Tuesday, January 01, 2013



EDISON, NJ 08817
PLEASE PRINT                               732-572-0500

NAME ____________________________________________________

ADDRESS _________________________________________________

CITY _______________________ STATE ____ ZIP ______________

CELL #(_____)_________________ PHONE-DAY(____)________________

NIGHT (______)_________________

TODAY'S DATE ____/_____/_____   E-MAIL ________________________

Referred By: __________________________________________ 
         If referred by a person, is this a client or attorney?  If you heard about the law office on the Internet, what search terms did you use?

WHAT ARE YOU CHARGED WITH  (Not the Summon(s) #) [provide tickets, hearing notice and other important papers to front desk to be copied]
1.         ____________________________________________________
2.         ____________________________________________________
3.         ____________________________________________________
Date of Offense: __________________ Time: _____ (A.M./P.M.) Your Age _____
Town: ___________________________  (street/location)?____________________

What Happened: ________________________________________________
         Write additional details on the back of this page. YOU MUST FILL OUT BOTH PAGES PRIOR TO SEEING THE ATTORNEY.    Mun Ct Questionnaire  rev 10/24/12

Kenneth Vercammen, Esq. Confidential interview form    page 2
Other Persons Arrested or Witnesses: [If none write none]
______________________  ____________________________
co-defendant/ Witness Name          Their Address           Phone No.
______________ ______________________________________
Name                    Address                                    Phone No.

3. Write down everything you said in police presence. What  did police say to you? 



4. Occupation: _____________ Employer: _______________ Town: _____________
      [Attach your business card to clipboard.]
     Do you need your driver’s license for work? ____ Distance driven to work: _______

5. Prior criminal arrests, convictions, PTI,  Conditional Discharge (include description of each charge, date of conviction, and town conviction for every offense) if none, write none:  criminal arrests                  Town                         Year


2. ___________________________________________________________

3. ___________________________________________________________
         6. Prior motor vehicle convictions, town and year (ex: drunk driving, no insurance, driving while suspended, etc.  if none, write none. If more than 3  offenses Use back of this page. 
       Traffic Violation                       Town                         Year

#2. ___________________________________________________________

#3. ___________________________________________________________
Prior Traffic ticket downgrades to no point tickets since 1999  [39:4-97.2 unsafe driving]:
1. Town _______________________ Year ___________ [if none, write none]
2. Town _______________________ Year ___________
[Please note the DMV/MVC only permits 2 "no point" downgrades. ]
     What questions do you have? How can we help you? What else is important? Please advise in criminal cases if you are not a US citizen. Write

additional details on the back of this page. _______________________________       

       Thank you for contacting Kenneth Vercammen & Associates, PC for representation in a Municipal Court matter.
             Legal Services To Be Provided- Please read and keep this page 3 for yourself!
Write your notes on the back of this paper during your interview
1.    Office consultation with client
2.    Preparation of statement to provide legal services [ retainer agreement ] setting forth fees and work to be performed;
3.    Offer sound legal advice to client; 5 free calls with client during and after case
4.    Preparation of Letter of Representation to Municipal Court after fee paid;
5.    Preparation of Letter of Representation to Municipal Court Prosecutor;
6.    Review documents supplied by client and court;
7.    Copies of all correspondence to Court and Prosecutor to client;
8.    Opening of file and client may have free client case folder, Municipal Court brochure, MVC/DMV points information brochure, and Expungement brochure;
9.    Review of necessary statutes and case law;
10.  Follow up with Municipal Prosecutor for discovery if suspension or jail is likely;
11.  Prepare defense and mitigating factors;
12.  Miscellaneous correspondence, drafting of brief/ pleadings if needed;
13.  Review Court hearing notice and send letter to client to remind them of hearing and  what to bring to hearing
14.  Travel to Municipal Court and Representation in Municipal Court.
15.  Preparation of End of Case Letter with client questionnaire.
16.  Free T-shirts,  Can Coozies, Water bottle, Coffee Mug for clients - Please ask.
17.  Free subscription to monthly e-mail newsletter providing legal updates
       and recent criminal , traffic and insurance laws
19.  Answer specific questions after the case is over
18. Free Brochures provided on other legal topics such as Personal Injury, Worker's Comp, Wills, Probate and other matter we help clients
 20. Invitations to annual client socials by email & Annual USA Flag Calendar 
       We will review and research necessary statutes and caselaw, speak with the prosecutor, prepare defenses and determine mitigating factors. We agree to provide conscientious, competent and diligent services and at all times will seek to achieve solutions, which are just and reasonable for you.
          Legal Fees.  Fees are to be paid at initial consultation (today).
         Fees must be paid by VISA, Master Card, American Express, check, money order or cash. 
Make checks payable to Kenneth Vercammen Law Office today.   Fees must be paid in full prior to a Letter of Representation being sent to the Court. Neither this office nor other area attorneys accept payment plans if the fees are less than $2,500. Fees are not reduced and not negotiable. Under the NJ Rules of Professional Conduct and Court Rules, we cannot send a letter of representation to the court until the Retainer is paid in full
       What you should do: After you have retained [paid] your attorney, call the court, and plead not guilty. In traffic tickets, the phone number is on the back of the ticket. Judges will often ask you how many tickets you have had in the past 5 years. You want to be accurate with your response. In traffic matters we recommend you contact the Motor Vehicle Commission and obtain a driver's license abstract. Call 888-486-3339 or 609-292-6500. Please note the DMV/MVC only permits 2 "no point" downgrades in 5 years. . If you have 2 downgrades to unsafe driving 39:4-97.2, you may not be eligible for a no point ticket. If you do not wait 5 years, after the 2nd no point ticket, the MVC computer will impose 4 points against you.