Dissolution of Marriage Client Questionaire

Name:
Address:
E-mail:
Phone:
-
Social Security Number
Driver's License Number
COPY OF DRIVER’S LICENSE
Dates of residency at current address
-
List any previous residences in the past five (5) years, and dates resided in each as well as the names of any adults that lived in each dwelling:
Employer's Name
Employer's Address
Employer's Telephone No
-
Date of Employment
-
Occupation
Salary
Pay Schedule
If not currently employed, list date of last employment, name of last employer, and reason currently unemployed
SPOUSE'S INFORMATION:
Spouse Name:
Spouse Social Security No.
Spouse Address:
Spouse Date of Birth
State of Birth
Spouse Home Phone:
-
Spouse E-mail:
Spouse Drivers License Number
Is spouse represented by counsel in this matter?
If yes, please complete the following. Attorney Name:
Attorney Address:
Attorney Phone:
-
Attorney Fax:
-
Spouse Employer's Name
Spouse Employer Address:
Job Title
Nature of Job:
Date of Employment:
Occupation:
Salary:
Spouse Pay Schedule
List any other jobs held during the course of this marriage (indicate employer and annual salary):
If not currently employed, list date of last employment, name of last employer, and reason currently unemployed:
GENERAL MARITAL HISTORY
Date of Marriage:
COPY OF MARRIAGE CERTIFICATE:
Place of Marriage:
Are you and your spouse currently living together:
If not, then Date of Separation:
Do you have an interest in reconciliation:
To the best of your knowledge, does your spouse want reconciliation:
(Wife) Do you want your name changed to your former name:
Describe the circumstances that caused your separation: (briefly)
If a suit for divorce has been previously filed by either spouse as to this marriage, please provide the date such was filed, the name of the primary attorney involved, the name or location of the court, and the reason the divorce was not finalized:
CHILDREN'S INFORMATION (from this marriage):
Child 1 Name:
Child 1 SSN
Child 1 Place of Birth:
Child 1 Date of Birth:
Child 1 Living With:
Child 1 Sex:
Child 2 Name:
Child 2 SSN:
Child 2 Place of Birth:
Child 2 Date of Birth:
Child 2 Living With:
Child 2 Sex:
Child 3 Name:
Child 3 SSN:
Child 3 Place of Birth:
Child 3 Date of Birth:
Child 3 Living With:
Child 3 Sex:
Child 4 Name:
Child 4 SSN:
Child 4 Place of Birth:
Child 4 Date of Birth:
Child 4 Living With:
Child 4 Sex:
Child 5 Name:
Child 5 SSN:
Child 5 Place of Birth:
Child 5 Date of Birth:
Child 5 Living With:
Child 5 Sex:
Is the wife currently pregnant?
If Yes, date child is due:
Do you have any information of any custody or visitation proceeding currently pending in a court of this or any other state concerning any child subject to this proceeding:
If Yes, please describe:
Do you have any knowledge of any support order issued by a court of this or any other state concerning any child subject to this proceeding?
If Yes to support order, please describe:
Other Information
Do you anticipate a dispute about the parenting plan (if so, please explain)?
Please describe how you and your spouse intend to divide time sharing for holidays, birthdays, summer vacation, winter and spring breaks, holidays from school bearing in mind that the standard division of some holidays, such as Mother’s Day, Father’s Day and each parents birthdays generally are spent with the appropriate parent even if the day falls on the other parent’s time sharing schedule:
Who should have primary parental responsibility of the children, and why?
Which parent’s address shall be used for the purposes of school?
Are any children adopted?
Are any other children of prior marriages or other dependents living in your residence?
Are any of the children in private school (if yes, indicate the cost of the private school, how such cost has been paid, if you and your spouse both agree on the private school, any special reasons why the child needs private schooling, and if you desire to continue the child in the private school, your belief as to why it is in such child's best interest and the expected impact on the child's life if private school is not continued)?
Describe children's involvement in school activities:
Describe the physical and mental health of the children:
Indicate if any child is being treated for any medical or psychological conditions (if so, indicate the name of the treating physician or counselor, the frequency of medical or psychological treatment, any medications prescribed, cost of medical or physiological care and medicines, portion of expense not covered by insurance, and the length of time you feel treatment will be necessary):
Describe the division of costs associated with out of pocket medical expenses, extra-curricular school/sporting events, tutors, private school costs, health insurance coverage and non-covered health expenses (such as braces or elective surgeries/procedures) that the parties' children may encounter in the future: (example, 50/50 everything or 60/40…)
Indicate if any child of the parties has separate assets or income, including trust or estate assets:
Indicate if any child of the parties has any special needs:
Do the children receive religious training (if so, indicate if there is any primary influence by you or your spouse in the religious training of the children or if this is likely to become an issue)?
What are you and your spouse's plans for child care and how shall such costs be divided?
What, if any, restrictions should be placed on both parents with regard to any travel outside of the state of Florida? (example: parent travelling with child shall give other parent 30 days’ notice and the location and contact information for where they will be taking the child…)
What, if any, restrictions should be placed on both parents with regard to any travel outside of the United States? (example: parent travelling with child shall give other parent 45 days’ notice and the location and contact information for where they will be taking the child. Any parent wishing to travel with the children must have written permission; the parents shall cooperate with providing any and all documentation or signatures required to obtain passports for the children…), bearing in mind that now taking a cruise outside of the US requires passports for children:
Describe any other issue pertaining to the children that you feel should be noted in reference to this case that has not been provided through previous answers
PRIOR MARITAL HISTORY (if none, skip this section)
Name of 1st Ex-spouse:
How, When and Where Marriage Terminated:
If there were any children born from this prior marriage, please list the name of each child, the date of birth and with whom such child is currently residing:(one per line)
Indicate if you currently pay or receive any child support on behalf of these children?
Name of 2nd Ex-spouse:
How, When and Where was the 2nd Marriage Terminated:
If there were any children born from this prior marriage, please list the name of each child, the date of birth and with whom such child is currently residing: (one per line)
Indicate if you currently pay or receive any child support on behalf of these children (2)?
SPOUSE'S PRIOR MARRIAGES:
Name of Spouse's 1st Ex-spouse:
How, When and Where was your spouse's 1 Marriage Terminated:
If there were any children born from this prior marriage, please list the name of each child, the date of birth and with whom such child is currently residing (one per line)(1st):
Indicate if your spouse currently pays or receives any child support on behalf of these children?
Name of spouse's 2nd Ex-spouse:
How, When and Where was spouses's 1st Marriage Terminated:
If there were any children born from spouse's 1st marriage, please list the name of each child, the date of birth and with whom such child is currently residing: (one per line)
Indicate if your spouse currently pays or receives any child support on behalf of these children for spouse's 1st marriage?
When marital difficulties began, did you and/or your spouse seek counseling? If so, provide the name of the marriage counselor, the duration of counseling, whether the counseling was joint or individual, and your reasons to discontinue counseling.
Has any spousal*[ or child]* abuse been reported to a law enforcement agency? If yes, provide name of agency and date of incident and attach a copy of any police report if available.
FAMILY FINANCES:
Which spouse has primary responsibility for the finances?
Was income consolidated?
Was any income or asset treated differently (if yes, please explain)?
Describe the method of filing tax returns (ex. Married filing jointly, etc..) and how shall any expected refund or debt for the current year be divided:
Describe any family savings plans or retirement plans:
Describe anything unusual or significant about the handling of family finances not mentioned above:
Provide any information not already requested in the preceding questions that you consider important to a fair and equitable result in your case (add additional pages, if necessary):
CLIENT'S NONMARITAL ASSETS & LIABILITIES
*****this section is not necessary in uncontested matters where the parties have already divided their property and debts
List any assets that you owned prior to the marriage, that were brought into the marriage:
List any liabilities owed by you prior to the marriage that were brought into the marriage, and indicate if any marital funds or assets have been used to pay for these liabilities:
Describe any inheritance you received during the marriage (include the date acquired, how acquired, where located, style of ownership, value at time of marriage, value when inherited, value when obtained, current market value, basis of valuation, date of valuation, average annual income derived from the asset, how income from this asset has been used during the marriage and if this asset or the income from the asset has been commingled with a joint account, used to defray normal family expenses or relied upon to obtain loans or credit):
Describe any major gifts you received during the marriage from someone other than your spouse (include the date acquired, how acquired, where located, style of ownership, value at time of marriage, value when obtained, current market value, basis of valuation, date of valuation, average annual income derived from the asset, how income from this asset has been used during the marriage and if this asset or the income from the asset has been commingled with a joint account, used to defray normal family expenses or relied upon to obtain loans or credit):
Are you a party of a trust agreement or a will currently being probated? (If yes, please explain):
Describe any gifts you have received from your spouse during the marriage of significant economic value which are still in existence, including engagement and wedding gifts (include the purchase price and current value of each):
SPOUSE'S NONMARITAL ASSETS & LIABILITIES
Premarital Assets - Spouse: List any assets that your spouse owned prior to the marriage, that were brought into the marriage:
Premarital liabilities - Spouse: List any liabilities that your spouse owed prior to the marriage that were brought into the marriage, and indicate if any marital funds or assets have been used to pay for these liabilities:
Disposition of Assets - Spouse During the last 3 years, or since significant marital problems first became apparent, has your spouse disposed of any assets with a value greater than $500.00 (if yes, please explain)?
Inheritance, Gifts, & Trusts - Spouse Describe any inheritance your spouse has received during the marriage (include the date acquired, how acquired, where located, style of ownership, value at time of marriage, value when inherited, value when obtained, current market value, basis of valuation, date of valuation, average annual income derived from the asset, how income from this asset has been used during the marriage and if this asset or the income from the asset has been commingled with a joint account, used to defray normal family expenses or relied upon to obtain loans or credit)
Describe any major gifts your spouse received during the marriage from someone other than yourself (include the date acquired, how acquired, where located, style of ownership, value at time of marriage, value when obtained, current market value, basis of valuation, date of valuation, average annual income derived from the asset, how income from this asset has been used during the marriage and if this asset or the income from the asset has been commingled with a joint account, used to defray normal family expenses or relied upon to obtain loans or credit):
Is your spouse a party in a trust agreement or a will currently being probated? (If yes, please explain):
Describe any gifts your spouse has received from you during the marriage of significant economic value which are still in existence, including engagement and wedding gifts (include the purchase price and current value of each):
RELIEF REQUESTED BY CLIENT
Children:
Alimony Permanent: $ Monthly
Alimony Rehabilitative: $ Monthly
Alimony Durational $ Monthly
Lump sum: $
Continued medical insurance:
Distribution of Real Estate:
Distribution of Personal Property:
Liabilities:
Other:
Maiden Name:
Temporary Orders:
If this is an uncontested dissolution; please supply a list of all marital assets and liabilities and the person who will receive the asset and/or be responsible for the liability.
Disclaimer: The information contained in this website is offered for informational purposes only and should in no way be construed as legal advice on any subject matter. Anyone reading content from this site, clients or otherwise, should act or refrain from acting on the basis of any content included in the site without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from an attorney licensed in the recipient’s state. The content of this website contains general information and may not reflect current legal developments, verdicts, or settlements. The People’s Choice Law expressly disclaims all liability in respect to actions taken or not taken based on any or all the contents of this website. Any information sent to the firm by Internet, e-mail, or through the website is not secure and is done so on a non-confidential basis. Transmission of information from this website does not constitute an attorney-client relationship between you and the People’s Choice Law, nor is it intended to do so. The transmission of the website, in part or in whole, and/or any communication with us via e-mail through this site does not constitute or create an attorney-client relationship between us and any recipients. For legal advice please consult a local attorney. We are a Florida based law firm with offices in the State of Florida staffed by Florida-licensed attorneys, and handle cases nationwide with the assistance of co-counsel, of counsel, and local counsel, where permitted. Some links within the People’s Choice Law’s website may lead to other websites, including those operated and maintained by third parties or government agencies. The People’s Choice Law includes these links solely as a convenience to you, and the presence of such a link does not imply a responsibility for the linked site or an endorsement of the linked site, its operator, or its contents. This website and its contents are provided “AS IS” without warranty of any kind, either expressed or implied, including, but not limited to, the implied warranties of merchantability, fitness for a particular purpose, or non-infringement. Furthermore, the People’s Choice Law does not wish to represent anyone desiring representation based upon viewing this website in a state where this website fails to comply with all laws and ethical rules of that state. Reproduction, distribution, republication, and/or re-transmission of material contained within the firm’s website is prohibited unless the prior written permission of the People’s Choice Law has been obtained.