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- 1 - Clie n t I n fo rm atio n Q uestio n nair e M arria ge D is so lu tio n S o t h at w e w ill b e a b le t o a n sw er y our q uestio ns a n d h an dle y our c ase i n a p ro m pt a n d effic ie n t m an ner, i t i s i m porta n t t h at y ou a tte m pt t o a n sw er t h e f o llo w in g q uestio ns f u lly a n d accu ra te ly . I f y ou n eed a d d itio nal s p ace f o r a n a n sw er, y ou m ay u se t h e b ack o f a p ag e. T he co m ple te d q uestio nnair e w ill b e k ep t c o nfid en tia l a n d w ill r e m ain i n o ur p osse ssio n. P le ase p rin t yo ur a n sw ers . D ate : _ ______ ___ Refe rre d b y: _ __ ____________Y O UR C URREN T P E R SO NAL I N FO RM ATIO N:1. Full N am e _ ______ _____________2. All previous names you have ever used _ ___________________3. Pre se n t S tr e et A ddre ss _ ___________________ C ity _ _ ______ C ou nty _ _______ S ta te _ ___ Z ip _ _______ 4. Hom e P hone _ ____ ___ B usin ess P hone _ ___ ____ P ag er _ _______ C ellu la r P hone _ _______ 5. Socia l S ecu rity N um ber _ __________________ _6. Len gth o f r e sid en ce i n M in neso ta _ __________ _________7. Age _ _______ B ir th d ate _ _______8. Relig io n _ _______ R ace _ _______9. Hig hest L ev el o f E ducatio n _ _______ Y ear C om ple te d _ _______10 . Pre se n t H ealth _ ___ ________________11 . Physic ia n o r C lin ic _ ___________________12 . Are y ou p re se n tly i n t h e m ilita ry s e rv ic e? _ ___________________13 . Nam e o f p ers o n [ o th er t h an y our s p ouse ] w ho w ould b e m ost l ik ely t o a lw ay s k now w here yo u c an b e r e ach ed ____________________ Tele p hone N um ber ____________________ R ela tio nsh ip t o y ou ____________________ - 2 - 16 . ADDRESS F O R M AIL I F D IF FE R EN T T H AN H OM E A DDRESS _________________ ___ Y O UR E M PL O YM EN T I N FO RM ATIO N:1. Em plo yer _ ________ ___________2. Addre ss _ _________ __________3. Occu patio n _ ______ _____________4. Len gth o f t im e w ith t h is E m plo yer _ ___________________5. How o fte n a re y ou r e g ula rly p aid ? W eek ly E very t w o w eek s T w ic e p er m onth M onth ly 6. Pre se n t G ro ss E arn in gs $ ________ P er _ _______7. Pre se n t N et E arn in g s $________ P er _ _______8. Exem ptio ns C la im ed : Fed era l M S S ta te M S 9. Ded uctio ns f ro m y o ur p ay ch eck : F ed era l $________ P er _ _______S ta te $________ P er _ _______F IC A $________ P er _ _______M ed ic al/D en ta l $________ P er _ _______O th er ( S pecif y ) $________ P er _ _______ 10. Describe the type and amount of other income (overtime, bonuses, commissions, other employment) ____________________11 . Desc rib e a ll o th er e m plo ym en t b en efits ( c ar, c ar a llo w an ce, m eals , m em bers h ip s, e tc .) __ _______________ ___12 . Deta il y our p rio r w ork e x perie n ce ( w hat, w hen a n d w here ) _ ________________ ___ - 3 - 13 . Do y ou r e ceiv e, o r e x pect t o r e ceiv e, a n y o f t h e f o llo w in g a s i n co m e: P ublic A ssis ta n ce Y es N o Socia l S ecu rity B en efits f o r Y ours e lf Y es N oSocia l S ecu rity B en efits f o r C hild (re n ) Y es N oUnem plo ym en t C om pen sa tio n Y es N oW ork er's C om pen sa tio n Y es N oRen ta l I n co m e Y es N oOth er I n co m e Y es N o I f Y es, What: _ _______ 14 . If y ou h av e r e m arrie d , i s y our p re se n t s p ouse e m plo yed ? _ _______ A ppro xim ate g ro ss e a rn in gs o f p re se n t s p ouse $________ p er_ _______A ppro xim ate n et e arn in gs o f p re se n t s p ouse $________ p er_ _______ Y O UR C URREN T F IN AN CIA L I N FO RM ATIO N: Fair M ark et A sse ts Valu e Encu m bra n ces_ _ _____ _____________ $________ $__________ _____ _____________ $________ $__________ _____ _____________ $________ $__________ _____ _____________ $________ $__________ _____ _____________ $________ $__________ _____ _____________ $________ $__________ _____ _____________ $________ $________1. What a re y our c u rre n t a p pro xim ate t o ta l m onth ly l iv in g e x pen se s? _ _______2. Hav e y ou i n clu ded e x pen se s f o r a n y o th er p ers o n(s ) i n t h is t o ta l? _ _______ W hose ? _ _________ __________ 3. Identify and explain any significant increase or decrease in your monthly expenses since the divorce ____________________ Bala n ce Month ly Reaso n D eb t - 4 - Cre d ito rs Due Pay m en ts In cu rre d_ ________________ ___ $________ $________ _________________________ ___ $________ $________ _________________________ ___ $________ $________ _________________________ ___ $________ $________ _________________________ ___ $________ $________ ________ S P O USE 'S E M PL O YM EN T I N FO RM ATIO N:1. Em plo yer _ ________ ___________2. Addre ss _ _________ __________3. Occu patio n _ ______ _____________4. Len gth o f t im e w ith t h is E m plo yer _ ___________________5. How o fte n a re y ou r e g ula rly p aid ? W eek ly E very t w o w eek s T w ic e p er m onth M onth ly 6. Pre se n t G ro ss E arn in gs $________ P er _ _______7. Pre se n t N et E arn in g s $________ P er _ _______8. Exem ptio ns C la im ed : Fed era l M S Sta te M S9. Ded uctio ns f ro m y o ur p ay ch eck : F ed era l $________ P er _ _______S ta te $________ P er _ _______F IC A $________ P er _ _______M ed ic al/D en ta l $________ P er _ _______O th er ( S pecif y ) $________ P er _ _______ 10 . Desc rib e t h e t y pe a n d a m ount o f o th er i n co m e ( o vertim e, b onuse s, c o m mis sio ns, o th er - 5 - em plo ym en t) _ __________ _________11 . Desc rib e a ll o th er e m plo ym en t b en efits ( c ar, c ar a llo w an ce, m eals , m em bers h ip s, e tc .) __ _______________ ___12 . Deta il y our p rio r w ork e x perie n ce ( w hat, w hen a n d w here ) _ ___________________13 . Do y ou r e ceiv e, o r e x pect t o r e ceiv e, a n y o f t h e f o llo w in g a s i n co m e: P ublic A ssis ta n ce Y es N oSocia l S ecu rity B en efits f o r Y ours e lf Y es N oSocia l S ecu rity B en efits f o r C hild (re n ) Y es N oUnem plo ym en t C om pen sa tio n Y es N oW ork er's C om pen sa tio n Y es N oRen ta l I n co m e Y es N oOth er I n co m e Y es N o I f Y es, W hat: _ ____ ___ C H IL D REN B O RN O R A D O PT ED I N TO T H IS M ARRIA G E: [ D o n ot l is t c h ild re n f ro m pre v io us m arr ia g es o r o th er r e la tio nsh ip s]: 1 . Child re n : C hild 's N am e Bir th date A ge M oth er/F ath er_ ________________ ___ ________ ________ _____________________________________ ___ ________ ________ _____________________________________ ___ ________ _ _______ _____________________________________ ___ ________ _ _______ ____________________ 2. Do t h e c h ild re n n ow l iv e w ith C lie n t? S pouse B oth 3 . Do y ou w an t c u sto dy o f t h is c h ild /th ese c h ild re n ? _ ___________4. Do y ou e x pect a c o n te st o ver w ho s h ould h av e c u sto dy o f t h e c h ild re n ? _ ___________ Wh y? _ ___________ ________M ARIT A L I N FO RM ATIO N: - 6 - 1. Did y ou s ig n a p re -m arita l [ a n te n uptia l] a g re em en t? _ ___________2. Date o f p re se n t m arria g e _ ___________3. City , c o unty , a n d s ta te w here y ou w ere m arrie d _ ___________4. Are y ou a n d y our s p ouse l iv in g t o geth er? _ ____ _______5. If n ot, d ate o f s e p ara tio n _ ___________6. Are y ou, o r y our s p o use , p re g nan t? _ __________ _7. Desc rib e a n y a ctio n t h at h as b een t a k en b y e ith er y ou o r y our s p ouse t o d is so lv e t h is ma rria g e _ ________ _______________________________8. Sta te t h e d ate , p urp ose a n d n am es o f i n div id uals i n volv ed i n a n y c o unse lin g o f y ou a n d/o r yo ur s p ouse _ _____ ______________9. Do y ou f e el t h ere i s a n y c h an ce t o s a v e t h is m arria g e? _ ___________10 . What a re y our p rim ary c o m pla in ts a b out y our s p ouse ? _ ___________11 . What a re y our s p ouse 's p rim ary c o m pla in ts a b ou t y ou? _ ___________12 . Is t h ere a h is to ry o f d om estic a b use i n y our m arria g e r e la tio nsh ip ? _ ___________ D esc rib e __ _______________ ___13 . Hav e y ou o r y our s p ouse e v er s o ught a n o rd er f o r p ro te ctio n a s a r e su lt o f d om estic a b use ? __ _______________ ___IN FO RM ATIO N A BO UT Y O UR O TH ER M ARRIA G ES O R R ELA TIO NSH IP S:1. Were y ou p re v io usly m arrie d ? _ ____________ _______2. When w ere y ou d iv orc ed ? _ _________________ __3. City , c o unty a n d s ta te o f d iv orc e _ ___________________4. Min or c h ild re n f ro m y our p rev io u s m arria g es o r r e la tio nsh ip s: [D o n ot l is t c h ild re n b orn o r a d opte d i n to y our c u rre n t m arria g e]: F ull N am e A ge B ir th d ate S ocia l S ecu rity #_ ___________ _ ___ _ ____ _ _______________________ _ ___ _ ____ _ ___________ - 7 - ____________ _ ___ _ ____ _ _______________________ _ ___ _ ____ _ ___________ 5. Who r e ceiv ed c u sto dy? _ __________________ _6. If c u sto dy w as a w ard ed p urs u an t t o a p ate rn ity d ecre e, s ta te t h e d ate o f t h e p ate rn ity d ecre e an d t h e c ity , c o unty , a n d s ta te i n w hic h i t w as i s su ed _ ___________________ 7 . Main te n an ce a n d c h ild s u pport p ay m en ts r eceiv ed b y y ou : M ain te n an ce $ _ ___________ p er _ ___________ f ro m _ ___________ C hild S upport $ _ ___________ p er _ ___________ f ro m _ ___________M ain te n an ce a n d c h ild s u pport p ay m en ts p aid b y y ou : M ain te n an ce $ ___ _________ p er _ _______ ____ f ro m _ ___________ C hild S upport $ __ __________ p er _ ________ ___ f ro m _ ___________ 8. Asse ts a w ard ed t o y o u _ ___________________IN FO RM ATIO N A BO UT Y O UR S P O USE 'S O TH ER M ARRIA G ES O R R ELA TIO NSH IP S: 1. Was y our s p ouse p re v io usly m arrie d ? _ ___________________2. When w as y our s p o use d iv orc ed ? _ __________ _________3. City , c o unty a n d s ta te o f d iv orc e _ ___________________4. Min or c h ild re n b y f r o m y our s p ou se 's p rev io u s m arria g es o r r e la tio nsh ip s: [ D o n ot l is t m in or c h ild re n b orn o r a d opte d i n to y our c u rre n t m arria g e]: F ull N am e A ge Bir th date Socia l S ecu rity #_ ___________ _ ___ _ ____ ________________________ _ ___ _ ____ ________________________ _ ___ _ ____ _ ___________ - 8 - 5. Who r e ceiv ed c u sto dy? _ __________________ _6. If c u sto dy w as a w ard ed p urs u an t t o a p ate rn ity d ecre e, s ta te t h e d ate o f t h e p ate rn ity d ecre e an d t h e c ity , c o unty , a n d s ta te i n w hic h i t w as i s su ed _ ___________________7. Main te n an ce a n d c h ild s u pport p ay m en ts r eceiv ed b y y ou r s p ou se : M ain te n an ce $ ___ _________ p er _ _______ ____ f ro m _ ___________ C hild S upport $ __ __________ p er _ ________ ___ f ro m _ ___________M ain te n an ce a n d c h ild s u pport p ay m en ts p aid b y y ou r s p ou se : M ain te n an ce $ ___ _________ p er _ _______ ____ f ro m _ ___________ C hild S upport $ __ __________ p er _ ________ ___ f ro m _ ___________ 8. Asse ts a w ard ed t o y o ur s p ouse _ ____________ _______Y O UR H EA LTH I N SU RA NCE: C overa g e p ro vid ed f o r: [ C heck a ll t h at a p ply ] N am e o f C arrie r Y ou Spouse D ep en den ts 1 . Med ic al _ ________ ___ ______ _____ _ ___________2. Den ta l __________ __ ______ _____ _ ___________3. Optic al_ _________ __ ______ _____ _ ___________4. Oth er __________ __ ______ _____ _ ___________S P O USE 'S H EA LTH I N SU RANCE: C overa g e p ro vid ed f o r: [ C heck a ll t h at a p ply ] N am e o f C arrie r Y ou S pouse D ep en den ts 1 . Med ic al _____ _______________ ______ _ ____ _ ___________2. Den ta l _____ _______________ ______ _ ____ _ ___________3. Optic al _____ _______________ _ _ ____ _ ____ _ ___________4. Oth er _____ _______________ ______ _ ____ _ ___________ - 9 - ASSE TS:A . Hom este ad : 1. Addre ss _ __ _________________ C ity _ _____ ______ C ounty _ ________ ___ S ta te _ ___________ 2. Do y ou h av e a c o py o f a d eed t o t h is p ro p erty ? _ ___________3. Is t h is p ro perty A bstr a ct o r T orre n s? _ ___________________ If T orre n s, C ertif ic ate o f T itl e N o _ ___________________ W here i s t h e C ertif ic ate o f T itle ? _ _____ ______________ 4. When w as t h is h om este ad p urc h ase d ? _ ___________C ost _ ___________ 5. Am ount o f d ow n p ay m en t $ _ _______ ___6. Sourc e o f d o w n p ay m en t _ ___________________7. In w hose n am e(s ) i s t h e t itle ? _ _______ ____________8. What i s t h e p re se n t f a ir m ark et v alu e? $ _ __________9. Pre se n t m ortg ag e o r c o ntr a ct f o r d eed b ala n ce _ ___________________10. Month ly p ay m en t $ _ __________11. To w hom a re t h e p ay m en ts m ad e? _ ___ ________________12. Does t h e p ay m en t i n clu des t a x es? _ ___________ I n su ra n ce? _ ___________13. What a re t h e y early t a x es? $ _ __________ I n su ra n ce? $ _ __________14. Are h ouse p ay m en ts d elin quen t? _ ____ _______ H ow m uch ? $ _ __________15. Desc rib e a ll i m pro vem en ts m ad e t o t h e p ro perty d urin g t h e m arria g e __ ________ __________ B . Oth er R eal E sta te : 1 . Addre ss _ __ _________________ C ity _ _____ ______ C ounty S ta te _ _________ 2. Type _ ____ _______________ - 10 - 3. Do y ou h av e a c o py o f a d eed t o t h is p ro perty ? _ _________ __________ 4. Is t h is p ro perty A bstr a ct o r T orre n s? _ ___________________ If T orre n s, C ertif ic ate o f T itle N o.__________ __________W here i s t h e C ertif ic ate o f T itle ?_ _________ __________ 5. When w as i t p urc h ase d ? _ ___________ C ost $ _ __________6. Am ount o f d ow n p ay m en t $ _ _______ ___7. Sourc e o f d o w n p ay m en t _ ___________________8. In w hose n am e(s ) i s t h e t itle ? _ _______ ____________9. Pre se n t f a ir m ark et v alu e $ _ __________10. Pre se n t m ortg ag e o r c o ntr a ct f o r d eed b ala n ce _ ___________________11. Month ly p ay m en t $ _ __________ 12. To w ho m a re t h e p ay m en ts m ad e? _ _________ __________ 13. Does t h e p ay m en t i n clu de t a x es? _ _____ ______ I n su ra n ce? _ ___________14. What a re t h e y early t a x es? $ _ __________ I n su ra n ce? $ _ __________15. Are p ay m en ts d elin quen t? _ __________ _ H ow m uch ? _ ___________16. Desc rib e a ll i m pro vem en ts m ad e t o t h e p ro perty d urin g t h e m arria g e_ ___________ C . Oth er R eal E sta te : 1 . Addre ss _ __ _________________ C ity _ _____ ______ C ounty S ta te 2. Type _ __________ _________ 3. Do y ou h av e a c o py o f a d eed t o t h is p ro p erty ? _ ___________________ 4. Is t h is p ro perty A bstr a ct o r T orre n s? _ ________________ ___ - 11 - If T orre n s, C ertif ic ate o f T itle N o.__________ __________W here i s t h e C ertif ic ate o f T itle ? _ _________ __________ 5. When w as i t p urc h ase d ? _ ___________ C ost $ _ __________6. Am ount o f d ow n p ay m en t $ _ _______ ___7. Sourc e o f d o w n p ay m en t _ ___________________8. In w hose n am e(s ) i s t h e t itle ? _ _______ ____________9. Pre se n t f a ir m ark et v alu e $ _ __________10. Pre se n t m ortg ag e o r c o ntr a ct f o r d eed b ala n ce _ ___________________ 11. Month ly p ay m en t $ _ __________12. To w ho m a re t h e p ay m en ts m ad e? _ _________ __________ 13. Does t h e p ay m en t i n clu de t a x es? _ _____ ______ I n su ra n ce? _ ___________14. What a re t h e y early t a x es? $ _ __________ I n su ra n ce? $ _ __________15. Are p ay m en ts d elin quen t? _ __________ _ H ow m uch ? $ _ __________16. Desc rib e a ll i m pro vem en ts m ad e t o t h e p ro perty d urin g t h e m arria g e _ _________ ______________________________ W E W IL L N EED A C O PY O F A D EED O R M ORTG AG E C O NTA IN IN G T H E LEG AL D ESC R IP T IO N F O R E A CH P A RCEL O F R EA L E ST A TE. E. Sav in gs A cco unts : 1 . Dep osito ry _ _ __________________ Bala n ce $ _ __________ N am e(s ) o n A cco unt _ ___________________ 2. Dep osito ry _ _ __________________ Bala n ce $ _ __________ N am e(s ) o n A cco unt _ ___________________ - 12 - F. Certif ic ate s o f D ep o sit: 1 . Dep osito ry _ _ __________________ Bala n ce $ _ __________ N am e(s ) o n A cco unt _ ___________________ 2. Dep osito ry _ _ __________________ Bala n ce $ _ __________ N am e(s ) o n A cco unt _ ___________________ G . Check in g A cco unts : 1 . Dep osito ry _ _ __________________ Bala n ce $ _ __________ N am e(s ) o n A cco unt _ ___________________ 2. Dep osito ry _ _ __________________ Bala n ce $ _ __________ N am e(s ) o n A cco unt _ ___________________ H . Cash M an ag em en t o r B ro kera g e A cco unts : 1 . Dep osito ry _ _ __________________ Bala n ce $ _ __________ N am e(s ) o n A cco unt _ ___________________ 2. Dep osito ry _ _ __________________ Bala n ce $ _ __________ N am e(s ) o n A cco unt _ ___________________ I. Sto ck : 1. Dep osito ry _ _ __________________ Bala n ce $ _ __________ N am e(s ) o n A cco unt _ ___________________ 2. Dep osito ry _ _ __________________ Bala n ce $ _ __________ N am e(s ) o n A cco unt _ ___________________ J. Bonds: 1 . Dep osito ry _ _ __________________ Bala n ce $ _ __________ N am e(s ) o n A cco unt _ ___________________ - 13 - 2. Dep osito ry _ _ __________________ Bala n ce $ _ __________ N am e(s ) o n A cco unt _ ___________________ K . Safe D ep osit B ox: D ep osito ry _ ______ ________D esc rib e c o nte n ts _ _ _____________W ho h as a ccess? _ _ _____________ L . Lis t a ll P en sio n/R eti r e m en t P la n s [ IR A , 4 01(k ), K eo gh, P ro fit S harin g, E SO P, S E P, PA YSO P, e tc .] T ype In W hose N am e? Valu e1. _ __ _________ ____________ $____________2. _ __ _________ ____________ $____________3. _ __ _________ ____________ $____________4. _ __ _________ ____________ $____________ M . Does a n yone o w e y o u o r y our s p ouse m oney ? _ ___________ 1. Who _ ______ ______ ___________ H ow m uch $ _ ___________2. Who _ ______ ______ ___________ H ow m uch $ _ ___________ N . Did y ou b rin g p ro perty o r m oney i n to t h is m arria g e? _ ___________ Desc rib e_ ________ ______O . Did y ou r s p ou se b rin g p ro perty o r m oney i n to t h is m arria g e? D esc rib e _ ________________ _______________________ P . Desc rib e a n y i n herit a n ce y ou h av e r e ceiv ed _________________ _______________________Q . Desc rib e a n y i n herit a n ce y ou r s p ou se h as r e ceiv ed _ ___________________R . Do y ou h av e a n y p ers o nal i n ju ry o r w ork er's c o m pen sa tio n c la im p en din g o r h av e y ou receiv ed a n y s e ttle m en t o r a w ard ? _ _________ ____________________ - 14 - S. Does y ou r s p ou se h av e a n y p ers o nal i n ju ry o r w ork er's c o m pen sa tio n c la im p en din g o r h as yo u r s p ou se r e ceiv ed a n y s e ttle m en t o r a w ard ? _ ____________ ___________T . Lif e I n su ra n ce 1 . Com pan y _ _ ____________________________ 2. Type o f P olic y _ __ ______________________3. Nam e o f I n su re d _ _ _____________4. Nam e o f B en efic ia ry _ ______________5. Annual P re m iu m $ _ __________ F ace V alu e $ _ __________ C ash V alu e $ _ ___ _______ Policy 1: 1. Com pan y _ _ _____________2. Type o f P oli c y _ ______________3. Nam e o f I n su re d _ ______________ 6. Nam e o f B en efic ia ry _ ______________A nnual P re m iu m $ _ _____ _____ F ace V alu e $ _ __ ________ C ash V alu e $ _ ________ __ Policy 2: 1. Com pan y _ _ _____________2. Type o f P oli c y _ ______________3. Nam e o f I n su re d _ ______________ 7. Nam e o f B en efic ia ry _ ______________A nnual P re m iu m $ _ _____ _____ F ace V alu e $ _ __ ________ C ash V alu e $ _ ________ __ U . Moto r V eh ic le s D riv en b y Y O U: 1. Kin d _ _____ ______ Y ear _ __________ _ M odel _ ___________ - 15 - 2. In w hose n am e? _ ______________3. Bala n ce o w ed $ _ __________ P ay m en ts $ _ __________ P er _ ___________4. Pay m en ts m ad e t o w hom ? _ _________ _____M oto r V eh ic le s D riv en b y S P O USE :1. Kin d _ _____ ______ Y ear _ __________ _ M odel _ ___________2. In w hose n am e? _ ______________3. Bala n ce o w ed $ _ __________ P ay m en ts $ _ __________ P er _ ___________4. Pay m en ts m ad e t o w hom ? _ _________ _____ V . Recre atio nal V eh ic le s: M ak e a n d M odel V alu e P ay m en ts B ala n ce D ue M oto rc y cle s _ ___ ________ $ _ _____ $ ______ $ _______ _____S now m obile s _ __ _________ $ ______ $ _ _____ $ _______ _____B oat, M oto r & _ __ _________ $ ______ $ _ _____ $ _______ _____T ra ile rR ecre atio nal _ __ _________ $ _ _____ $ _ _____ $ _______ _____V eh ic le s W . Valu e o f: J e w elr y $ _________ ___ F urs $ ____________ A rt $ ____________P re cio us M eta ls $ __ __________ C olle ctio ns [ d esc rib e] $ ___________________________ X . House h old G oods a n d F urn is h in gs: 1 . Estim ate d v alu e _ ______________ - 16 - 2. Bala n ce o w ed $ _ __________ P ay m en ts $ _ __________ P er _ ___________ 3. Pay m en ts m ad e t o w hom ? _ _________ _____ Y . Desc rib e a n y o th er a sse ts t h at y ou k now o f _ ___ ___________D EBTS: B ala n ceM onth lyP ay m en tR easo n D eb t I n cu rre d P ers o n I n cu rrin g D eb t C re d ito rD ue P ay m en t $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ M IS C ELLA NEO US:1. Do y ou o r y our s p ou se h av e a w ill? _ ________ ______2. When w ere t h e w ills e x ecu te d o r l a st r e v is e d ? _ _ _____________3. Do y ou o r y our s p ou se d esir e t o h av e a n am e c h an ge a s a r e su lt o f t h is p ro ceed in g? __ _______________ ________ I f s o , w hat n am e i s d esir e d ? _ ______________4. Are y ou o r y our s p o use n am ed a s a p arty i n a n y p en din g l a w su it, i n clu din g b an kru ptc y ? _ ______________ - 17 - A C O PY O F T H E S U M MONS A ND P E T IT IO N A ND A NY O TH ER C O URT D O CUM EN TS C O NCER NIN G Y O UR C ASE , I F A NY, A S W ELL A S LEG AL D ESC RIP T IO NS, T A X R ETU RNS, F IN ANCIA L S T A TEM EN TS, A ND O TH ER F IN ANCIA L R EC O RDS SH OULD B E P R O VID ED A S S O ON A S P O SSIB LE. I a ck n ow le d ge t h at I a m r esp on sib le f o r p aym en t o f t h e i n it ia l c o n su lt a tio n f e e a t t h e ra te o f $ p er h ou r a t t h e t im e o f t h e i n it ia l c o n su lt a tio n . D ate _ _ ________________ _ __________________________________