DOCUMENTS TO BE FILLED OUT AND RETURNED TO ATTORNEY ____ 1. ____ 2. ____ 3. ____ 4. ____ 5. General Information Sheet Property List Debt List Monthly Expenses Visitation Schedule ( Please review and make any changes you desire-for each change please state your reason for such change) DOCUMENTS TO BE PROVIDED TO ATTORNEY (Please provide copies - we would prefer you keep your originals) ____ 1. ____ 2. ____ 3. Past three years tax returns, including W-2 forms Current pay stubs from January to present Past six months bank statements for all checking and savings accounts (upon receiving it, provide current months bank statement) Verification of debts (i.e., credit card statements, invoices, monthly statements, etc.) Verification of assets (i.e., monthly or quarterly statement of any asset listed above in General Information Sheet) Vehicle titles Boat titles, Motorcycle titles NADA (blue book) value of automobiles (highlight car value - you may obtain this information from a bank, car dealership, etc.) Warranty Deed or Quit Claim Deedto all real estate, including residence and/or any and all land. Verification of medical insurance cost for children only Verification of monthly day care cost for children Costs of transportation for visitation Verification of other child support payments made either by you or your spouse for any children of a previous marriage or children prior to marriage Certificates of Deposit

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GENERAL INFORMATION SHEET (To be completed by client) Full Name: _____________________________ Birthdate: Address: Phone: (H): (W): (FAX): _____________________________ ___________________________________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ SS # ______________________________

(PAGER): _______________________________________________ (Cellular Phone): _________________________________________ Occupation: ___________________________________________________ Job Title: _____________________________________________________ Employer: _____________________________________________________ Address: ______________________________________________________ ______________________________________________________ Dates of Current Employment: ___________________________________________________

Job Benefits: ___________________________________________________ Education: __________________________________________________ Date of Prior Marriage:__________________________________________ Ante Nuptial Agreement: Yes___ No___ Date of Separation: ___________ Restore to Prior Name: Yes___ No___ ****************************************************************************** Spouse Full Name: _____________________________ SS #__________________________

Spouse Birthdate: Address: Phone: (H): (W):

_____________________________

___________________________________________________________________ _______________________________________________ _______________________________________________

(FAX): _______________________________________________ (PAGER):_____________________________________________ (Cellular Phone):________________________________________ Occupation: ___________________________________________________ Job Title: _____________________________________________________ Employer: _____________________________________________________ Address: ______________________________________________________ ______________________________________________________ Dates of Current Employment: ___________________________________________________

Job Benefits: ___________________________________________________ Education: __________________________________________________ Date of Spouse’s Prior Marriage: _______________________________________________ Restore to Prior Name: YES___ NO____ ****************************************************************************** Date of Marriage:_________________________________ Place of Marriage:_________________________________ ******************************************************************************

Children of this Marriage: Name: _________________________DOB: ____________S.S.#______________ Indian Tribe and Percentage:__________________________________________ Name: _________________________DOB: ____________S.S.#______________ Indian Tribe and Percentage:__________________________________________ Name: _________________________DOB: ____________S.S.#______________ Indian Tribe and Percentage:__________________________________________ Name: _________________________DOB: ____________S.S.#______________ Indian Tribe and Percentage:__________________________________________ Residence of Children for past 5 years:______________________________________________ _________________________________________________________________ Special Health or Handicap Problems of any Children or Family Members: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

Client’s Children of Prior Marriage: Name: _________________________DOB: ____________S.S.#______________ Name: _________________________DOB: ____________S.S.#______________ Name: _________________________DOB: ____________S.S.#______________ Name: _________________________DOB: ____________S.S.#______________ Child Support Paid: ___________ Child Support Received:__________ Amount of Child Support $________________________________________

Spouse’s Children of Prior Marriage: Name: _________________________DOB: ____________S.S.#______________ Name: _________________________DOB: ____________S.S.#______________ Name: _________________________DOB: ____________S.S.#______________ Name: _________________________DOB: ____________S.S.#______________ Child Support Paid: ___________ Child Support Received:__________ Amount of Child Support $________________________________________

CLIENT INCOME INFORMATION (Following information can be obtained from pay stub or employer) How are you paid? _____ Weekly _____ Twice a month 1. _____ Every 2 weeks _____ Monthly

GROSS Income from each pay period: Salary and wages, including commissions, bonuses, allowances and overtime payable.............................. Pensions and retirements...........................................

$__________ $_____ _____ $__________ $__________ $__________ $__________ $__________ $__________ $__________

Social Security........................................................... Disability/Unemployment insurance......................... Public Assistance (welfare, AFDC payments, etc..... Child Support from prior marriage............................ Rents.......................................................................... Any other source....................................................... Gross Income............ 2. Itemized Deductions: State and Federal Income Taxes................................ Number of exemption taken ___________________ Social Security (FICA)............................................... Medical Insurance....................................................... Other insurance (explain)______________________ Union or other dues..................................................... Retirement or pension funds........................................ Savings plan................................................................. Credit Union (Specify whether for savings or loan payment)___________________________________ Total Deductions.........

$__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________

SPOUSE INCOME INFORMATION (Following information can be obtained from pay stub or employer) How are you paid? _____ Weekly _____ Twice a month 1. _____ Every 2 weeks _____ Monthly

GROSS Income from each pay period: Salary and wages, including commissions, bonuses, allowances and overtime payable.............................. Pensions and retirements...........................................

$__________ $_____ _____ $__________ $__________ $__________ $__________ $__________ $__________ $__________

Social Security........................................................... Disability/Unemployment insurance......................... Public Assistance (welfare, AFDC payments, etc..... Child Support from prior marriage............................ Rents.......................................................................... Any other source....................................................... Gross Income............ 2. Itemized Deductions: State and Federal Income Taxes................................ Number of exemption taken ___________________ Social Security (FICA)............................................... Medical Insurance....................................................... Other insurance (explain)______________________ Union or other dues..................................................... Retirement or pension funds........................................ Savings plan................................................................. Credit Union (Specify whether for savings or loan payment)___________________________________ Total Deductions.........

$__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________

REAL ESTATE/PROPERTY Residence Address:__________________________________________________________________ Type of Property:___________________________________________________________ Date Acquired:_____________________________________________________________ Original Cost:$_____________________ Mortgage Balance:$_________________ Market Value:$_____________________ Do you have a current market analysis or appraisal of real property:___________________ (If so, please provide to attorney) Legal Description:__________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ (You will find the legal description on a Warranty Deed or Quit Claim Deed, or you can call the County Clerk’s Office in the County in which the property is located) ****************************************************************************** Rental Address:__________________________________________________________________ Type of Property:___________________________________________________________ Date Acquired:_____________________________________________________________ Original Cost:$_____________________ Mortgage Balance:$_________________ Market Value:$_____________________ Do you have a current market analysis or appraisal of real property:___________________ (If so, please provide to attorney) Legal Description:__________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ (You will find the legal description on a Warranty Deed or Quit Claim Deed, or you can call the County Clerk’s Office in the County in which the property is located.) ****************************************************************************** Other Address:__________________________________________________________________ Type of Property:___________________________________________________________ Date Acquired:_____________________________________________________________ Original Cost:$_____________________ Mortgage Balance:$_________________ Market Value:$_____________________ Do you have a current market analysis or appraisal of real property:___________________ (If so, please provide to attorney) Legal Description:__________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ (You will find the legal description on a Warranty Deed or Quit Claim Deed, or you can call the County Clerk’s Office in the County in which the property is located)

ASSETS Do you own any of the following: ____ Securities-stocks, bonds Specify:_________________________ _________________________ Bank Accounts: (Checking, Savings, Certificate of Deposit, etc.) Specify:________________________________ _______________________________________ Banker:________________________________ ____ Life Insurance Policies: Policy No. ____________ ____________ ____________ ____________ Face Amount $__________ $__________ $__________ $__________ Cash Value $___________ $___________ $___________ $___________ Value $_________

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Balance $__________

Name of Company Insured ___________________ ____________ ___________________ ____________ ___________________ ____________ ___________________ ____________ ____

Retirement or Profit Sharing Accounts: Name: ______________________________________________________ ______________________________________________________ Other Assets (Not listed above) ______________________________________________________

Value $__________ $__________ $__________

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Business Interests (Indicate name, share, type of business, present market value less indebtedness, name of creditor, balance due, equity value, name of other owners) ________________________________________________________________________ ________________________________________________________________________

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

PROPERTY LIST (Include vehicles, household goods and furnishings, boats, etc.) (Separate property is property owned prior to marriage or that was acquired from separate funds after marriage or acquired by gift, devise, or inheritance after marriage) Debt (If any) $________ Award To Whom Sep/Joint (S or J) ______ _ ______ _ ______ _ ______ _ ______ _ ______ _ ______ _ ______ _ ______ _ ______ _ ______ _ ______ _ ______

Description of Property _ __________________

Value $________

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VEHICLES Car (Client) _________________________________________________________ Payments: ____________________ Balance: ___________________________ VIN #____________________________________________________________ Insurance Co.____________________Coverage_________________________ Mortgagee: __________________________________________________

Car (Spouse) _________________________________________________________ Payments: ____________________ Balance: ___________________________ VIN #____________________________________________________________ Insurance Co.____________________Coverage_________________________ Mortgagee: __________________________________________________

Car (Child) _______________________________________________________

Payments: ____________________ Balance: ___________________________ VIN #____________________________________________________________ Insurance Co.____________________Coverage_________________________ Mortgagee: _______________________________________________________

Car (other) _______________________________________________________ Payments: ____________________ Balance: ___________________________ VIN #____________________________________________________________ Insurance Co.____________________Coverage_________________________ Mortgagee: _______________________________________________________

DEBT LIST (All current debts owed by you, your spouse, or jointly-including mortgages, credit cards, personal loans, etc.) Debt Payable $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ Current Balance $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ Monthly Payment $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______

Creditor’s Name and Purpose for Debt ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

MONTHLY EXPENSES (Include expenses for yourself and any children, and remember these expenses are monthly-please divide accordingly by number of months if expense is for more than one month) Housing: Rent or Mortgage Payment....................................................................................$___________ Are real property taxes and insurance included in payment?..............._______Yes _______ No If not, please list as expenses:................................................................................$___________ House maintenance and repairs..............................................................................$___________ Utilities Bills: Telephone...............................................................................................................$__________ _ Electric....................................................................................................................$__________ _ Gas..........................................................................................................................$__________ _ Water, trash, sewer.................................................................................................$___________ Cable.......................................................................................................................$__________ _ Internet....................................................................................................................$__________ _ Cellular Phone........................................................................................................$___________ Food and Household Supplies.............................................................................$___________ Clothing: Clothing, shoes, accessories for yourself...............................................................$___________ Clothing, shoes, accessories for children...............................................................$___________ Health Expenses: Doctor.....................................................................................................................$__________ _ Dentist ...................................................................................................................$___________ Eyeglasses..............................................................................................................$___________ Prescription/Medicines..........................................................................................$___________ Special Medical Expenses: Orthodontist ..............................................................................................$___________ Psychiatrist, counselor, etc.........................................................................$___________ Insurances: Health Insurance Is Health Insurance deducted from salary?__________________________ Automobile Insurance (monthly)...........................................................................$___________

Life Insurance........................................................................................................$___________ Personal Liability...................................................................................................$___________ Children’s Expenses: Day Care/Child Care..............................................................................................$___________ Babysitter (occasional)...........................................................................................$___________ School lunches........................................................................................................$___________ School Supplies....................................................................................................$____________ Tuition..................................................................................................................$___________ _ Activities:.............................................................................................................$____________ Dance lessons.......................................................................................................$____________ Music lessons.......................................................................................................$____________ Football/Cheerleading Band.....................................................................................................................$____________ Clubs....................................................................................................................$____________ Other:___________________________________________________________ Automobile/Transportation: Car Payment........................................................................................................$____________ Gas and Oil..........................................................................................................$____________ Repairs/Maintenance...........................................................................................$____________ License Tag (divide by 12 months).....................................................................$____________ Pikepass...............................................................................................................$____________ Miscellaneous Expenses: Entertainment and Eating Out..............................................................................$____________ Laundry and Cleaning..........................................................................................$____________ Barber/Beauty Shop ............................................................................................$____________ Cosmetics, shampoo, etc (not listed w/Food and Household Supplies................$____________ Newspapers/Magazines/Books ............................................................................$____________ Dues(social/fitness clubs).....................................................................................$____________ Donations(church, etc.).........................................................................................$____________ Gifts .....................................................................................................................$____________ Pet Care (food, Veterinarian, etc.)........................................................................$____________ Other Expenses Not Listed: _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________

_________________________________________ _________________________________________ _________________________________________ _________________________________________ Total Monthly Expenses:______________

Reasons for Divorce: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

Marriage Counseling Tried or Desired: _________________________________________________________________ _________________________________________________________________

Did Either Contribute to the Education of the Other: _________________________________________________________________ _________________________________________________________________