire distribution at 21 or 23, or 1/3 at 21, 1/3 at 30 and 1/3 at 30 )

(b) Do you wish a Guardianship established for minor children (i.e. if both you

and spouse die simultaneously and leave minor children)_____Yes _____No

39. Any charitable bequests_________________________________________

____________________________________________________________

____________________________________________________________

FIDUCIARIES

40. Executor(s) and Alternate Executor of Wills:

Name____________________________Relationship___________ Age______

Address_________________________________________________________

Name____________________________Relationship___________ Age ______

Address__________________________________________________________

41. Trustee(s) and Alternate Trustee(s):

Name____________________________Relationship___________ Age ______

Address_____________________________________________________

Name__________________________Relationship____________ Age ______

Address_________________________________________________________

42. Guardian and alternate(s) of minor children or incompetents:

Name__________________________Relationship____________ Age ______

Address_________________________________________________________

Name__________________________Relationship____________ Age ______

Address_________________________________________________________

LIVING WILL

43. Do you want extraordinary means used to preserve your life?_____________

44. Appointment of your Health Care Representative to make decisions concerning medical treatment if unable to make such decisions:

Name_______________________________ Relationship _______________

Alternate____________________________ Relationship ________________

45. Appointment of spouse's Health Care Representative to make decisions concerning medical treatment if unable to make such decisions:

Name ______________________________ Relationship ________________

Alternate____________________________ Relationship ________________

POWER OF ATTORNEY

46. In the event you are incapacitated, who is designated to handle

Financial affairs?

Name_______________________________ Relationship ________________

Personal affairs?

Name_______________________________ Relationship ________________

47. In the event spouse is incapacitated, who is designated to handle

Financial affairs?

Name_______________________________ Relationship ________________

Personal affairs?

Name_______________________________ Relationship ________________

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