Fill and Sign the Form 16cez

Form 16(c)EZRev.2/07 1 The Family Court of the State of Delaware New Castle Date Financial Report/Pre-Trial Order Filed with the Court: ____________________ EZ FINANCIAL REPORT/PRE-TRIAL ORDER CASE NUMBER: PETITION NUMBER: FILE NUMBER: PETITIONER'S NAME AND ADDRESS RESPONDENT'S NAME AND ADDRESS HOME PHONE: ( ) HOME PHONE: ( ) WORK PHONE: ( ) WORK PHONE: ( ) PETITIONER'S ATTORNEY NAME AND ADDRESS RESPONDENT'S ATTORNEY NAME AND ADDRESS Check Relief requested by Parties: Petitioner (P) Respondent (R) 1. Property Division 2. Permanent Alimony 3. Temporary Alimony 4. Child Support 5. Attorney's Fees and Costs 6. Custody 7. Visitation I. FAMILY INFORMATION A. Dates of: Marriage: Separation: Divorce: B. Name and age of minor children of the parties. Indicate with whom the child resides: Mother (M); Father (F); Other (O). C. Describe any financial obligations to other dependents, if any. Petitioner (P) Respondent (R) Kent Sussex County For Form 16(c)EZRev. 2/07 2 II. PERSONAL INFORMATION Petitioner Respondent A. Date of Birth: B. Education: C. Describe employment history. (Include type of work, dates and length of employment, salary history and reason employment was terminated.) Petitioner Respondent III. EMPLOYMENT AND INCOME INFORMATION A. List annual gross income for last three (3) years, including both earned (employment) and unearned (interest, dividends, non-taxable reportable income, Federal and State tax refunds, other returns or investments, etc) ATTACH FEDERAL AND STATE RETURNS AND W-2 FORMS FOR PAST THREE (3) YEARS. Petitioner Respondent ________ $ ________ $ (YEAR) (YEAR) ________ $ ________ $ (YEAR) (YEAR) ________ $ ________ $ (YEAR) (YEAR) B. Indicate average monthly payroll deduction of each party during preceding twelve (12) months (if paid weekly, multiply by 52 and divide by 12; if paid on alternate weeks, multiply by 26 and divide by 12; if paid twice per month, multiply by 2). Petitioner Respondent 1. Federal $ ____________________ $ ____________________ 2. State $ ____________________ $ ____________________ 3. City $ ____________________ $ ____________________ 4. FICA $ ____________________ $ ____________________ 5. Other mandatory deductions such as union dues; required pension contributions; credit union payments. (list item and amount) $ ____________________ $ ____________________ $ ____________________ $ ____________________ 6. Other voluntary deductions such as life, health, and/or dental insurance; optional pension plan. (list item and amount) $ ____________________ $ ____________________ $ ____________________ $ ____________________ Form 16(c)EZRev. 2/07 3 III. INCOME INFORMATION (continued) Petitioner Respondent 7. Wage attachments $ ____________________ $ ____________________ 8. Monthly business expenses $ ____________________ $ ____________________ TOTAL $ ____________________ $ ____________________ C. Identify all benefits provided by employer and state estimated value thereof (car, apartment, profit sharing, etc., but excluding health and/or insurance policies). Petitioner Respondent Benefit Estimated value Benefit Estimated Value $ ____________________ $ ____________________ $ ____________________ $ ____________________ IV. EXPENSE INFORMATION A. Monthly expenses (1/12 of actual payments made during preceding twelve (12) months and present or projected costs based on recent experience). PETITIONER RESPONDENT Rent $ $ Mortgage (tax, insurance & escrow) $ $ Water $ $ Sewer $ $ Electric $ $ Gas and Oil $ $ Garbage $ $ Cable T.V. $ $ Telephone $ $ Groceries (including household & personal items) $ $ Clothing $ $ Health Insurance $ $ Out-of-pocket medical expenses $ $ Medical expenses for children $ $ Child Support $ $ Child care costs $ $ Other (list item and amount) $ $ __________________________ $ $ __________________________ $ $ TOTAL $ $ Form 16(c)EZRev. 2/07 4 V. DEBTS OF THE PARTIES Please complete the chart below with respect to each debt resulting from\� this marriage. If you have been making installment payments, identify which ones and how many you have made in the NOTES column. CREDITOR TITLE (J), (P), (R) DATE INCURRED PAYMENT AMOUNT BALANCE DUE NOTES $ $ $ $ $ $ $ $ $ VI. ASSETS OF THE PARTIES REAL PROPERTY Address: Date Acquired: Present Mortgage Balance: $ Title Held By: (PETITIONER) (RESPONDENT) Present Market Value: $ $ Source of Down-Payment: $ $ CHECKING ACCOUNTS/SAVINGS ACCOUNTS Bank Account Number Present Balance Title (J), (P), (R) $ $ $ TITLED PROPERTY (DMV TITLE CERTIFICATE) Make, Model, & Year Date Acquired Present Value Balance on Loan Title (J), (P), (R) Basis for Non-Marital Claim $ (P) (R) $ (P) (R) HOUSEHOLD FURNISHINGS AND PERSONAL PROPERTY Item Present Value Basis for Non-Marital Claim (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) Form 16(c)EZRev. 2/07 5 (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) OTHER Please list any asset not specified in any of the preceding categories and indicate present value, percentage claimed and, if applicable, the basis for the claim that the asset is non-marital proper\�ty. Item Present Value Title (J), (P), (R) $ $ $ $ $ $ $ $ $ PENSION PLAN If you participate in a pension plan at your place of business or employment, please attach a copy of the plan and state the amount of your monthly contribution, the date that your pension matures,\� and the anticipated date of your retirement. Petitioner Plan Monthly Contribution Date of Maturation Retirement Date $ Respondent Plan Monthly Contribution Date of Maturation Retirement Date $ RETIREMENT PLAN If you have a retirement plan other than your pension plan at your place of employment and your Social Security benefits, please describe the plan (such as IRA, Plumbers Union, etc.) and state\� the present value and maturity date. Plan Description Present Value Maturity date Basis for Non-Marital Claim (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) Plan Description Present Value Maturity date Basis for Non-Marital Claim (P)$ (R)$ (P) (R) (P)$ (R)$ (P) (R) Form 16(c)EZRev. 2/07 6 BY SIGNING THIS DOCUMENT, BOTH PARTIES HEREBY CERTIFY, SUBJECT TO CIVIL AND CRIMINAL PENALTIES, THAT THEY HAVE ACCURATELY SET FORTH ALL THEIR INCOME, ASSETS AND DEBTS. STATE OF DELAWARE : : SS. COUNTY OF ________________: BE IT REMEMBERED , that on this __________ day of _________________, _________, appeared before me, a subscriber, a Notary Public for the State and County aforesaid, ____________________ who, being by me duly sworn according to law, did dispose and say that the foregoing answers are true and correct to the best of his/her knowledge and belief. _____________________________________________ PETITIONER _____________________________________________ COUNSEL FOR PETITIONER _____________________________________________ NOTARY PUBLIC _____________________________________________ DATE STATE OF DELAWARE : : SS. COUNTY OF ________________: BE IT REMEMBERED , that on this __________ day of _________________, _________, appeared before me, a subscriber, a Notary Public for the State and County aforesaid, ____________________ who, being by me duly sworn according to law, did dispose and say that the foregoing answers are true and correct to the best of his/her knowledge and belief. _____________________________________________ RESPONDENT _____________________________________________ COUNSEL FOR RESPONDENT _____________________________________________ NOTARY PUBLIC _____________________________________________ DATE SO ORDERED THIS __________ day of ________________, _________. ______________________________________ JUDGE/COMMISSIONER