Domestic Relations Interview Information

ANDREW G. ICE

Attorneys at Law

4030 mt. carmel-tobasco road, #127

Cincinnati, Ohio 45255

Email: elephone (513) 651-4227

Cell Phone - 513-638-0252Fax (513) 843-7817

DOMESTIC RELATIONS INTERVIEW INFORMATION

AND DOCUMENTATION

PLEASE NOTE THAT OTHER THAN EMERGENCY SITUATIONS NO PAPERWORK SHALL BE FILED WITH THE COURT UNTIL THIS FORM IS FULLY COMPLETED AND THE REQUESTED DOCUMENTS ARE PROVIDED. IN ADDITION ALL ATTORNEY FEES AND FILING FEES WILL NEED TO BE PAID IN ADVANCE OF ANY FILING. FILING FEES ARE TO BE PAID BY CHECK OR MONEY ORDER MADE PAYABLE TO THE CLERK OF COURTS IN THE COUNTY THE CASE IS TO BE FILED.

CLIENT INFORMATION

Name______

Address______

______City, State and County

Telephone______Home

______Work

______Cell

______Email

SSN______

DOB:______

Age______

Birthplace______City and State

Race______

Religion______

High School______

Grade Comp.______

College______

Do you have any mental or physical conditions that impair your ability to work, if yes, please explain the nature and extent of your condition:

______

Employer______

Emp. Address______

______

Position______

Salary/Hourly______Indicate yearly amount or hourly rate - Current yr.

Salary History______Last Year

______2 years ago

______3 years ago

** For Salary please break down base pay vs. overtime. Also include a separate notation for any bonuses. For bonuses please indicate if they are guaranteed, reoccurring or a limited event. Please also indicate any non-monetary income from employment (i.e., car allowance, gas reimbursement, health benefits, airline miles, etc.). Lastly indicate if there is any reason that your income will change in the next 12 months.

______

Hours per wk.______

Paychecks12242652Other

Local Tax Rate______

Union Dues______

Child or Spousal Support Paid (other than current Wife or children) - If yes please indicate the Court from which the order originates and the monthly amount.

______

Day Care Costs for children of the marriage ______yearly cost.

Health Insurance Cost:

Monthly Cost for Individual: $______
Monthly Cost for Family or to insure minor children: $______

Other Income______Please indicate nature and amount

______(ex. social security, pension, child support, etc)

Mothers Name______Indicate Living or Deceased

Father's Name______Indicate Living or Deceased

Former Marriages______Indicate Name and Divorced or Deceased

______

Children other than current marriage or relationship. Indicate name, dob. and other parent and who the child resides with.

______

SPOUSE INFORMATION

Name______

Address______

______City, State and County

Telephone______Home

______Work

______Cell

______Email

SSN______

DOB:______

Age______

Birthplace______City and State

Race______

Religion______

High School______

Grade Comp.______

College______

Do you have any mental or physical conditions that impair your ability to work, if yes, please explain the nature and extent of your condition:

______

Employer______

Emp. Address______

______

Position______

Salary/Hourly______Indicate yearly amount or hourly rate

Hours per wk.______

Salary History______Last Year

______2 years ago

______3 years ago

______

Paychecks12242652Other

Local Tax Rate______

Union Dues______

Child or Spousal Support Paid (other than current Wife or children) - If yes please indicate the Court from which the order originates and the monthly amount.

______

Day Care Costs for children of the marriage ______yearly cost.

Health Insurance Cost:

Monthly Cost for Individual: $______
Monthly Cost for Family or to insure minor children: $______

Other Income______Please indicate nature and amount

______(ex. social security, pension, child support, etc)

Mothers Name______Indicate Living or Deceased

Father's Name______Indicate Living or Deceased

Former Marriages______Indicate Name and Divorced or Deceased

______

Children other than current marriage or relationship. Indicate name, dob. and other parent and who the child resides with.

______

INFORMATION ON CURRENT MARRIAGE AND CHILDREN

Date of Marriage______

Location of Marriage______

Date of Separation______

Reason for Divorce/Dissolution ______

Have you been a resident of the State of Ohio for 6 months _____ yes _____ no

What County have you been a resident of for the last 90 days ______

Children of Marriage

NameDOB(and City):Social SecurityAgeLiving With

______

Please state the address(es) where the children have lived for the last 5 years including dates the children lived at the home, address(es) of the home(s) and individuals that resided in the household.

______

Have either your or your spouse been convicted or charged with any crimes of domestic violence, crimes against the family or crimes against children. If yes please state date, Court, charge and case number.

______

Do you or your spouse have an alcohol or drug problem: If yes explain:

______

Have you or your spouse ever been convicted or a crime (DUI included). If yes please explain:

______

Do the child(ren) have any special needs/medical/physical/emotional, If yes, please explain

______

Are the children currently attending school, If yes, please indicate school, school district, which parent resides in district and dates enrolled. If private school please indicate costs and whether the children will continue if private school and through what grade.

______

Please state your preference for Custody

Wife______Husband______Shared Parenting______

Please state your preference for a parenting schedule

______

Please state your preference for Holiday and Vacation schedule if different from the attached standard court order.

______

PROPERTY AND DEBT DISCLOSURE

Real Estate______yes ______no

If yes number of parcels ______

Address of Real Estate______

______

Titled Owner______

Mortgage(s)______Include name, address, and amount owed for

______any debt secured by the real estate.

______

Who is a debtor on mort.______

______

Value of Home______

Date of Last app.______

Amount of Down payment______

Source of Down payment ______

Other information: Please indicate is the house is to be sold and terms, If either party is going to be retaining the resident please indicate which party and terms of retaining the home such as equity payment or refinancing terms.

______

**** The above information needs to be listed for each piece of real estate

HOUSEHOLD GOODS:

Are all household goods and furnishings already divided to the parties mutual satisfaction _____ Yes _____ No

If No please indicate what items need to be exchanged

______

If you believe that personal property is going to be an issue in your case please list all personal property obtained between the date of marriage and date of physical separation with the exception of items obtained by gift, inheritance or property acquired prior to the marriage. These last three items need be listed on a separate page. With regards to any gift or inheritance please list the date of the gift or inheritance, the item, and the person making the gift or inheritance. For property acquired prior to marriage state the item, and when you acquired it.

AUTOMOBILES, MOTORCYCLES OR OTHER TITLED ITEMS

For each of the above mentioned items please list make, mode and year, mileage, date obtained, purchase price, current Kelly Blue Book Trade in value (kbb.com) or nada (nada.com), liens (for each lien state the name of lien holder, amount of lien and monthly payment), vin number, and titled owner.

1.______

2.______

3.______

4.______

FUNDS ON DEPOSIT

List all bank accounts of both parties, including type of account, location, account number and current balance. Please also indicate if any funds were deposited prior to marriage or deposited by gift or inheritance.

RETIREMENT ACCOUNTS AND BROKERAGE ACCOUNTS, STOCK AND BONDS

Please list all retirement benefits, brokerage accounts and stock and bonds of the parties. Including name, type of account, address, and balance. For all retirement accounts and pension please provide a copy of the summary plan description.

LIFE INSURANCE

Please list all currently held life insurance of both parties. Include policy information, insured, beneficiary and cash surrender value. Please provide a copy of the deck page for all policies.

ALL OF OTHER ASSETS

Please list all other assets of held by you or your spouse not listed above that has a value of more than $500.00. For each item please describe the item and list its fair market value.

HEALTH INSURANCE INFORMATION

HUSBANDAvailableWIFE

 Yes Nothrough employment Yes No

 Yes NoOther group plan Yes No

INSURER'S NAME
ADDRESS
POLICY NUMBER
Monthly premium of Individual Plan (employee share)
Monthly premium of Family Plan (employee share)

(Indicate "0" if available at no cost to party)

COVERAGES

Summarize health care benefits, i.e., major medical only, deductible, co-payments, health maintenance organization, etc. Attach separate sheet where necessary.

 Yes No / Is coverage presently in effect? /  Yes No
 Self Above named spouse / Who is Covered? /  Self Above named
spouse
 Dependent children of the marriage /  Dependent children of marriage
 Yes No / Is a participant card available? /  Yes No
 Yes No / Is a prescription card available? /  Yes No
Employer's Ins. Coordinator's
Name and Telephone Number
The cost to purchase COBRA coverage will be

Affiant's Monthly Living Expenses:

List your ACTUAL expenses for your present household in the first column. Give estimated expenses if you don't have exact figures. If you expect changes soon, list your ANTICIPATED expenses in your household after the divorce case in the second column. Explain why you expect your expenses to change. Also, if you are living with your parents or someone is helping with your living expenses, please explain.

My Average Monthly Expenses / Actual Monthly Expenses in My Present Household / Anticipated Future Monthly Expenses in My Household
There are now ___ Adults and Children living in my present household. / I am assisted with my living expenses by: / The reason I expect my household living expenses to change soon is:
A. Housing / Actual / Anticipated
Rent or First Mortgage
Real Estate Taxes (if not included above)
Real Estate Insurance (if not included above)
Second Mortgage, if any
Utilities:
Electric (level billing or avg/month
Gas (if billed separately)
Fuel Oil/Propane
Water & Sewer
Telephone (basic monthly charge)
Water Softener
Trash Collection
Telephone (average long distance)
Cable Television
Home Cleaning, Maintenance, Repair
Lawn Service, Snow Removal
Other:
Housing Total / (A) / (A)
B. Other Necessary Living Expenses / Actual / Anticipated
FOOD, ETC.:
Grocery (include food, paper & cleaning products, toiletries, etc.)
Restaurant
TRANSPORTATION, ETC.
Car Loan or Lease
Gasoline
Car Maintenance & Repair
Parking, Public Transit
CLOTHING, ETC.:
Clothes
Dry Cleaning, Laundry
Personal Grooming
Other:
Other:
Other Necessities Total / (B) / (B)
C. Child Related Expenses / Actual / Anticipated
Child Care, Work or Educational Related
Clothing
School Lunches
Children's Allowances
Extra-Curricular Activities
Other:
Child Related Expenses Total
Actual / Anticipated
D. Education Expenses for: / You / Child(ren) / You / Child(ren
Tuition
Books
Fees
Tutor
Activities
College Loan Repayment
Other:
Education Total
E. Medical Expenses (out-of-pocket) for / You / Child(ren) / You / Child(ren)
Doctor
Dentist
Optical
Orthodontist
Prescriptions
Other:
Medical Total
F. Insurance / Actual / Anticipated
Life
Auto
Health
Disability
COBRA Insurance Coverage
Personal Property
Other:
Insurance Total
G. Enrichment (Your expenses. Put child(ren)'s expenses under C or D, above) / Actual / Anticipated
Entertainment
Lessons
Books, Newspapers, Magazines
Sports
Clubs
Hobbies
Donations
Gifts
Vacation
Other:
Enrichment Total
H. Miscellaneous Expenses / Actual / Anticipated
0.
Miscellaneous Expenses Total
Actual / Anticipated
Grand Total of Monthly Expenses
(Sum of A-H in each column)

DEBTS OF MARRIAGE

List ALL YOUR DEBTS, debts of your spouse, and joint debts. Do not leave any category blank. For each item, if none, put "NONE." If you don't know exact figures for any item, give your best estimate, and put "EST." You are under a continuing legal duty to file an updated version of this form if you learn of any additional information. If more space is needed, attach extra pages.

Type / Name of Creditor/
Purpose of Debt / Total Debt Due / Monthly Payment
A. Secured debts(Mortgages, car, etc.)
B.Unsecured debts,
Including credit cards
Please include account numbers

If any of the debt listed above was incurred prior to the marriage please state the name of the creditor and the date the debt was incurred.

______

Can you identify an asset that was obtained by incurring any of the debt listed above? Example: You have a debt to a credit card for a washer and dryer and one party has sole possession of the washer and dryer. If yes, please identify the debt, the nature of the asset obtained and the date incurred.

______

Do you have any student loan debt? If yes, when was the student loan debt obtained, and was any of the debt used to pay for anything other than your education.

______

Bankruptcy

Filed by: Wife, Husband, Both / Date of Filing:
Case Number: / Date of Discharge or Relief from Stay / Type of Case
(Ch. 7, 11, 12, 13) / Current Monthly Payments

DOCUMENTS TO BE PROVIDED

1. Drivers License

2. Current pay stub

3. 3 years taxes

4. 6 months bank statement

5. Health Insurance Card

6. Declarations Page for all insurance policies

7. Summary Plan Description for all retirement accounts

8. Current statements for all retirement accounts, brokerage accounts, stocks, bonds, etc.

9. Copy of all car titles

10. Copy of insurance cards (auto)

11. Deed to any property.

12. Copy of all Mortgage(s).

Divorce/Dissolution/Domestic Information Sheet

This document is intended as general information for any domestic case handled by my office:

1. Do not cancel any kind of insurance that is currently in place under any circumstance without checking with my office.

2. Do not attempt to change or modify your children's current health care provider, daycare or school without checking with this office.

3. Do not incur any debt of any significance (over $200.00) during a divorce or dissolution without speaking to my office.

4. If you are going to communicate with your spouse, ex-spouse, or any person involved in your case, and that relationship is not amicable, all communication should be by email or text.

5. Communicating with an individual referenced in number 4 above, you should follow the instructions outlined in the attached "Responding to Hostile Mail".

6. Assume that all communications you are having with an individual mentioned in 4 above are being recorded.

7. Do not involve your children in any aspect of your case without speaking to my office.

8. Any exchanges of parenting time with an individual mentioned in 4 above should be in a public place or police station.

9. Remember that the parent that allows the other parent the most flexibility in exercising parenting time has an advantage in a custody case. Bottom Line: Play fair and nice when it comes to the kids.

10. Remember there is no winner in a custody case. There is only the parent that is looking out for the best interest of the child(ren).

11. In many cases my office can respond quicker to text or email.

12. Pay attention to your case on the clerk of courts website in the county in which the case has been filed.

COURT OF COMMON PLEAS

DIVISION OF DOMESTIC RELATIONS

HAMILTON COUNTY, OHIO

Plaintiff
-vs-
Defendant / Case No.
Judge
Magistrate
MANDATORY DISCLOSURE ORDER

PURSUANT TO LOCAL RULE 1.26 IT IS HEREBY ORDERED AS FOLLOWS:

Within 45 days of service of the Complaint for Divorce, Legal Separation or Annulment on the defendant, each party shall disclose to the other all of the following information and documents that is in his or her custody, possession or control:

(1) Deeds to all real estate that the party owns or claims an interest;

(2) Titles to all vehicles that the party owns or claims an interest;

(3) The most recently issued statements on all bank accounts, annuities, stocks, and bonds on which the party's name appears or to which the party claims an interest;

(4) The most recently issued statements regarding pensions, profit sharing plans, retirement benefits, and IRAs, including the most recent summary plan description, on which the party's name appears or to which the party claims an interest;

(5) All life insurance policies owned by the party or for which the party or their child(ren) is/are a beneficiary in force now or within the last six months, including the most recent cash value statements;

(6) The last three years' income tax returns;

(7) Proof of current income from all sources;

(8) Health, dental, and vision insurance coverage available to the party along with ALL plan options and costs (i.e. single, family, etc.);

(9) All COBRA benefits to which either party may be entitled, including cost estimates;

(10) Childcare expenses incurred for the child(ren);

(11) The most recently issued statements for all liabilities including, but not limited to, mortgages, lines of credit, loans, and credit card accounts on which the party's name appears or for which a party is responsible;

(12) Completed Property Statement (Form No. DR4.l);

(13) Completed Affidavit of Income, Expenses & Financial Disclosure (Form No. DR 7.3).

The disclosures required herein shall be made by providing copies of documents in one of the following manners:

(1) Electronic e-mail to the other party's attorney;

(2) Facsimile to the other party's attorney;

(3) Mail to the other party's attorney; or

(4) Hand delivery to the other party's attorney.

If a party is unrepresented, this disclosure shall be as provided herein to the party.

FOR GOOD CAUSE SHOWN, A MOTION OR AN AGREED ENTRY MAY BE FILED TO MODIFY THE MANDATORY DISCLOSURE ORDER OR TO EXTEND THE TIME TO DISCLOSE THE FOREGOING INFORMATION AND DOCUMENTS.

FAILURE TO COMPLY WITH THE MANDATORY DISCLOSURE ORDER MAY RESULT IN SANCTIONS, INCLUDING, BUT NOT LIMITED TO, THE FOLLOWING:

(1) A FINDING OF CONTEMPT;

(2) AWARD OF ATTORNEY FEES;

(3) DISMISSAL OF CLAIMS; AND

(4) RESTRICTIONS UPON THE SUBMISSION OF EVIDENCE.

Judge/Magistrate