DOUGLAS W. LEWIS ATTORNEY AT LAW

Transcription

1 DOUGLAS W. LEWIS ATTORNEY AT LAW Telephone: Constitution Boulevard Facsimile: Lawrenceville, GA WIFE S INFORMATION DIVORCE QUESTIONNAIRE Full Name: Any other name commonly used: Former/Maiden name: If Wife wants former/maiden name restored, state full name: Current Address: Street Address City County State Zip Code To what address do you wish correspondence sent: Cell No. _ Home No. Work No. Indicate the primary phone number to call: Indicate if any restrictions/directions regarding phone calls to you: Personal Work Indicate the primary to use, if any: Age: Date of Birth: Race: Soc. Sec. No. Birthplace: Education (list highest grade reached): Local Family (list name, relation, phone number and city):

2 HUSBAND'S INFORMATION Full Name: Any other name commonly used: Current Address: Street Address City County State Zip Code To what address do you wish correspondence sent: Cell No. Home No. Work No. Indicate the primary phone number to call: Indicate if any restrictions/directions regarding phone calls to you: Personal Work Indicate the primary to use, if any: Age: Date of Birth: Race: Soc. Sec. No. Birthplace: Education (list highest grade reached): Local Family (list name, relation, phone number and city): Marital Information Date of Marriage: Place: Including this marriage, how many times have you been married? Including this marriage, how many times has your spouse been married? Are you and your spouse living together now? If not, when did you separate and who left first? When was the last time you had sexual relations with your spouse? Where were you living at the time of your separation?

3 If separated, please list all other addresses since the separation here: from _ to from _ to from _ to _ Other than what is listed above, have you and your spouse lived together continuously throughout the marriage? If not, please explain: Have you tried marriage counseling? If so, when and with whom? Children of Marriage Full Names DOB Age Sex Resides with All addresses the children have lived for the past 5 years and with whom they lived: Address Lived with Do any of your children have any physical or other problems that will be a factor in this case (i.e., learning disability, physical impairment, etc.)? If so, please explain: Do you have any other children and if so state their name, age and address: Does your spouse have any other children and if so state their name, age and address: Do you anticipate a dispute about custody of the children?

4 Wife's Employment If not employed, state last date of employment: If employed, state the employer: Address: City/State/Zip: Work No.: Employed since: Gross Monthly Income (before taxes): Net Monthly Income ('take-home pay'): Job Title: $ $ State any other source of income: Please state the education and vocational training (including numbers of years you attended school): Husband's Employment If not employed, state last date of employment: If employed, state the employer: Address: City/State/Zip: Work No.: Employed since: Gross Monthly Income (before taxes): Net Monthly Income ('take-home pay'): Job Title: $ $ State any other source of income: Please state the education and vocational training (including numbers of years you attended school):

5 Marital Residence State whether you own real estate or rent: Address of Marital Residence: County in which residence is located: Date of Purchase: Approximate Purchase Price: Name(s) on the Warranty Deed Date and Amount of Last Appraisal: Estimated Current Value of the Marital Residence: 1st Mortgage Holder: Mortgage Bal. $ Name(s) on the Mortgage: 2nd Mortgage Holder: Mortgage Bal. $ Name(s) on the Mortgage: Total Monthly Mortgage Payment: $ Are the mortgage payments current? If not, then state the date of the last payment and the amount past due: State the names of those living in the residence: Do you desire residence? Yes No Vehicles I. (a) Description: Orig. Cost $ (b) Title Vested In.: Value Now $ (c) Mortgage Holder: Mo. Pymt. $ (d) Date Paid Off: Bal. Owed. $ II. (a) Description: Orig. Cost $ (b) Title Vested In.: Value Now $ (c) Mortgage Holder: Mo. Pymt. $ (d) Date Paid Off: Bal. Owed. $ III. (a) Description: Orig. Cost $ (b) Title Vested In.: Value Now $ (c) Mortgage Holder: Mo. Pymt. $

6 (d) Date Paid Off: Bal. Owed. $ Which vehicle(s) do you desire? Who will pay remaining payments? State the name of the car insurance company Boats/Trailers/Airplanes I. (a) Description: Orig. Cost $ (b) Title Vested In.: Value Now $ (c) Mortgage Holder: Mo. Pymt. $ (d) Date Paid Off: Bal. Owed. $ II. (a) Description: Orig. Cost $ (b) Title Vested In.: Value Now $ (c) Mortgage Holder: Mo. Pymt. $ (d) Date Paid Off: Bal. Owed. $ Which do you desire? Who will pay remaining payments? Gifts or Inheritances To Whom By Whom Date/Amount

7 Furniture & Furnishings (List Items you desire) Description Present Value Description Present Value Furniture & Furnishings (List all items you are willing to give to spouse) Description Present Value Description Present Value [use separate sheet if additional space is needed]

8 Debts of Marriage Name on When Account Name of Company Opened Acct. No Amounts Owed Life Insurance Policy Name Husband/Wife Face Amount Cash Value Amt. Beneficiary $ $ $ $ $ $ $ $ Medical Insurance Company Name Where Husband/Wife Pymt. Amt Payroll Ded's $ $ $ $ Health of parties and children:

9 Checking Accounts Name on Account Name of Institution Acct. Number Balance $ $ $ Savings Accounts/Certificates of Deposit/Money Market Funds Name on Account Description Name of Institution Acct. Number Balance Jewelry & Collectibles of Value Description Where Held Estimated Value $ $ $ $

10 IRA's/Retirement Plans/Profit Sharing Plans Name on Account Description Name of Institution Acct. Number Balance Stocks/Bonds/Mutual Funds Name on Account Description Name of Institution Acct. Number Balance

11 Real Property other than Marital Residence Address: Title Vested In: 1st Mortgage Holder: 2nd Mortgage Holder: $ $ Total Monthly Mortgage Payment: $ Value Today $ Address: Title Vested In: 1st Mortgage Holder: 2nd Mortgage Holder: $ $ Total Monthly Mortgage Payment: $ Value Today $ Please list any additional personal or real property which has not previously been listed in this space or on the reverse side:

12 MISC. INFORMATION: Has your spouse consulted an attorney regarding this matter? If so, please indicate his/her name and address, if known: Have you consulted other attorneys regarding this matter? If so, please state who you have seen and when: Do you have a Will? If so, who are the beneficiaries? Do you have an accountant or have you ever used an accountant? If so, please state his/her name and address: Are there bank accounts, lines of credit, stock and investment accounts or other accounts to which your spouse has access? If so, please clarify: Does your spouse have in his or his possession credit cards for which you are responsible? If so, please specify: Have you ever signed anything which may affect the case, including prenuptial or postnuptial agreement(s), or other documents presented by your spouse? If so, please describe what you signed: Where did you first hear about us? Referral (please provide name) Internet Yellow Pages Other *DO NOT discuss this case, or aspects of it, with anyone other than your attorney. Remember that you are married until the Final Judgment is signed by the judge; you should comport yourself accordingly. Signature: Date: