Matrimonial Questionnaire

    Your Information

    First Name

    Last Name

    Email Address

    Work Phone Number

    Home Phone Number

    Cell Phone Number

    Address

    Address (line 2)

    City

    State

    Zip Code

    Marriage Information

    Date of Marriage

    Place of Marriage

    Your Date of Birth

    Your State of Birth

    How many times have you been married?

    Your Previous Address (for the prior three years)

    Spouse's Name

    Spouse's Address

    Spouse's Date of Birth

    Spouse's State of Birth

    How many times has your spouse been married?

    Spouse's Previous Address (for the prior three years)

    Wife's Maiden Name

    Children's Names and Dates of Birth

    Your Employment Information

    Employer's Name

    Employer's Address

    Your Occupation

    Length of Time Employed

    Your Annual Income

    Employment Benefits

    Pension plan for current employer?

    401(K) plan or similar savings plan with current employer?

    Past Employments (please provide as much information as possible)

    Pension plan for past employer?

    401(K) plan or similar savings plan with past employer?

    Current Value

    Spouse's Employment Information

    Spouse's Employer's Name

    Spouse's Employer's Address

    Spouse's Occupation

    Length of Time Employed

    Spouse's Annual Income

    Employment Benefits

    Pension plan for current employer?

    401(K) plan or similar savings plan with current employer?

    Past Employments (please provide as much information as possible)

    Pension plan for past employer?

    401(K) plan or similar savings plan with past employer?

    Current Value

    Your Education Information

    Your Education Level

    College Degree (if applicable)

    Year you received your College Degree (if applicable)

    Was your College Degree obtained prior to or after date of marriage?

    Was your Advanced Degree obtained prior to or after date of marriage?

    Spouse's Education Information

    Spouse's Education Level

    Spouse's College Degree (if applicable)

    Year your spouse received their College Degree (if applicable)

    Was your spouse's College Degree obtained prior to or after date of marriage?

    Was your spouse's Advanced Degree obtained prior to or after date of marriage?

    Marital Assets

    Do you own or rent real estate?

    Date Purchased (if applicable)

    Purchase Price (if applicable)

    Down Payment Amount (if applicable)

    Source of Down Payment (if applicable)

    Name of Mortgage Bank (if applicable)

    Balance (if applicable)

    Other real estate holdings, name(s) on the deed, date purchased, address, purchase price, mortgage balance

    Bank Accounts

    Name(s) on Account

    Bank

    Account Number

    Balance

    Name(s) on Account

    Bank

    Account Number

    Balance

    Name(s) on Account

    Bank

    Account Number

    Balance

    Stocks/Bonds

    Name(s) on stocks/bonds

    # of shares/bonds

    Name of company

    Date purchased

    Amount of purchase price

    Source of funds

    Current value

    Name(s) on stocks/bonds

    # of shares/bonds

    Name of company

    Date purchased

    Amount of purchase price

    Source of funds

    Current value

    Automobiles

    Year

    Make

    Own or lease

    Title holder

    Bank name

    Bank balance

    Value

    Year

    Make

    Own or lease

    Title holder

    Bank name

    Bank balance

    Value

    Debts - Credit Cards

    Balance

    Monthly Payment

    Joint/Individual

    Balance

    Monthly Payment

    Joint/Individual

    Balance

    Monthly Payment

    Joint/Individual

    Balance

    Monthly Payment

    Joint/Individual

    Debts - Installment Loans

    Balance

    Monthly Payment

    Joint/Individual

    Balance

    Monthly Payment

    Joint/Individual

    Balance

    Monthly Payment

    Joint/Individual

    Balance

    Monthly Payment

    Joint/Individual

    Separate Property

    Did you own property in your individual name prior to your date of marriage? If so, then please set forth a list of those assets, when acquired by you, purchase price and current value

    Did you acquire any property as a gift or inheritance during the course of your marriage, other than gifts from your spouse? If so, then please set forth a list of those assets, when acquired by you, who you acquired them from, and current value

    Have you and your spouse signed a separation agreement? If so, then please bring copy with you to the appointment.

    Have you any existing custody/visitation and/or support orders from any family court? If so, then please bring copies with you to the appointment.

    Other Information

    Other (Any additional information not previously requested but that you feel relevant to your situation)