Wife's Information
General Information
Electronic Records
Employment Information
Education
Miscellaneous
Husband's Information
General Information
Electronic Records
Employment Information
Education
Miscellaneous
Family Information
Medical Insurance
Wife's Insurance Information
Husband's Insurance Information
Children by this Marriage & Residence of Children for Last Five Years
Children by Other Marriages
Assets - Property
Real Estate
Motor Vehicles
Please select how many vehicles (cars, trucks, motorcycles, boats, RVs, etc.) you own. Include leased vehicles.
Expected Inheritances
Please describe expected inheritances for you and your spouse.
Professional/Business Equipment
Please describe for you and your spouse. State Values if known.
Professional/Business Equipment 1
Non-Marital Property
Did either spouse own property or possess funds prior to this marriage or inherit any property or funds during marriage or receive a gift during this marriage?
Other Assets
Please list details such as description, location, and value for any other assets.
Assets - Property
Monetary Accounts
Please select how many monetary accounts you have. Include Savings, Checking, Credit Union, CODs, Money Market Accounts, and Savings Bonds/Government Securities.
Life Insurance Policies
Deferred Compensation
Please select how many deferred compensation accounts you have. Include KEOUGH, 401K, IRAs, etc.
Other Bonds & Stocks
Please select number of other bonds and stocks, stock plans, futures, etc.
Pension & Profit Sharing
Accounts/Notes Receivable
Please list any debtors who owe you money.
Partnerships/Joint Ventures or Other Business Interests
Partnership/Joint Venture 1
Safety Deposit Boxes
Tax Refunds Due
Debts/Liabilities
Debts
Please select the number of debts you have. Include every known debt incurred or owed by either spouse, and any obligations that will arise in the near future except real estate mortgages.
Monthly Expenses
Do not include on this sheet items deducted from your salary
To determine the monthly amount, multiply the weekly by 4.3, or divide yearly total by 12. Fill out only those items which apply. If estimated, so state.
Housing Costs
Utilities
Food
Clothing
Transportation
Child Care
Medical, Dental, Etc.
Other Expenses
Debt Service
Miscellaneous Expenses
Marital History
Please give a summary of reasons leading up to marital discord/separation:
