MATRIMONIAL QUESTIONNAIRE [ATTORNEYS OFFICE]

Date: _________________________ Hopatcong Office: Newton Office: Hamburg Office: Attorneys Initials: Source of Referral:

Legal Name: Address:

Mailing Address (if different):

Tel. Nos.: (Work) Email: Age: Social Security No. Name and Address of Employer:

(Home) Date of Birth: Religion: Drivers License No.

(Cell)

How long employed? Title or Occupation: Educational Background: Work Experience:

Gross Pay $

Net Pay $

INFORMATION ON SPOUSE Legal Name: Address:

Description: Height: Date of Birth: Religion: Name and Address of Employer:

Weight: Age:

Eye Color: Social Security No.

Hair:

How long employed?

Gross Pay $

Net Pay $

Title or Occupation:

Educational Background: Work Experience: INFORMATION ON PRESENT MARRIAGE Date of Marriage: Ceremony: Civil Maiden Name: Prior Divorces: Prior Proceedings (Support, Domestic Violence, etc.): Religious Place: Certificate Available

CHILDREN OF PRESENT MARRIAGE Name: Name: Name: Date of Birth: Date of Birth: Date of Birth: Age: Age: Age:

CHILDREN OF YOURS OR YOUR SPOUSE'S FROM A PRIOR MARRIAGE Name: Name: Name: Date of Birth: Date of Birth: Date of Birth: GROUNDS FOR DIVORCE Separation Date: Adultery: Irreconcilable Differences: Other: Mental Cruelty (describe): Habitual Drunkenness: Age: Age: Age:

Personal Injury or other claims against spouse (rape, intentional infliction of emotional distress, assault, etc.):

STATEMENT OF ASSETS Description If you contend asset should not be considered in equitable distribution, state reason (gift, premarital, inheritance, etc.) $ $ $ $ $ $ $ $ $ $ $ $ $ 4. Stocks and Bonds $ $ $ $ $ $ $ $ $ $ $ $ $ $ STATEMENT OF LIABILITIES Description 1. Mortgage in Real Estate $ $ $ 2. Other Long Term Debts $ Monthly Payment $ $ $ $ Total Owed Value

1.

Real Property

2.

Bank Accounts, Certificates of Deposit

3.

Vehicles

5.

Pension, Profit Sharing, Retirement Plan(s), IRS's, 401K's, etc.

6.

Businesses, Partnerships, Professional Practices

7.

Other

3.

Revolving Charges

$ $ $ $ $ $

$ $ $ $ $ $ $ $ $ $ $

4.

Other Short Term Debts

$ $

5.

Contingent Liabilities

$ $ $

FOR ATTORNEY'S USE O NLY Attorney's Notes:

Custody/Removal'-------------------------------------------------------------------Child Support Analysis:

Alimony Analysis:

Equitable Distribution:

Pre-Marital Assets: Inheritances: Debts'-------------------------------------------------------------------------------

Experts'----------------------------------------------------------------------------Unusual Circumstances:

Fee Quote: Payment Plan/Guarantor: Source of Referral: Change of Will'---------------------------------------------------------------------