Divorce and Marital Agreement Questionnaire and Checklist

1 .Please provide the following contact information for the Husband:*

Husband's First name
Husband's Last name
Husband's Middle initial
Husband's Street address
Address (cont.)
Husband's City
Husband's State
Husband's Zip/Postal code
Husband's Work Phone
Husband's Home Phone
Husband's FAX
Husband's EMAIL If Known

2.Please provide the following contact information for the Wife:*

Wife's First name
Wife's Last name
Wife's Middle initial
Wife's Street address
Wife's Address (cont.)
Wife's City
Wife's State
Wife's Zip code
Wife's Home Phone
Wife's Work Phone
Wife's FAX
Wife's EMAIL  If Known

3.Are you the plaintiff or defendant?*

Plaintiff
Defendant

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Jurisdiction and Grounds for Divorce: These questions establish your  eligibility for filing a divorce in your state. Residence requirements vary from state-to-state. You must also be separated for a specific period of time before you can file you divorce documents. The amount of time that you are separated will vary from state to state and will depend upon the grounds for divorce. In most states, you must be separated from each other for a period of from 6 months to 1 year in order to secure an uncontested divorce. 

4.Length of time Husband has resided in state in months?*

[Insert number of months]
 

5.Length of time Husband has resided in county in months?*

[Insert number of months]
 

6.Length of time Wife has resided in state in months?*

[Insert number of months]
 

7.Length of time Wife has resided in county in months?*

[Insert number of months]
 

8. On what date did you separate?*

-- mm/dd/yy

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Additional information about you and your spouse.*

9. Husband's date of birth:*

-- mm/dd/yy
 

10. Wife's date of birth?*

-- mm/dd/yy
 

11. Is Husband a U.S. citizen?*

Yes No
 

12. Is Wife a U.S.citizen?*

Yes No
 

13. Is the plaintiff serving in the Armed Forces?*

Yes No
 

14. Is the defendant serving in the Armed Forces?*

Yes No

If the defendant is a member of the Armed Forces you must comply with the requirements of the "Solders' and Sailors' Civil Relief Act of 1940. These requirements are explained in the step-by-step instructions that come with the completed forms.

15. What was your marriage residence street address?*

16. Use this space for an apartment number.*

17. What city did you live in when married?*

18. What state did you live in when married?*

19. What was the zip code for your marriage residence?*

20. What was the county of your marriage residence?*

 

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Questions About Your Marriage:*

21. In what county were you married?*

22. In what state were you married in?*

23. What was the date of your marriage?*

-- mm/dd/yy
 

24. What was the name of the official who married you? [Required in NJ]*

25. What was the title of the official who married you?.*

e.g., Rabbi, Priest, Judge
 

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Marital Separation Agreement

26. Do you have a Marital Separation Agreement?*

Yes No
 

27. If you have a Marital Separation Agreement,
on what date was it executed?*

-- mm/dd/yy
 

28. If you have a Marital Separation Agreement,
do you want it to be incorporated into the
final judicial divorce decree?*

Yes No

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Wife's Maiden Name

29. What was the Wife's maiden name?*

30. Does the Wife want her maiden name restored after the divorce?*

Yes No

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If you do not have any children, skip to Marital Property Section.

Children's Information* 

31. How many children do you have from this marriage?

32. What is the full legal name of the first child?.

33. What is this child's date of birth?

-- mm/dd/yy
 

34. Is this child a male?

Yes No
 

35. What is the full legal name of the second child?

36. What is the second child's date of birth?

-- mm/dd/yy
 

37. Is this child a male?

Yes No
 

38. What is the full legal name of the third child?

39. What is the date of birth of third child?

-- mm/dd/yy
 

40. Is the third child a male?

Yes No
 

41. What is the full legal name of the fourth child?

42. What is the date of birth of the fourth child?

-- mm/dd/yy
 

46. Is the fourth child a male?

Yes No
 

47. What is the full legal name of the fifth child?

48. What is the date of birth of the fifth child?

-- mm/dd/yy
 

49. Is the fifth child a male?

Yes No
 

50. What is the full legal name of the sixth child?

51. What is the date of birth of the sixth child?

-- mm/dd/yy
 

52. Is the sixth child a male?

Yes No
 

53. What is the full legal name of the seventh child?

54. What is the date of birth of the seventh child?

-- mm/dd/yy
 

55. Is the seventh child a male?

Yes No
 

56. Is there an outstanding child support order ?

Yes No
 

57. Which court issued the child support order?

58. What is the docket number for the child support order?

59. Who are the children living with?

Mother Father Grandparent Other Third Party
 

60. Who should have legal custody of the children?*

Father Mother Joint, Shared Living
 

61. Who should have physical custody of the children?*

Mother Father Joint/Shared
 

62. Upon death of custodial parent, should Agreement recite that non-custodial parent shall have custody:
Yes  No

63. Monthly child support Husband shall pay to the Wife?

[Calculate required child support separately from Table and insert here or leave blank if you do not know the amount]*

[Monthly]
 

64. Monthly child support Wife must pay to the Husband?
[may be zero, calculation derived from Table. If you do not know, leave blank].*

[Monthly]
 

65. Which parent will provide medical insurance for the children?
[Leave blank if you do not know now].*

66. Which parent will claim the tax exemption for the children?*

[Leave blank if you do not know].

67. Payments to Increase with Consumer Price Index (CPI): Yes No

68. Payments to Increase on Specific dates  :[Indicate below dates and amounts]:

69. Payments for College:

Non-Custodial parent to make additional payments while children in college:
$Per Child:

70. Both parties to pay into college Fund: [Indicate the amount to be paid by each for each child]:


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71. Visitation

Non-custodial parent to have "reasonable" visitation.*
Non-custodial parent to have visitation rights pursuant to a specific schedule
Sat or Sun weekly
Sat & Sun biweekly
Christian Holidays or Jewish Holidays

How many weeks in summer:
"Reasonable" visitation rights for grandparents.

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72. Moving Children's Residence:

No restrictions
Visitation rights shall be adjusted
Moving prohibited
Moving more than 50 miles prohibited

73. Moving Restrictions to Terminate When:

Child reach majority
On a Specific Date:
Remarriage of custodial parent
Health of custodial parent requires move
Agreement to be silent about termination.

Financial Statements: If you have children, both parties will have to complete financial statements and bring these financial statements to the divorce hearing. The Master or Judge will review these financial statements to determine that the minimum required child support payment required by your state has been calculated correctly. You cannot pay an amount which is less than the minimum amount required by your state.  If you have children, you will need to complete Financial Statements, and attach these to your Marital Separation Agreement.

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74. Spousal Support

Husband to pay specific amounts to wife. Insert amounts and whether weekly, biweekly, monthly, or other time period.*

Amount of Spousal Support and Time Period.

Husband to pay "reasonable amounts"

No maintenance or alimony to be provided

No maintenance but wife can apply to a court at later date.

Payments to terminate on a specific date (other than death/remarriage) - Date:

Payments to increase with CPI

Payments increase on specific dates - specify dates and amounts:

 

Court may not modify spousal support or alimony.

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Marital Home*

75.  Do you own a marital home?

Yes No
 

76. Who will keep the marital home? Choose one of the following options:

Wife [Legal title to be transferred].
Husband [Legal title to be transferred]
We will sell the marital home
Legal title to be transferred to Husband and Wife as tenants in common
Legal title unchanged
Transferee to pay lump sum for transferor's interest: $

Transferor to continue to pay expenses of marital residence - Please describe which expenses will be paid and how much:

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77. Possession of marital residence:*

Wife*
Wife may reside until sale*

78. Marital residence to be sold only if:

Vacated
Remarries
Cohabits with Adult
Children emancipated

79. What is the complete address of your marital home?*

80. Approximate Value of House

81. Balance Owed on House       

82. Proceeds of sale of marital residence to be paid:
Equally to Husband and Wife
to Wife
to Husband
$ to Wife, balance to Husband
$ to Husband, balance to Wife.

Other

Minimum acceptable sales price.

83. Is marital residence affected by:

An existing mortgage
Insurance premiums
real estate taxes
coop or condo charges or fees

84. These are to be paid by:

Husband and Wife in equal shares
Husband
Wife
Other:

85. Minor repairs to be paid by:

Husband and Wife in equal shares
Husband
Wife
Other:
Agreement to be silent

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Marital Property*

86. Please list all marital property, including house?

87. Please list all non-marital property, listing one item of property on a line:


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Debts*

88. Please list all joint debts, if any, one debt per line.

89. Which items of marital property will the Husband retain (list one item per line)?

90. Which items of marital property will the Wife retain (list one item per line)?

91. Which debts will the Husband assume (one debt per line)?

92. Which debts will the Wife assume (one debt per line)?

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Retirement Benefits  [If no retirement benefits skip this section].*

93. Does either spouse have retirement benefits to be divided?

Yes No

94. Will each party keep his/her own retirement benefits?
Yes   No

95. If not, how will retirements benefits be divided?



96. Name of employer generating the retirement benefits?

97. Name of the Spouse with retirement benefits to be divided?



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98. Joint Bank Accounts

We have bank account containing funds

Approximate Amount

To be paid to:

Husband
Wife
Husband and Wife Equally
In some other way, please describe:

 

Agreement to be silent on subject

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99. Income Taxes

Parties to file joint returns in current year

Refunds are to be paid to:
Husband
Wife
Parties Equally
In Proportion to income
Other manner:

Any deficiency (or taxes due) are to be paid by:

Husband
Wife
Parties Equally

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100. Life Insurance

Husband is to:

Maintain existing life insurance
Maintain existing life insurance and increase coverage
Purchase new life insurance because none exists.
Agreement is to be silent on subject.

Amount of existing insurance $
Amount of additional insurance$

Total Insurance to be maintained: $
The life insurance is to be for the benefit of:

Wife, or if she dies children
Just Wife
Just Children

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101. Medical Insurance

Husband to maintain medical insurance for benefit of:
Wife and Children
Just Wife
Just Children
Husband to maintain "major medical" coverage
Husband need not maintain insurance if Wife's employer provides coverage
Requirement for insurance to end on a specific date.

Deductible Under Medical Insurance:

Husband pays deductible
Husband pays half the deductible
Wife pays deductible
Agreement to be silent on subject

Should the same rule apply to:

Dental and orthodontic expenses
All medical expenses not covered by insurance

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102. Last Will and Testament

Husband can freely dispose of his estate
Husband must bequeath $ to Wife, or she dies to children
Husband must bequeath % of his estate to Wife, or if she dies to children.
Husband must bequeath $ to children directly.
Husband must bequeath % to children.
Requirement ends on a specific date:
Wife to be subject to same requirement as to her estate.

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103. Net Worth Representations

Agreement to contain representations of Net Worth and Income:

Husband's approximate income is:

Husband's net worth is between: $

Wife's approximate income is:

Wife's Net worth is between: $

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104. Disputes and Changes

If there is a material change in economic circumstances, either party may apply to a court for modification.

Disputes to be resolved by arbitration.

End of Questionnaire

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