Fill and Sign the Family Contempt Form

Family Law – Modification & Contempt Questionnaire BACKGROUND INFORMATION: State your full legal name and any other name by which you have been known:       State your present residence and telephone numbers.       State your place and date of birth:       EDUCATION: List all business, commercial, and professional licenses that you have obtained since the entry of the Final Judgment sought to be modified:       List all of your education since the entry of the Final Judgment sought to be modified including, but not limited to, vocational or specialized training, including the following: a. (1) name and address of each educational institution.       (2) dates of attendance.       (3) degrees or certificates obtained or anticipated dates of same.       b. (1) name and address of each educational institution.       (2) dates of attendance.       (3) degrees or certificates obtained or anticipated dates of same.       EMPLOYMENT: For each place of your employment or self-employment since the entry of the Final Judgment sought to be modified, state the following: a. First Place of Employment (1) name, address, and telephone number of your employer.       (2) dates of employment.       (3) job title and brief description of job duties.       (4) starting and ending salaries.       (5) name of your direct supervisor.       (6) all benefits received, including, for example, health, life, and disability insurance; expense account; use of automobile or automobile expense reimbursement; reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension or profit sharing plans.       b. Second Place of Employment (1) name, address, and telephone number of your employer.       (2) dates of employment.       (3) job title and brief description of job duties.       (4) starting and ending salaries.       (5) name of your direct supervisor.       (6) all benefits received, including, for example, health, life, and disability insurance; expense account; use of automobile or automobile expense reimbursement; reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension or profit sharing plans.       Other than as an employee, if you have been engaged in or associated with any business, commercial, or professional activity since the entry of the Final Judgment sought to be modified that was not detailed above, state for each such activity the following: a. First Business Activity (1) name, address, and telephone number of each activity.       (2) dates you were connected with such activity.       (3) position title and brief description of activities.       (4) starting and ending compensation.       (5) name of all persons involved in the business, commercial, or professional activity with you.       (6) all benefits and compensation received, including, for example, health, life, and disability insurance; expense account; use of automobile or automobile expense reimbursement; reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension or profit sharing plans.       b. Second Business Activity (1) name, address, and telephone number of each activity.       (2) dates you were connected with such activity.       (3) position title and brief description of activities.       (4) starting and ending compensation.       (5) name of all persons involved in the business, commercial, or professional activity with you.       (6) all benefits and compensation received, including, for example, health, life, and disability insurance; expense account; use of automobile or automobile expense reimbursement; reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension or profit sharing plans.       If you have been unemployed at any time since the entry of the Final Judgment sought to be modified, state the dates of unemployment.       ASSETS: Real Estate . State the street address, if any, and if not, the legal description of all real property that you own or owned during the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. For each property, state the following: Property address #1:       (1) the names and addresses of any other persons or entities holding any interest and their percentage of interest.       (2) the present fair market value.       Property address #2:       (1) the names and addresses of any other persons or entities holding any interest and their percentage of interest.       (2) the present fair market value.       Tangible Personal Property . List all items of tangible personal property that are owned by you or in which you have had any interest during the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, including, but not limited to, motor vehicles, tools, furniture, boats, jewelry, art objects or other collections, and collectibles whose fair market value exceeds $100. Item Percentage And Type Interest You Hold. Names And Addresses Of Any Other Persons Or Entities Holding Any Interest Present Fair Market Value                                                                                                 Intangible Personal Property . Other than the financial accounts (checking, savings, money market, credit union accounts, retirement accounts, or other such cash management accounts) listed below, list all items of intangible personal property that are owned by you or in which you have had any ownership interest (including closed accounts) within the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, including, but not limited to, partnership and business interests (including good will), deferred compensation accounts unconnected with retirement, including but not limited to stock options, sick leave, and vacation pay, stocks, stock funds, mutual funds, bonds, bond funds, real estate investment trusts, receivables, certificates of deposit, notes, mortgages, and debts owed to you by another entity or person. Item Percentage And Type Interest You Hold. Names And Addresses Of Any Other Persons Or Entities Holding Any Interest And The Names And Addresses Of The Persons And Entities Who Are Indebted To You. Present Fair Market Value Or The Amounts You Claim Are Owned By Or Owed To You                                                                                                 Retirement Accounts : List all information regarding each retirement account/plan, including but not limited to defined benefit plans, 401k, 403B, IRA accounts, pension plans, federal government plans, money purchase plans, Keogh plans, profit sharing plans, annuities, employee savings plans, etc. that you have established and/or that have been established for you by you, your employer or any previous employer. For each account, state the following: Name, Account Number, and Location Type Of Account Name And Address Of The Fiduciary Plan Administrator/Service Representative Fair Market Value Of Your Interest Value On The Date Of Separation Value On The Date Of Filing Of The Petition For Dissolution Vested Amount, If Any Date At Which You Became/Become Eligible To Receive Some Funds                                                                                                                                                 You may answer this question by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. Financial Accounts . For all financial accounts (checking, savings, money market, credit union accounts, or other such cash management accounts) listed in your Financial Affidavit, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name. Name And Address Of Institution Name In Which The Account Is Or Was Maintained Account Number Names Of Each Person Authorized To Make Withdrawals From The Accounts Highest Balance Within Each Of The Preceding 3 Years, Or Since The Entry Of The Final Judgment Sought To Be Modified, If Shorter Lowest Balance Within Each Of The Preceding 3 Years, Or Since The Entry Of The Final Judgment Sought To Be Modified, If Shorter                                                                                                             You may answer this question by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. Closed Financial Accounts . For all financial accounts (checking, savings, money market, credit union accounts, or other such cash management accounts) closed within the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name. Name And Address Of Institution Name In Which The Account Is Or Was Maintained Account Number Name Of Each Person Authorized To Make Withdrawals From The Account Date Account Was Closed                                                             Trust . For any interest in an estate, trust, insurance policy, or annuity, state the following: (1) if you are the beneficiary of any estate, trust, insurance policy, or annuity, give for each one the following: i. (a) identification of the estate, trust, insurance policy, or annuity.       (b) the nature, amount, and frequency of any distributions of benefits.       (c) the total value of the beneficiaries’ interest in the benefit.       (d) whether the benefit is vested or contingent.       ii. (a) identification of the estate, trust, insurance policy, or annuity.       (b) the nature, amount, and frequency of any distributions of benefits.       (c) the total value of the beneficiaries’ interest in the benefit.       (d) whether the benefit is vested or contingent.       (2) if you have established any trust or are the trustee of a trust, state the following: (a) the date the trust was established.       (b) the names and addresses of the trustees.       (c) the names and addresses of the beneficiaries.       (d) the names and addresses of the persons or entities who possess the trust (e) each asset that is held in each trust, with its fair market value.       Name of Accountant, Bookkeeper, or Records Keeper . State the names, addresses, and telephone numbers of your accountant, bookkeeper, and any other persons who possess your financial records, and state which records each possesses. Name Address Phone Number                                                       LIABILITIES: Loans, Liabilities, Debts, and Other Obligations . For all loans, liabilities, debts, and other obligations (other than credit cards and charge accounts) listed in your financial statement, indicate for each the following: Name And Address Of Creditor Name In Which The Obligation Is Or Was Incurred Loan Or Account Number Nature Of The Security, If Any Payment Schedule Present Balance And Current Status Of Your Payments Total Amount Of Arrearage, If Any                                                                                                                                                                                                                   You may answer this question by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. Credit Cards and Charge Accounts . For all financial accounts (credit cards, charge accounts, or other such accounts) listed in your financial statment, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: Name And Address Of Creditor Name In Which The Account Is Or Was Maintained Account Number Lowest Balance Within Each Of The Preceding 3 Years, Or Since The Entry Of The Final Judgment Sought To Be Modified, If Shorter. Highest Balance Within Each Of The Preceding 3 Years, Or Since The Entry Of The Final Judgment Sought To Be Modified, If Short Present Balance And Current Status Of Your Payments Total Amount Of Arrearage, If Any                                                                                                                                                                                                                   You may answer this question by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. Closed Credit Cards and Charge Accounts . As to all financial accounts (credit card, charge accounts, or other such accounts) closed with no remaining balance, within the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: Name of Creditor Address Account Number Name Of Each Person Authorized To Sign On The Accounts Date The Balance Was Paid Off And Amount                                                                                           You may answer this question by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. MISCELLANEOUS: If you are claiming a diminished earning capacity since the entry of the Final Judgment sought to be modified as grounds to modify alimony or deviate from the child support established in your case, describe in detail how your earning capacity is lowered and state all facts upon which you rely in your claim. If unemployed, state how, why, and when you lost your job.       If you are claiming a change in a mental or physical condition since the entry of the Final Judgment sought to be modified as grounds to modify alimony or change the child support established in your case, describe in detail how your mental and/or physical capacity has changed and state all facts upon which you rely in your claim. Identify the change in your mental and/or physical capacity, and state the name and address of all health care providers involved in the treatment of this mental or physical condition.       If you are requesting a change in shared or sole parental responsibility, primary residency, the parenting schedule, or any combination thereof, for the minor child(ren), describe in detail the change in circumstances since the entry of the Final Judgment sought to be modified that you feel justify the requested change. State when the change of circumstances occurred, how the change of circumstances affects the child(ren), and why it is in the best interests of the child(ren) that the Court make the requested change.       Attach your parenting schedule. If you do not feel the requested change in shared or sole parental responsibility, primary residency, the parenting schedule, or any combination thereof, for the minor child(ren) is in their best interests, describe in detail any facts since the entry of the Final Judgment sought to be modified that you feel justify the Court denying the requested change. State, in your opinion, what change, if any, of the parenting arrangement is justified or agreeable to you and why it is in the best interests of the child(ren).