GARY E. WILLIAMS
Attorney & Counselor at Law
DISSOLUTION OF MARRIAGE QUESTIONNAIRE
Please complete the following questionnaire. The information is necessary for the attorney to accurately and competently handle your case. Your responses are protected by attorney/client privilege and will be held in strict confidence.
DATE: ______
1.NAME: ______
First Name MiddleLast Name
2.OPPOSING PARTY’S NAME:______
3.YOUR SOCIAL SECURITY NUMBER: ______
YOUR DATE OF BIRTH: ______
OPPOSING PARTY’S SOCIAL SECURITY NUMBER:______
OPPOSING PARTY’S DATE OF BIRTH: ______
4.HOW LONG HAVE YOU LIVED IN FLORIDA?______
5.DATE OF MARRIAGE: ______
PLACE OF MARRIAGE: ______
6.COUNTY AND STATE WHERE YOU AND THE OPPOSING PARTY LAST LIVEDTOGETHER AS HUSBAND AND WIFE:______
7.DATE OF SEPARATION: ______
8.REASON FOR SEPARATION: ______
9.HAS A DISSOLUTION OF MARRIAGE
ALREADY BEEN FILED?YESNO
If yes, in what county and state?______
A.HAVE YOU BEEN SERVED WITH
LEGAL PAPERS?YESNO
Do you have copies of the document with you?YES NO
If you do not have the documents with you,
Do you have the case number?YESNO
If yes, please provide: ______
B.HAVE YOU HIRED A PRIOR ATTORNEY
FOR THIS MATTER? YESNO
If yes, name: ______
May we contact your prior attorney?YESNO
10.ADDRESS WHERE YOU CAN BE SERVED WITH LEGAL PAPERS:
______
______
11.ADDRESS WHERE THE OPPOSING PARTY CAN BE SERVED WITH LEGAL PAPERS: ______
______
12.DOES THE OPPOSING PARTY HAVE
AN ATTORNEY?YESNOUNKNOWN
If known, attorney’s name:______
13.CHILDREN BORN OR ADOPTED DURING THE MARRIAGE:
CURRENTLY LIVING WITH
NAMEDATE OF BIRTHSEX MOTHER/FATHER/OTHER
______
______
______
CHILDREN BORN OR ADOPTED FROM ANOTHER RELATIONSHIP:
CURRENTLY LIVING WITH
NAMEDATE OF BIRTHSEX MOTHER/FATHER/OTHER
______
______
______
14.CHILD SUPPORT
ARE YOU ORDERED/PAYING CHILD SUPPORT FOR
CHILDREN FROM ANOTHER RELATIONSHIP?YESNO
If yes, how much per month? ______
ARE YOU RECEIVING CHILD SUPPORT FOR
CHILDREN FROM ANOTHER RELATIONSHIP?YESNO
If yes, how much per month? ______
15.ARE YOU PARTICIPATING IN COUNSELING?YESNO
If yes, with whom? ______
DO YOU HAVE A DRUG OR ALCOHOL PROBLEM?YESNO
If yes, are you participating in Alcoholics
Anonymous or Narcotics Anonymous?YESNO
ARE THE OPPOSING PARTY AND/OR CHILDREN
PARTICIPATING IN COUNSELING?YESNO
If yes, with whom? ______
DOES THE OPPOSING PARTY HAVE A DRUG
OR ALCOHOL PROBLEM?YESNO
If yes, is the opposing party participating in Alcoholics
Anonymous or Narcotics Anonymous?YESNO
16.IN WHAT STATES HAVE YOUR CHILDREN RESIDED IN DURING THE LAST SIX (6) MONTHS? ______
Where do the children presently live? ______
17.ARE YOU EXPECTING A CHILD?YESNO
If yes, is the expected child from the marriage relationship?YESNO
If expected child is of a relationship outside of this marriage, who
Is the other biological parent? ______
18.YOUR PLACE OF EMPLOYMENT: ______
ADDRESS: ______
______
19.YOUR YEARLY INCOME: ______
Weekly income, if yearly income unknown: ______
20.OPPOSING PARTY’S PLACE OF EMPLOYMENT:______
ADDRESS: ______
______
21.OPPOSING PARTY’S YEARLY INCOME: ______
Weekly income, if yearly income unknown: ______
22.ASSETS:
A.MARITAL HOME
Address:______
Date Purchased: ______
Purchase Price: ______
Current Fair Market Value: ______
Current Mortgage/Credit Line Balance(s): ______
Name(s) on the Deed: ______
B.OTHER REAL ESTATE
Address: ______
Date Purchased: ______
Purchase Price: ______
Current Fair Market Value: ______
Current Mortgage/Credit Line Balance(s): ______
Name(s) on the Deed: ______
C.TRANSPORTATION (Cars, Trucks, Motorcycles, Boats, etc.)
What vehicle do you drive?
MAKE/YEAR: ______
Date Purchased: ______
Purchase Price: ______
Current Fair Market Value: ______
Current Loan Balance: ______
Name(s) on the Title: ______
What vehicle does the opposing party drive?
MAKE/YEAR: ______
Date Purchased: ______
Purchase Price: ______
Current Fair Market Value: ______
Current Loan Balances: ______
Name(s) on the Title: ______
D.ADDITIONAL TRANSPORTATION
MAKE/YEAR: ______
Date Purchased: ______
Purchase Price: ______
Current Fair Market Value: ______
Current Loan Balance: ______
Name(s) on the Title: ______
E.ADDITIONAL TRANSPORTATION
MAKE/YEAR: ______
Date Purchased: ______
Purchase Price: ______
Current Fair Market Value: ______
Current Loan Balance: ______
F.OTHER ITEMS OF SIGNIFICANT VALUE: (ART, TOOLS, COLLECTIONS, ETC.)
ITEMVALUE
______
______
______
______
______
G.INTANGIBLE ASSETS:
CASH ON HAND: ______
BANK ACCOUNTS: ______
______
STOCKS, BONDS, MONEY MARKETS: ______
______
IRA’S OR OTHER RETIREMENT OR PENSION PLANS: ______
______
______
23.NON-MARITAL ASSETS: [Defined as assets acquired outside the marriage – such as gifts, inheritances, items owned prior to marriage, etc.] List any items, approximate values, and circumstances under which each item was acquired:
ITEMVALUECIRCUMSTANCES
______
______
______
______
______
24.DO YOU FEAR THE OPPOSING PARTY WILL DISPOSE
OR ATTEMPT TO HIDE MARITAL ASSETS?YESNO
If yes, why: ______
25.DO YOU EXPECT CUSTODY TO BE CONTESTED?YESNO
If yes, why: ______
26.DO YOU EXPECT VISITATION TO BE A PROBLEM?YESNO
If yes, why: ______
27.IS THE OPPOSING PARTY VIOLENT TO YOU OR
YOUR CHILDREN?YESNO
If yes, explain: ______
HAVE PETITION(S) FOR DOMESTIC
VIOLENCE BEEN FILED?YESNO
If yes, how many? ______
HAVE PETITIONS FILED BEEN
DISMISSED BY A JUDGE?YESNO
If yes, how many? ______
28.ARE YOU CURRENTLY COVERED
BY HEALTH INSURANCE?YESNO
Through whom? [My Employment] [Opposing Party’sEmployment]
Does this insurance cover the entire family? YESNO
29.DO YOU WANT YOUR FORMER NAME
RESTORED TO YOU?YESNO
If yes, clearly print your full name [include middle name]:
______
HAVE YOU EVER FILED BANKRUPTCY?YES NO
HAVE YOU EVER BEEN CONVICTED OF A CRIME?YESNO
TYPE(S) OF CRIME(S) [Circle applicable]: FELONYMISEMEANOR
Please explain: ______
______
HAS THE OPPOSING PARTY EVER BEEN
CONVICTED OF A CRIME?YESNO
TYPE(S) OF CRIME(S): [Circle applicable]: FELONYMISDEMEANOR
Please explain: ______
______
30.LIABILITIES:
MEDICAL BILLS: ______
CREDIT CARDS: ______
MORTGAGES: ______
OTHER DEBTS: ______
Additional Information: ______
______
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