Divorce Questionnaire
The Law Office of Whitney L. Thompson, PLLC Please complete this questionnaire. If you spend the time to complete all items, you will give us the background information necessary to begin to understand the complexity of the personal aspects of your case. All information will be held in strict confidence.
Today's Date
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Month
 -
Day
Year
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Client's Name
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First Name
Last Name
Client: Have you used any other alias names?
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Yes
No
If Yes, list of other alias names.
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Client's DOB
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 -
Month
 -
Day
Year
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Client's Age
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Please enter your current age.
Client's Sex
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Female
Male
Client's Place of Birth
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City, Texas
Client: Do you have a Driver License Number?
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Yes
No
Client's Driver License Number
*
Do not use any dashes or other symbols
Client: Are you a US Citizen
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Yes
No
Client: Do you have a SSN?
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Yes
No
Client's SSN
*
This information will be kept confidential. Do not use any dashes or other symbols
Client's Current Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What County do you reside in?
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How long have you resided in your County?
How long have you lived in Texas?
Do you want to receive mail from our office to a different address?
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Yes
No
Client's Preferred Mailing Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Client's E-mail Address
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Enter an email address you would like to be contacted at about your case.
Client's Phone Number
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 -
Area Code
Phone Number
Client's Highest Education Level:
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Client: Are you employed?
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Yes
No
Client: When was your last employer and with who?
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Name of last employer & when
Client: How long have you been employed with your current employer?
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years or months
Client's Employer's Name
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Client's Supervisor's Name
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Current Employer Supervisor
Monthly Net Income (after taxes)
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Client's Job Title:
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Client's Work Number
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 -
Area Code
Phone Number
Client's Work Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Information About Spouse
Spouse's Full Name
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First Name
Last Name
Spouse: Has your spouse used any other alias names?
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Yes
No
If Yes, list the other alias names used
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Spouse's DOB
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 -
Month
 -
Day
Year
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Spouse's Age
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Spouse's Place of Birth
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City, State
Spouse: Does your spouse have a Driver License Number?
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Yes
No
Spouse: Driver License Number
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Please do not use dashes.
Spouse: US Citizen?
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Yes
No
Spouse: Does your Spouse Have a SSN?
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Yes
No
Spouse: SSN
*
Please do not use dashes.
Spouse's Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Spouse's Phone Number
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 -
Area Code
Phone Number
Spouse's Highest Education
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Is Your Spouse Employed?
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Yes
No
Spouse's Job Title
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Name of Spouse's Employer:
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Spouse's Employer's Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Spouse's Employer's Phone Number
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Area Code
Phone Number
Spouse's Net Monthly Income (after taxes)
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Information About Marriage
Date of Marriage
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Month
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Day
Year
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Place of Marriage
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Date of Separation
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Month
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Day
Year
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Are you seeing a marriage counselor or any other counselor?
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Yes
No
If Yes, state the counselor's name
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Are you requesting a name change?
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Yes
No
What is your religious preference?
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What is your spouse's religious preference?
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If Yes, list the name you are requesting
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First Name
Last Name
Are any of the following marital difficulties involved in your marriage?
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Â
Myself
Spouse
Neither
Both
Illegal Drug/Alcohol
Sexual Disappointment
Sexual Infidelity
Financial Disputes
Physical Violence
Religion
Incompatibility
Mental Health Issues
Committed a Felony
Been Arrested
Been in Jail or Prison
Prescription Drugs
Arrested for DWI
Arrested for DUI
Gambling (legal or illegal)
Attempted Suicide
Hospitalize for Emotional or Psychiatric Treatment
Child Abuse
Adultery
Homosexual relationships
Engaged in Unusual Sexual Preferences
Pregnancy Outside the Marriage
Venereal Disease
Please describe any of the difficulties you below:
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Provide as much detail as possible.
Does your spouse have an attorney now?
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Yes
No
If Yes, who?
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Have you or your spouse ever filed for divorce?
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Yes
No
If Yes when and where?
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Have you ever been married before?
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Yes
No
If Yes, how many times?
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Has your spouse ever been married before?
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Yes
No
If Yes, how many?
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Children Born During Marriage
Please only include children who are under the age of 18 years of age
Are there any children who are under the age of 18 who were born during the marriage?
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Yes
No
(1) Name of Child
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First Name
Last Name
(1) Sex of the Child
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Female
Male
(1) DOB of the Child
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 -
Month
 -
Day
Year
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(1) Place of Birth of the Child:
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City, State
(1) Child's SSN
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Please do not include any dashes.
(1) Do you need to list another child?
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Yes
No
(2) Name of Child
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First Name
Last Name
(2) Sex of the Child
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Female
Male
(2) DOB of the Child
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 -
Month
 -
Day
Year
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(2) Place of Birth of the Child:
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City, State
(2) Child's SSN
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Please do not include any dashes.
(2) Do you need to list another child?
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Yes
No
(3) Name of Child
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First Name
Last Name
(3) Sex of the Child
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Female
Male
(3) DOB of the Child
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 -
Month
 -
Day
Year
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(3) Place of Birth of the Child:
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City, State
(3) Child's SSN
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Please do not include any dashes.
(3) Do you need to list another child?
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Yes
No
(4) Name of Child
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First Name
Last Name
(4) Sex of the Child
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Female
Male
(4) DOB of the Child
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 -
Month
 -
Day
Year
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(4) Place of Birth of the Child:
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City, State
(4) Child's SSN
*
Please do not include any dashes.
Who are the children living with now?
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Myself
My spouse
Other
Will there be a dispute over the children?
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Yes
No
If there is No dispute over the children, who will the children live with at the end of the divorce?
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Myself
My spouse
(if necessary please bring in a separate sheet of paper with additional names and information).
Is the wife current pregnant?
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Yes
No
Is the husband the biological father of all of the children born during the marriage?
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Yes
No
If the husband is NOT the biological father of all of the children born during the marriage, explain:
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Explain who is the biological father of the child(ren)
Do you and/or your children have health insurance?
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Yes
No
If Yes, please provide the following information below: 1. Health Insurance Company 2. Policy Number 3. Source of Insurance 4. Cost of Premium and 5. Who pays the Premium each month
Please provide as much information as possible. This information is needed for the court.
Do the children own any property other than (clothing or furniture)?
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Yes
No
If Yes, please list all property.
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Please provide as much detail as possible.
Children Before or Outside of the Marriage
Please list all children before our outside of the marriage from either you or your spouse.
Did you or your spouse have any children before or outside of the marriage?
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Yes
No
(1) Child's Name
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First Name
Last Name
(1) Child's Gender
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Female
Male
(1) Child's DOB
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 -
Month
 -
Day
Year
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(1) Child's Place of Birth
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(1) Do you know the child's SSN?
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Yes
No
(1) Child's SSN
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(1) Who does the child's reside with?
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(1) Do you need to list another child?
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Yes
No
(2) Child's Name
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First Name
Last Name
(2) Child's Gender
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Female
Male
(2) Child's DOB
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 -
Month
 -
Day
Year
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(2) Child's Place of Birth
*
(2) Do you know the child's SSN?
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Yes
No
(2) Child's SSN
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(2) Who does the child's reside with?
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(2) Do you need to list another child?
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Yes
No
(3) Child's Name
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First Name
Last Name
(3) Child's Gender
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Female
Male
(3) Child's DOB
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 -
Month
 -
Day
Year
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(3) Child's Place of Birth
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(3) Do you know the child's SSN?
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Yes
No
(3) Child's SSN
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(3) Who does the child's reside with?
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(3) Do you need to list another child?
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Yes
No
(4) Child's Name
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First Name
Last Name
(4) Child's Gender
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Female
Male
(4) Child's DOB
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 -
Month
 -
Day
Year
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(4) Child's Place of Birth
*
(4) Do you know the child's SSN?
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Yes
No
(4) Child's SSN
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(4) Who does the child's reside with?
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(if necessary please bring in a separate sheet of paper with additional names and information).
Do either of you pay child support for the children before or outside of the marriage?
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Yes
No
If Yes, who and how much child support per month is paid?
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Emergency Contact
This is a person(s) who you would like for our office to contact about your pending case if you are not able to be reached.
Emergency Contact's Name
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First Name
Last Name
Emergency Contact's Relationship to You:
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Emergency Contact's Phone Number
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 -
Area Code
Phone Number
Emergency Contact's Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Summary of Community Property
Please list anything acquired during the marriage.
Do you and your spouse own any real estate property (marital home, vacation homes, or rental property).
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Yes
No
(1) Property Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
(1) Year Property Purchased?
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(1) Fair Market Value of the Property as of today?
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(1) Do you owe a mortgage on the property?
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Yes
No
(1) If Yes, Name of the Mortgage Company?
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(1) Monthly mortgage payments?
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(1) Total Mortgage Debt Balance as of today:
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(1) Do you need to list another piece of real property?
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Yes
No
(2) Property Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
(2) Year Property Purchased?
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(2) Fair Market Value of the Property as of today?
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(2) Do you owe a mortgage on the property?
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Yes
No
(2) If Yes, Name of the Mortgage Company?
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(2) Monthly mortgage payments?
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(2) Total Mortgage Debt Balance as of today:
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(2) Do you need to list another piece of real property?
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Yes
No
(3) Property Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
(3) Year Property Purchased?
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(3) Fair Market Value of the Property as of today?
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(3) Do you owe a mortgage on the property?
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Yes
No
(3) If Yes, Name of the Mortgage Company?
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(3) Monthly mortgage payments?
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(3) Total Mortgage Debt Balance as of today:
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(if necessary please bring in a separate sheet of paper with additional real property and information).
Motor Vehicles, Boats, Airplanes, Cycles, & Trailers
Please list any property acquired during the marriage.
Do you have any motor vehicles, boats, airplanes, cycles or trailers to list?
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Yes
No
(1) Year of Motor Property
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(1) Make & Model
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(1) Who drives the vehicle
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Yes
No
(1) Fair Market Value of the property?
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(1) Is there a loan on the property?
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Yes
No
(1) If yes, how much is the monthly payment?
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(1) How much is balance owed as of today?
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(1) Do you need to list another piece of property?
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Yes
No
(2) Year of Motor Property
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(2) Make & Model
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(2) Who drives the vehicle
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Yes
No
(2) Fair Market Value of the property?
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(2) Is there a loan on the property?
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Yes
No
(2) If yes, how much are the monthly payments?
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(2) What is the balance owed as of today?
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(2) Do you need to list another piece of property?
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Yes
No
(3) Year of Motor Property
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(3) Make & Model
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(3) Who drives the vehicle
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Yes
No
(3) Fair Market Value of the property
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(3) Is there a loan on this property?
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Yes
No
(3) If Yes, how much is the monthly payments?
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(3) If Yes, how much is the balance owed as of today?
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(3) Do you need to list another piece property?
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Yes
No
(4) Year of Motor Property
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(4) Make & Model
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(4) Who drives the vehicle
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Yes
No
(4) Fair Market Value of the Property?
(4) Is there a loan on this property?
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Yes
No
(4) If Yes, how much is the monthly payments?
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(4) If Yes, how much is the balance owed as of today?
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(if necessary please bring in a separate sheet of paper with additional property and information).
Bank Accounts
Please list all separate and joint bank accounts.
Do either you or youse spouse have a bank account?
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Yes
No
(1) Name of Bank
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(1) Who Can Withdraw From Account?
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Myself
Spouse
Other
(1) Type of Account
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Checking
Savings
Other
(1) Available Balance Today?
(1) Do you need to list another account?
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Yes
No
(2) Name of Bank
*
(2) Who Can Withdraw From Account?
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Myself
Spouse
Other
(2) Type of Account
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Checking
Savings
Other
(2) Available Balance Today?
*
(2) Do you need to list another account?
*
Yes
No
(3) Name of Bank
*
(3) Who Can Withdraw From Account?
*
Myself
Spouse
Other
(3) Type of Account
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Checking
Savings
Other
(3) Available Balance as of Today?
*
(3) Do you need to list another account?
*
Yes
No
(4) Name of Bank
*
(4) Who Can Withdraw From Account?
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Myself
Spouse
Other
(4) Type of Account
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Checking
Savings
Other
(4) Available Balance as of Today?
*
(4) Do you need to list another account?
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Yes
No
(5) Name of Bank
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(5) Type of Account
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Checking
Savings
Other
(5) Who Can Withdraw From Account?
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Myself
Spouse
Other
(5) Available Balance as of Today?
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(if necessary please bring in a separate sheet of paper with additional accounts and information).
Stock and Mutual Funds
Please list all mutual funds
Do you or your spouse have a stock or mutual fund?
*
Yes
No
(1) Name of Fund
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(1) Estimated Value as of Today
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(1) Do you need to list another stock or mutual fund?
*
Yes
No
(2) Name of Fund
*
(2) Estimated Value as of Today
*
(2) Do you need to list another stock or mutual fund?
*
Yes
No
(3) Name of Fund
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(3) Estimated Value as of Today
*
(3) Do you need to list another stock or mutual fund?
*
Yes
No
(4) Name of Fund
*
(4) Estimated Value as of Today
*
(4) Do you need to list another stock or mutual fund?
*
Yes
No
(5) Name of Fund
*
(5) Estimated Value as of Today
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(if necessary please bring in a separate sheet of paper with additional funds and information).
Life Insurance
Please list all life insurance policies
Do you or your spouse have life insurance policies?
*
Yes
No
(1) Name of Company
*
(1) Insuring life of: (name of person)
*
(1) Cash Value as of Today?
*
(1) Do you need to list another policy?
*
Yes
No
(2) Name of Company
*
(2) Insuring the life of: (name of person)
*
(2) Cash Value as of Today?
*
(2) Do you need to list another policy?
*
Yes
No
(3) Name of Company
*
(3) Insuring the life of: (name of person)
*
(3) Cash Value as of Today?
*
(if necessary please bring in a separate sheet of paper with additional policies and information).
Retirement, Pensions, & Other Company Benefits
Please list you and your spouse's company benefit information below
Do you and/or your spouse have company benefit accounts?
*
Yes
No
(1) Type of Account
*
(1) Whose Name is the Account in?
*
Spouse
Mine
(1) Estimated Value of the Account as of Today?
*
(1) Do you have another account to list?
*
Yes
No
(2) Type of Account
*
(2) Whose Name is the Account in?
*
Spouse
Mine
(2) Estimated Value of the Account as of Today?
*
(2) Do you have another account to list?
*
Yes
No
(3) Type of Account
*
(3) Whose Name is the Account in?
*
Spouse
Mine
(3) Estimated Value of the Account as of Today?
*
(3) Do you have another account to list?
*
Yes
No
(4) Type of Account
*
(4) Whose Name is the Account in?
*
Spouse
Mine
(4) Estimated Value of the Account as of Today?
*
(if necessary please bring in a separate sheet of paper with additional accounts and information).
Separate Property
List any of you or your spouse's separate property that was acquired BEFORE the marriage
Do you or your spouse own any separate property?
*
Yes
No
If YES, list the property description here (i.e cars, homes, etc.)
*
Did you or your spouse receive a gift or inheritance during your marriage?
*
Yes
No
If YES, list the gift and inheritance here (i.e the amount and who the inheritance was from)
*
Debts
Please list all debts other than a home or vehicle.
Do you and your spouse owe additional debts?
*
Yes
No
(1) Who Debt Owed to:
*
(1) Monthly Payment
*
(1) Total Amount Owed as of Today?
*
(1) Do you need to list another debt?
*
Yes
No
(2) Who is the Debt Owed to:
*
(2) Monthly Payment
*
(2) Total Amount Owed as of Today?
*
(2) Do you need to list another debt?
*
Yes
No
(3) Who is the Debt Owed to:
*
(3) Monthly Payment
*
(3) Total Amount Owed as of Today?
*
(3) Do you need to list another debt?
*
Yes
No
(4) Who is the Debt Owed to:
*
(4) Monthly Payment
*
(4) Total Amount Owed as of Today?
*
(4) Do you need to list another debt?
*
Yes
No
(5) Who is the Debt Owed to:
*
(5) Monthly Payment
*
(5) Total Amount Owed as of Today?
*
(5) Do you need to list another debt?
*
Yes
No
(6) Who is the Debt Owed to:
*
(6) Monthly Payment
*
(6) Total Amount Owed as of Today?
*
(6) Do you need to list another debt?
*
Yes
No
(7) Who is the Debt Owed to:
*
(7) Monthly Payment
*
(7) Total Amount Owed as of Today?
*
(if necessary please bring in a separate sheet of paper with additional debts and information).
Miscellaneous
Please answer the following questions.
Does anyone owe you and/or your spouse money
*
Yes
No
If YES, please state (1) who owes the money and (2) how much is owed:
*
Are you or your spouse involved in any lawsuit?
*
Yes
No
If YES, please explain:
*
Do you own any livestock or mineral interest?
*
Yes
No
If YES, please identify below:
*
Do you or your spouse belong to any club with an equity interest?
*
Yes
No
If YES, state where below:
*
Have you filed your taxes for all of the previous years?
*
Yes
No
If No, (1) how much do you owe or was a refund issued? (2) How much was the balance owed or the refund issued? Please explain below:
*
How did you file?
*
Jointly
Married filing Separately
Who prepared your tax return?
*
Do you have a prenuptial agreement? (if yes, please bring a copy with you to your meeting).
*
Yes
No
Do you and/or you spouse have a Will?
*
Yes
No
If YES, please please provide detail on who prepared the Will:
*
What are your goals in this divorce?
*
Do you have any urgent concerns? (Example interaction with spouse, visitation, and financial issues, and etc.)
*
Yes
No
If YES, please provide details:
*
Closing Questions
Did someone refer you to our office?
*
Yes
No
Name of the Person who Referred You:
*
First Name
Last Name
Have you consulted or retained any other attorneys on this matter before?
*
Yes
No
If Yes, please state who you consulted with and when:
*
Submit
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