DISSOLUTION OF MARRIAGE QUESTIONNAIRE

Date

1.

Email

2.

OPPOSING PARTY’S NAME

3.

4.

HOW LONG HAVE YOU LIVED IN FLORIDA?

5.

6.

COUNTY AND STATE WHERE YOU AND THE OPPOSING PARTY LAST LIVED TOGETHER 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?
YesNo

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?
YesNoUnkown

If known, attorney’s name

13.

CHILDREN BORN OR ADOPTED DURING THE MARRIAGE:

CHILDREN BORN OR ADOPTED FROM ANOTHER RELATIONSHIP:

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.

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.

YOUR OPPOSING PARTY’S PLACE OF EMPLOYMENT:

ADDRESS:

21.

YOUR OPPOSING PARTY’S YEARLY INCOME:

Weekly income, if yearly income unknown:

22.

ASSETS:

A. MARITAL HOME

B. Other Real Estate

C. TRANSPORTATION (Cars, Trucks, Motorcycles, Boats, etc.)

What vehicle do you drive?

What vehicle does the opposing party drive?

D. ADDITIONAL TRANSPORTATION

E. ADDITIONAL TRANSPORTATION

F. OTHER ITEMS OF SIGNIFICANT VALUE: (ART, TOOLS, COLLECTIONS, ETC.)

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:

24.

DO YOU FEAR THE OPPOSING PARTY WILL DISPOSE OR ATTEMPT TO HIDE MARITAL ASSETS?
YesNo

If yes, name:

25.

DO YOU EXPECT CUSTODY TO BE CONTESTED?
YesNo

If yes, name:

26.

DO YOU EXPECT VISITATION TO BE A PROBLEM?
YesNo

If yes, name:

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, explain:

IS THE OPPOSING PARTY VIOLENT TO YOU OR YOUR CHILDREN?
YesNo

If yes, explain:

28.

ARE YOU CURRENTLY COVERED BY HEALTH INSURANCE?
YesNo

Through whom? [My Employment] [Opposing Party’s Employment] 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?
YesNo

HAVE YOU EVER BEEN CONVICTED OF A CRIME?
YesNo

TYPE(S) OF CRIME(S)
FELONYMISEMEANOR

Please explain:

30. LIABILITIES

MEDICAL BILLS:

CREDIT CARDS:

MORTGAGES:

OTHER DEBTS:

Additional Information

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