Divorce With Children Questionnaire This form is encrypted using 3rd party servers. All information is safe. Divorce With Children Questionnaire Name* First Last Email* Phone*GENERAL INFORMATION Who will be the filing party (husband or wife)?* Which county are the documents to be filed in?* Which spouse lives in this county?* How long has the husband or wife lived in this county?* Is the husband or wife in the military?* Yes No Which spouse is in the military?* WIFE’S INFORMATIONWife’s Full Name:* What is the wife’s former name?* Does wife wish to return to her former name?* Yes No Birthdate:* DD slash MM slash YYYY Address:Street Address* Address Line 2* City* State / Province / Region* Postal / Zip Code* CountryFirst ChoiceSecond ChoiceThird ChoiceTelephone Number*Email address* Occupation* Employer Name* Employer Address:* Employer Phone Number* Gross Monthly Income:* HUSBAND’S INFORMATIONHusband’s Full Name* Birth Date:* DD slash MM slash YYYY Address Street Address* Address Line 2* City* State / Province / Region* Postal / Zip Code* Telephone Number*Country*First ChoiceSecond ChoiceThird ChoiceEmail address* Occupation* Name* Employer Name* Employer Address* Employer Phone Number:* Gross Monthly Income* MARRIAGE INFORMATIONDate of Marriage* DD slash MM slash YYYY Date of Separation:* DD slash MM slash YYYY ASSET AND DEBT INFORMATION Community Property/Debt Please list all of your community property (provide the fair market value and how property will be divided):Residential property (give address and legal description):*Vehicles (year/make/model)*Pensions/401K (name of plan/company/acct number):*Bank Accounts (name of bank/type of account/ acct number:*Other Please list all of your community debt (list creditor name and amount owed)Separate Property/DebtSPOUSAL SUPPORTWould you like to add a spousal support arrangement? Yes No If yes, please answer the following: Who will be paying spousal support? How much will be paid per month? When will payments end (provide date)? How much will be paid per month? OTHER INFORMATION/NOTESCHILDREN’S INFORMATION1st Child Name 1st Child Birth date DD slash MM slash YYYY 1st Child City and State of Birth 1st Child Gender Girl Boy Where has the child lived for the past five years? Provide the dates, addresses, and who the child lived with. 2nd Child Name 2nd Child Birth date DD slash MM slash YYYY 2nd Child Gender Girl Boy Where has the child lived for the past five years? Provide the dates, addresses, and who the child lived with. 3rd Child Name 3rd Child Birth date DD slash MM slash YYYY 3rd Child City and State of Birth 3rd Child Gender Girl Boy Where has the child lived for the past five years? Provide the dates, addresses, and who the child lived with. 4th Child Name 4th Child Birth date DD slash MM slash YYYY 4th Child City and State of Birth 4th Child Gender Girl Boy Where has the child lived for the past five years? Provide the dates, addresses, and who the child lived with. CUSTODY AND VISITATIONWhat custody arrangements have you and your spouse agreed upon? Joint Custody Sole physical to wife Sole physical to father Can not agree What is the standard weekly schedule (provide the days and times the children will reside with each parent)? What is the holiday schedule (mother odd, father even, etc.)? Who will the children reside with for the winter, spring, summer vacations? Which parent will claim the child on their taxes? Mother Father CHILD SUPPORTUntitledIs the husband or wife receiving public assistance for the child/ren? Yes No If yes, which spouse is receiving assistance? Husband Wife Which parent agrees to pay child support? Husband Wife Can Not Agree How much will be paid per month? Which parent will pay health insurance premiums and medical expenses for the children? Husband Wife Can Not Agree