Fill and Sign the Divorce Questionnaire Form

Divorce Questionnaire PERSONAL INFORMATION Date :       Client Spouse Full name       Full name       Birth date       Birth date       Age       Age       Birthplace       Birthplace       Address       Address       Work phone       Work phone       Home phone       Home phone       Cell phone       Cell phone       Pager       Pager       E-mail address       E-mail address       Fax       Fax       Social Security no.       Social Security no.       Driver's License no.       State       Driver's License no.       State       Occupational License no(s).       Occupational License no(s).       Armed Forces status       Armed Forces status       Next of kin       Relation       Address       Next of kin       Relation       Address       MARRIAGE Date of marriage       Date of separation       City/County/State       How long have you lived in this state?       County?       No. of previous marriages: yours       spouse       How previous marriage(s) terminated: Client       Spouse       Wife’s maiden name       Wife’s name before this marriage       Does wife desire name change? Yes To what?       No Is there a prenuptial or postnuptial agreement? Yes Please attach a copy of the agreement. No What is the primary reason you want this divorce? irreconcilable differences adultery abandonment physical abuse mental abuse spouse’s addiction other       CHILDREN 1. Name       Birth date       Age       School       Grade       Social Security no.       Living with Client Spouse 2. Name       Birth date       Age       School       Grade       Social Security no.       Living with Client Spouse 3. Name       Birth date       Age       School       Grade       Social Security no.       Living with Client Spouse 4. Name       Birth date       Age       School       Grade       Social Security no.       Living with Client Spouse 5. Name       Birth date       Age       School       Grade       Social Security no.       Living with Client Spouse Residence of the children during the last five years: Where? With whom? How long? Is wife pregnant? Yes When is birth expected?       No Is anyone other than the spouse claimed to be the father? Yes No If yes, who?       Are any of the children adopted? Yes No If yes, who?       Do you or your spouse have a health insurance policy that covers the children? Yes No Name of health care insurance provider for children       Policy, group, or contract number       Paid by whom?       Is the premium for the insurance paid through deduction from your or your spouse’s pay? Mine My spouse’s Does your / your spouse's health insurance require that you/he/she have the children as dependents to continue health insurance for them? Yes No Deductible       Co-pay on doctor visits       Co-pay on prescriptions       As to the premium, please state: cost for employee only       amount deducted each pay period       cost for employee and spouse       how often is the deduction made?       cost for employee and children       weekly every two weeks two times per month once per month If you, your spouse or any of your children have any serious health problems, please describe:       Child care: No Yes How many weeks per year?       Paid by whom?       Weekly cost- During school       Summer       Are you paying or receiving support for other children? No Yes How much per week? $       No. of children       Is your spouse paying or receiving support for other children? No Yes How much per week? $       No. of children       Provide copies of the court support orders. Does either party have children from a prior relationship? Yes No Name       Parents:       Living with Client Spouse Birth date       Age       Social Security no.       Name       Parents:       Living with Client Spouse Birth date       Age       Social Security no.       Name       Parents:       Living with Client Spouse Birth date       Age       Social Security no.       CUSTODY AND SUPPORT What do you think the custody and visitation rights should be and why?       If you and your spouse have agreed on custody, describe.       Does anyone else claim visitation rights with your children? No Yes State the person's name, address, and relationship.       Has support been paid since separation? No Yes How much per week?       If you and your spouse have agreed on child support, how much per week?       Do the children have a custody preference? Yes . Describe       No PREVIOUS LITIGATION Has either spouse previously filed for divorce, separation, annulment, custody, etc., in this county or elsewhere? Yes Indicate when and where filed, status of case, case number, and name of judge.       No Has there been any previous domestic violence case filed in this county involving you and/or your spouse or any other family member? Yes Indicate when and where filed, status of case, case number, and name of judge.       No Does anyone else claim custody over children of you or your spouse? Yes Indicate when and where filed, status of case, case number, and name of judge.       No Have you had any cases filed regarding care of the children? Yes Indicate when and where filed, status of case, case number, and name of judge.       No Is one of the parties currently under court order to pay support for another child not of this marriage? Yes Indicate when and where filed, status of case, case number, and name of judge.       No FAMILY HEALTH AND SOCIAL ISSUES Do you, your spouse, or your children have any serious physical or mental disability, disorder, handicap or incurable disease? Yes Please explain       No Any addiction issues with drugs, alcohol? Yes What type of substance?       What treatment and by whom?       When?       Place of treatment       Outcome of treatment       No Any romantic liaisons by either party? No Yes Who?       Any problems with debts?       Gambling?       Any marriage counseling? No Yes Please explain reason, date, and duration       Personal counseling (yours/spouse's)       Are you willing to start/continue counseling? Yes No Would you sign a waiver of confidentiality so that we may have access to your records? Yes No Does either spouse wish to reconcile? Yes No If yes, briefly describe       Are you or your spouse receiving government aid? Yes Caseworker       Case no.       No RESTRAINING ORDER INFORMATION Please describe any violent incidents, including place and time       Has either spouse ever been arrested, convicted, imprisoned, or placed on probation? Yes Explain.       No Have you or anyone in your household has ever been arrested for anything other than routine traffic tickets, state who, when, why and what:       Has your spouse or anyone in your spouse’s household has ever been arrested for anything other than routine traffic tickets, state who, when, why and what:       If your spouse says you or anyone in your household is emotionally unstable, state who and why:       Physical Description of Client: Race Height Weight Eye color Hair color Glasses: No Yes Worn all the time? Yes No Mustache/beard: Yes Color       No Distinguishing scars or tattoos       Any current restraining orders? No Yes Physical Description of Spouse: Race Height Weight Eye color Hair color Glasses: No Yes Worn all the time? Yes No Mustache/beard: Yes Color       No Distinguishing scars or tattoos       Any current restraining orders? No Yes Is carrying a weapon a condition of his/her employment? Yes No EMPLOYMENT Client Spouse Employer       Address       Date of hire       Employer       Address       Date of hire       Occupation       Occupation       Weekly gross pay       Weekly gross pay       Weekly take home       Weekly take home       Pension       Pension       Early retirement benefits       Early retirement benefits       Bonuses or commissions       Bonuses or commissions       Profit-sharing       Profit-sharing       Total income last year       Total income last year       Please attach a copy of your last three pay stubs. Indicate if any deductions are mandatory (other than taxes), for example, union dues, pension, etc. Please attach the last two income tax returns (personal and business) with their schedules and W-2 forms. Previous Employer       Address       Annual Income       Previous Employer       Address       Annual Income       Other income sources (pension, retirement, government assistance, veterans benefits, Social Security, investment funds): Type       Gross per year       In whose name       Type       Gross per year       In whose name       Type       Gross per year       In whose name       EDUCATION Client Spouse Highest degree obtained       Highest degree obtained       High school       Date of diploma or GED       High school       Date of diploma or GED       Univ./College       Degree       Date obtained       Univ./College       Degree       Date obtained       Univ./College       Degree       Date obtained       Univ./College       Degree       Date obtained       Additional training       Additional training       Did either spouse contribute to the education of the other? Yes Describe.       No ASSETS (Attach additional sheets if necessary.) List significant items of property you owned before this marriage or received as a gift or inheritance during the marriage. If you no longer have these items, explain what happened to them.       List significant items of property your spouse owned before this marriage or received as a gift or inheritance during the marriage. If your spouse no longer has these items, explain what happened to them.       List significant items of property you and your spouse received, as a couple, during this marriage as a gift or inheritance. If you or your spouse no longer has these items, explain what happened to them.       List significant items of property your children received as a gift or inheritance during your marriage. If your children no longer have these items, explain what happened to them.       Real property Resident address       Date purchased       Purchase price       Mortgage co.       Account no.       In whose name       Monthly payments       Balance due       Paid by Husband Wife Both Land contract       In whose name       Home equity loan       Account no.       In whose name       Amount of property taxes       Are they included in monthly payment? Yes No Additional real estate Address       Date purchased       Purchase price       Mortgage co.       Account no.       In whose name       Monthly payments       Balance due       Paid by Husband Wife Both Vehicles (car, boat, trailer, recreational vehicle, etc.) 1. Year/make       Vehicle identification number       In whose name       Possession       Purchase price       Monthly payments       Lien holder       Balance due       2. Year/make       Vehicle identification number       In whose name       Possession       Purchase price       Monthly payments       Lien holder       Balance due       3. Year/make       Vehicle identification number       In whose name       Possession       Purchase price       Monthly payments       Lien holder       Balance due       4. Year/make       Vehicle identification number       In whose name       Possession       Purchase price       Monthly payments       Lien holder       Balance due       Bank accounts or credit union accounts 1. Name of bank and branch       Account number       Type of account (savings, checking, money market)       Signatories       Source of funds       Balance       2. Name of bank and branch       Account number       Type of account (savings, checking, money market)       Signatories       Source of funds       Balance       3. Name of bank and branch       Account number       Type of account (savings, checking, money market)       Signatories       Source of funds       Balance       Individual retirement accounts Financial institution       Account number       Balance       In whose name       Financial institution       Account number       Balance       In whose name       Retirement plans, pensions, Keoghs, 401(k) plans, profit-sharing plans, stock bonus or option plans, etc. (attach copies of plan descriptions and annual reports for each) Employer or financial institution       Name and type of plan       Vested percentage       Value       Account no.       In whose name       Employer or financial institution       Name and type of plan       Vested percentage       Value       Account no.       In whose name       Employer or financial institution       Name and type of plan       Vested percentage       Value       Account no.       In whose name       Investments Broker/ firm       Type of investment       Account no.       In whose name       Type of account (savings, checking, money market)       Purchase price       Current value       What was source of stock or funds to purchase?       Broker/ firm       Type of investment       Account no.       In whose name       Type of account (savings, checking, money market)       Purchase price       Current value       What was source of stock or funds to purchase?       Patents, inventions, copyrights, etc.       Life insurance Client Spouse Name of insurer       Name of insurer       Name of insured       Name of insured       Name of beneficiary       Name of beneficiary       Type of insurance (term, whole life, etc.)       Type of insurance (term, whole life, etc.)       Policy no.       Policy no.       Amount of policy       Amount of policy       Cash surrender value       Cash surrender value       Loans against policy       Loans against policy       Business interests (corporations, partnerships, sole proprietorships, etc.) Name and type of business interest       Type of ownership interest       Value of interest       Initial investment and when       Additional amounts invested and when       Community property (property acquired with your spouse) Have you ever lived in a community property state (Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin)? Yes Provide details and the status of assets brought into this state.       No Miscellaneous assets Jewelry       Value       Art work       Value       Antiques       Value       Coin and other collections       Value       Inheritance       Value       Annuities       Value       Safe deposit box       Location       Accounts receivable       Gifts Have you or your spouse made any substantial gifts in the past or placed property in joint names with anyone other than the spouse? Yes Provide details.       No Trust beneficiaries Yes Provide details.       No Assets held at time of marriage       Do you suspect any assets are being given away, sold, or hidden from you? Yes Briefly explain.       No EXPENSES Expenses Rent/Mortgage 2nd Mtg/Assoc. Fees Property Tax Electric Gas Water/Sewer Telephone Cell Phone Cable/Satellite Internet Trash Lawn Care/Services Household Maintenance/Repairs Clothing/Laundry Groceries Lunch (school/work) House Insurance Auto Insurance Life Insurance Auto Loan 1 Auto Loan 2 Auto Maintenance Auto Registration Gas/Bus Fare Parking/Tolls Charities Memberships/Hobbies/Lessons Gifts Cigarettes/Alcohol Child Care Medical/Dental (out of pocket) Beauty Security Alarm Student Loans/Tuition Personal Loans Credit Cards Entertainment Vacation Pet Care Other Other Other Other Other Other (select totals below and press F9 key to automatically calculate total Total Expenses= $ 0.00 Total Monthly Income - Monthly Expenses= $ 0.00 LIABILITIES Please indicate with an asterisk any accounts that you have reason to believe are delinquent: Indebtedness (i.e., credit cards, educational loans, personal loans, etc.) 1. Creditor       Account no.       Type of indebtedness (credit card, etc.)       Is the account current? Yes No Present balance due       Monthly payment       Named borrowers       Who will pay until the divorce judgment?       2. Creditor       Account no.       Type of indebtedness (credit card, etc.)       Is the account current? Yes No Present balance due       Monthly payment       Named borrowers       Who will pay until the divorce judgment?       3. Creditor       Account no.       Type of indebtedness (credit card, etc.)       Is the account current? Yes No Present balance due       Monthly payment       Named borrowers       Who will pay until the divorce judgment?       4. Creditor       Account no.       Type of indebtedness (credit card, etc.)       Is the account current? Yes No Present balance due       Monthly payment       Named borrowers       Who will pay until the divorce judgment?       Delinquent Debt Type Amount Length of Time Overdue Mortgage             Property Tax             Income Tax             Car Loan             Credit Card                   Business Debt       Other                   Other obligations (for example, spousal support to a former spouse)       Is anyone other than the spouse and identified children financially dependent on you? Yes Give details.       No On your spouse? Yes Give details.       No RELIEF TO BE REQUESTED Divorce Separate maintenance Annulment Custody of children       Visitation rights       Child support payments       Alimony       Spouse to vacate home       Contribution to your attorney fees       Restoration of former name       Procurement of $       in life insurance to secure child support Property division Property injunction Domestic abuse restraining order Health insurance for children or yourself       Home utility payments       Home insurance (Plaintiff/Defendant)       Mortgage payments       Debts       Other       Attorney fee arrangement       The items checked below are needed to complete your divorce case file. Please collect the items that have been checked and bring in copies or originals to the paralegal as soon as possible. Car titles You Your spouse Life insurance cash value statement Savings account statements Items needed Tax returns with schedules and W-2s-last two years Paycheck stubs-last two months You Your spouse Mortgage statement: Marital home Vacation property Income property Pension or retirement account statement You Your spouse Investment account balance statements Appraisal for       Appraisal for       Prenuptial or postnuptial agreement Past three years tax returns, including W-2 forms Current pay stubs from January to present Past six months bank statements for all checking and savings accounts (upon receiving it, provide current months bank statement) Verification of debts (i.e., credit card statements, invoices, monthly statements, etc.) Verification of assets (i.e., monthly or quarterly statement of any asset listed above in General Information Sheet) Vehicle titles Boat titles, Motorcycle titles NADA (blue book) value of automobiles (highlight car value - you may obtain this information from a bank, car dealership, etc.) Warranty Deed or Quit Claim Deed to all real estate, including residence and/or any and all land. Verification of medical insurance cost for children only Verification of monthly day care cost for children Costs of transportation for visitation Verification of other child support payments made either by you or your spouse for any children of a previous marriage or children prior to marriage Certificates of Deposit