KENNETH VERCAMMEN & ASSOCIATES, PC
ATTORNEY AT LAW
2053 Woodbridge Avenue
Edison, NJ 08817
(Phone) 732-572-0500
(Fax) 732-572-0030
website: centraljerseyelderlaw.com

Please fill out completely and fax or mail back. This form is extremely important. Your accuracy and completeness in responding will help me best represent you. All sections and information must be filled out prior to sitting down with the attorney.

PLEASE PRINT

YOUR NAME _________________________________________________

ADDRESS ___________________________________________________

CITY ___________________________ STATE ____ ZIP _____________

CELL (____)____________________ TODAY'S DATE ____/_____/______

PHONE-DAY (____)________________ NIGHT (____)________________

E-MAIL ___________________________________________

Decedent’s Name ___________________________________

Date of Death (mm/dd/yy) ___ ___ /___ ___ /___ ___ ___ ___

Your relation to the person who passed away: _______________________

Referred By: ______________________________________
[Probate-Inherit Quest Macbook.doc rev 4/10/08]

*All Pages and Information must be filled out prior to seeing the Attorney. This information is required by the Surrogate's Office and the Inheritance Tax Bureau.

Date of Will? (mm/dd/yy) ___ ___ /___ ___ /___ ___ ___ ___
(If no will, write "no will")

Location of original Will ____________________
Indicate if Surrogate "Probate letters" were issued and where issued: __________

Executor/ Administrator if not person filing out this form ____________

*The following questions are required by the Surrogate's Office and the Inheritance Tax Bureau to be answered. Please answer all these questions to the best of your knowledge so we can best help you. If none, write none.
Decedent’s S.S. No. ___ ___ ___ /___ ___ /___ ___ ___ ___

County of Residence ________________________________

SCHEDULE “A” REAL PROPERTY If none, write none

1. Street and Number _____________________________________

Town: ____________________

Lot: ___ Block: ____ County: ____________________

Title/Owner of Record: _______________

Full Market Value of Property: $________ Mortgage Balance: $_________
Tax Assessor Assessed Value: $____________________

Any other Real Estate: $______________________

SCHEDULE B-1: BANK ACCOUNTS/BROKERAGE ACCOUNTS
2) SCHEDULE B-1: STOCK
3) SCHEDULE B-1: INVESTMENT BONDS
4) SCHEDULE B-1: ALL OTHER PROPERTY

BANK ACCOUNTS/BROKERAGE ACCOUNTS
SCHEDULE “B (1)” BANK ACCOUNTS, STOCK, CD, OTHER ASSETS
All Other Personal Property Owned Individually or Jointly; Market Value, Indicate the Manner of Registration at Date of Death. If none, write none for each line. Use back of page if you need more space, or attach a list of assets.

Bank Accounts - Individually or Jointly Owned Date of Death Value

Name of Bank, Acct. # _____________ $_____________

___________________________________________ $_____________
___________________________________________ $_____________

Stock
(A) Number of Shares
(B) Name of Stock - Registered Owners(s)
(C) State of Inc.
(D) Date of Death Per Share Value
(E) Total Market Value
(F) Decedent’s Equity
Name of Stock Co., Acct. # ________________ $_____________
___________________________________________ $_____________

INVESTMENT BONDS
(A) Bonds - Individually or Jointly Owned
(B) Date of Death Value
(C) Decedent’s Equity*
___________________ $_____________
___________________ $_____________
___________________ $_____________

SCHEDULE B (1) - ALL OTHER PROPERTY
RESIDENT DECEDENT
Cars _______________________________________ $_____________
Other assets over $10,000 ______________________ $_____________
___________________________________________ $_____________
___________________________________________ $_____________

___________________________________________ $_____________
___________________________________________ $_____________
___________________________________________ $_____________

SCHEDULE “B” CLOSELY HELD “BUSINESSES”
RESIDENT DECEDENT
SCHEDULE “B (2) CLOSELY HELD “BUSINESSES”
Proprietorship, Partnership, Joint Venture and/or Closely Held Corporation in which the Decedent Held Any Interest, Market Value at Date of Death [attach details]If none, write none. ________________ $_____________

SCHEDULE “D” EXPENSES
Estimated Expenses for Funeral $ ____________________

Probate Administration $ ____________________

Counsel Fees: $ ____________________

Executor’s or Administrator’s Commissions $ ____________________

Other Administration Expenses (list individually), attach receipts.
Expense _________________ $ ____________________
Expense _________________ $ ____________________
Expense _________________ $ ____________________
Expense _________________ $ ____________________
Expense _________________ $ ____________________
Expense _________________ $ ____________________

SCHEDULE “E” BENEFICIARIES

In case of Intestacy, the parentage of all collateral heirs (such as nieces, nephews, cousins, etc.) must be set forth. The relationship of step-parent, step-child, step-brother or step-sister must be so stated.

BENEFICIARIES AND ADDRESSES
(State full names and addresses of all who have an interest, vested, contingent or otherwise, in estate)

HEIRS AT LAW/
NEXT OF KIN: RELATIONSHIP: ADDRESS: APPROX. AGE: % INTEREST:

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

Any specific bequests/gifts in will? _____________________________

_________________________________________________________

(NOTE: LIST CHILDREN OF DECEASED NEXT OF KIN - /ALSO GIVE AGE OF ANY MINORS)
State full names of all beneficiaries who died before or after decedent's death: ____________________________

1. The Inheritance Tax Bureau will require certain documents. Please attach a photocopy (not original) of the decedent’s Will, Death Certificate, codicils, trusts, and last full year’s Federal Income Tax Return. This is required by the Surrogate's Office (Tax Bureau). We will also need photocopies of the Deed and Tax Bill to submit to the Inheritance Tax Bureau.

SUMMARY
1. Real Property - Schedule A $_______________
2. All Other Assets - Schedule B(1) $_______________
3. Closely Held “Businesses” - Schedule B $_______________
4. Transfers prior to death - Schedule C $_______________
5. Gross Estate . . Total Lines 1 thru 4 $_______________
6. Deductions/Expenses . . . - Schedule D $_______________
7. Net Estate . Total - Line 5, minus Line 6 $_______________
8. Contingent Amount Included in Line 7 $_______________
9. Balance of Estate (Line 7, minus Line 8) $_______________

Are any questions in Schedule “C” answered yes? Yes __ No ___
Have or will you file or are you required to file a Federal Estate Tax Return for estates over $2,000,000? Yes __ No ___
Has or will any disclaimer been filed? If so, attach copy Yes __ No ___
If the decedent died after December 31, 2001, did the decedent’s taxable estate plus adjusted taxable gifts for Federal estate tax purposes under the provision of the Internal Revenue Code in effect on December 31, 2001 exceed $675,000? Yes __ No ___ If yes, by how much $ ___ ___ ___

How can we help you? What questions do you have? Is there anything else important:

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

New clients: When you come into the office would you like:
Pen ___, Foam can holder ___, USA key chain ___, Calendar ___, T-Shirt _____?
All new clients are entitled to receive our Free Email Newsletter featuring updates in Probate, Traffic Law, and Personal Injury/ Insurance. Thank you.

SCHEDULE “C” TRANSFERS
(THESE QUESTIONS ARE REQUIRED BY THE INHERITANCE TAX BUREAU (DIVISION OF TAXATION)
1. Did decedent, within three years of death, transfer property, valued at $500.00 or more, without receiving full financial consideration therefore? ___ Yes ___ No

2. Did decedent, at any time, transfer property, reserving (in whole or in part) the use, possession, income, or enjoyment of such property? ___ Yes ___ No

3. Did decedent, at any time, transfer property on terms requiring payment of income to decedent from a source other than such property? ___ Yes ___ No

4. Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change because of a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of law? ___ Yes ___ No
If answer to any of the above questions is “Yes”, set forth a description of property transferred, the fair market value at date of death, dates of transfers, and to whom transferred. Submit copy of trust deed or, agreement, if any. (If transfers are claimed to be untaxable, also submit detailed statement of facts on which such claim is based, proof as to decedent’s physical condition and copy of death certificate.)

5. Was decedent a participant in any pension plan that provided for payment to another of an annuity or lump sum on or after death? ___ Yes ___ No

6. Did decedent purchase or in any manner participate in any contract or plan providing for payment of an annuity or lump sum on or after death to another, except life insurance contracts payable to a designated beneficiary? ___ Yes ___ No
(Matured endowment policies, claim settlement certificates, supplementary contracts, annuity contracts and refunds thereunder and interest income certificates even though issued by an insurance company are not considered life insurance contracts.)

7. Was a single premium life insurance policy issued on decedent’s life in conjunction with an annuity contract? ___ Yes ___ No
If answer to questions 5, 6 or 7 is “Yes,” attach photostatic copies of all such contracts, plans, and policies.

8. Were any accumulated dividends due on any contract of insurance? (If yes, list below) ___ Yes ___ No

For each transfer, set forth Date of Transfer; Description of Property, Both Real and Personal: Actual Consideration if Any; Names and Relationship to Decedent of Donees, Assignees, Transferees, etc.

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Market Value at Date of Death __________________________

Meet with an experienced Attorney to handle your important legal needs.
Please call the office to schedule a confidential "in Office" consultation.
Attorneys are not permitted to provide legal advice by email.

Kenneth Vercammen is the Managing Attorney at Kenneth Vercammen & Associates in Edison, NJ. He is a New Jersey trial attorney has devoted a substantial portion of his professional time to the preparation and trial of litigated matters. He has appears in Courts throughout New Jersey each week for litigation and contested Probate hearings.

Mr. Vercammen has published over 125 legal articles in national and New Jersey publications on elder law, probate and litigation topics. He is a highly regarded lecturer on litigation issues for the American Bar Association, NJ ICLE, New Jersey State Bar Association and Middlesex County Bar Association. His articles have been published in noted publications included New Jersey Law Journal, ABA Law Practice Management Magazine, and New Jersey Lawyer.

He is chair of the Elder Law Committee of the American Bar Association General Practice Division. He is also Editor of the ABA Estate Planning Probate Committee Newsletter and also the Criminal Law Committee newsletter. Mr. Vercammen is a recipient of the NJSBA- YLD Service to the Bar Award. And past Winner "General Practice Attorney of the Year" from the NJ State Bar Association. He is a 22 year active member of the American Bar Association. He is also a member of the ABA Real Property, Probate & Trust Section.

He established the NJlaws website www.njlaws.com which includes many articles on Elder Law. Mr. Vercammen received his B.S., cum laude, from the University of Scranton and his J.D. from Widener/Delaware Law School, where he was the Case Note Editor of the Delaware Law Forum, a member of the Law Review and the winner of the Delaware Trial Competition.

RECENT SPEAKING ENGAGEMENTS ON WILLS, ELDER LAW, AND

American Bar Association - Elder Law 2008 New York Annual Meeting
Edison Adult School -Wills, Elder Law & Probate- 2007, 2006, 2005, 2004, 2003, 2002 [inc Edison TV], 2001, 2000,1999,1998,1997
Nuts & Bolts of Elder Law - NJ Institute for Continuing Legal Education/ NJ State Bar ICLE/NJSBA 2007, 2006, 2005, 2004, 2003, 2002, 2000, 1999, 1996
Elder Law and Estate Planning- American Bar Association Miami 2007
Elder Law Practice, New Ethical Ideas to Improve Your Practice by Giving Clients What They Want and Need American Bar Association Hawaii 2006
South Plainfield Seniors- New Probate Law 2005, East Brunswick Seniors- New Probate Law 2005
Old Bridge AARP 2002; Guardian Angeles/ Edison 2002; St. Cecilia/ Woodbridge Seniors 2002;
East Brunswick/ Halls Corner 2002;
Linden AARP 2002
Woodbridge Adult School -Wills and Estate Administration -2001, 2000, 1999, 1998, 1997, 1996
Woodbridge Housing 2001; Metuchen Seniors & Metuchen TV 2001; Frigidare/ Local 401 Edison 2001; Chelsea/ East Brunswick 2001, Village Court/ Edison 2001; Old Bridge Rotary 2001; Sacred Heart/ South Amboy 2001; Livingston Manor/ New Brunswick 2001; Sunrise East Brunswick 2001; Strawberry Hill/ Woodbridge 2001;
Wills and Elder Law - Metuchen Adult School 1999,1997,1996,1995,1994,1993
Clara Barton Senior Citizens- Wills & Elder Law-Edison 2002, 1995

Contact the Law Office of
Kenneth Vercammen & Associates, P.C.
at 732-572-0500
for an appointment.

Kenneth Vercammen & Associates, P.C.
2053 Woodbridge Ave.
Edison, NJ 08817
732-572-0500

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2012 Kenneth Vercammen & Associates, P.C.