NOTE: You MUST fill in the fields marked in red.
Information about you
(first) (middle) (last) 1. Full LEGAL Name: 2. Date of Birth : (mm/dd/yyyy) 3. Street Address : 4. City : (mm/dd/yyyy) 5. County : 6. Lived there since 7. State : GAAKALARAZCACOCTDCDEFLHIIAIDILINKSKYLAMAMDMEMIMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYPR (Puerto Rico)AE (Armed Forces) 8. Zip Code: 9. I am the : HusbandWife in this marriage 10. Daytime Phone #: (with area code) 11. Evening Phone #: (with area code) 12. Can we call you at work? 13. at home? 14. Employer : 15. Employer's City: 16. Annual Salary :
Information about your spouse
(first) (middle) (last) 17. Full LEGAL Name: 18. Date of Birth : (mm/dd/yyyy) 19. Street Address : 20. City : 21. County : 22. Lived there since (mm/dd/yyyy) 23. State : GAAKALARAZCACOCTDCDEFLHIIAIDILINKSKYLAMAMDMEMIMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYPR (Puerto Rico)AE - (Armed Forces) 24. Zip Code: If "Other", please specify in Field 60:
25. Employer : 26. Employer's City: 27. Annual Salary :
Information about your marriage
28. Your/your spouse's maiden last name: (fill in ONLY if a return to the Wife's maiden name is desired) 29. Date of marriage : (eg: July 4, 2001, not 07/04/2001) 30. Place of marriage : (city, county, state and country) 31. This is my : 1st2nd3rd4th5th6th7th8th9th10thmarriage 32. This is my spouse's : 1st2nd3rd4th5th6th7th8th9th10thmarriage 33. Date you separated : (eg: July 4, 2001, not 07/04/2001)
If you have no children, but you have property, and you or your spouse wish to claim alimony, click here.
If you have children, continue to the next section.
Information about your children
34a. Were there any minor (under 18) children born or adopted during this marriage? no12345678
34b. List the names and dates of birth (mm/dd/yyyy) of these minor children 1 , born 2 , born 3 , born 4 , born 5 , born 6 , born 34c. Who will maintain LEGAL custody? MotherFatherBoth Parents 34d. Who will maintain PHYSICAL custody? MotherFather
34e. Who lives in the marital residence? MotherFatherBoth Parents
Child support
Child Support is based on the following guidelines:
34f. Are there any special circumstances to consider when determining child support. noyes click here for an explanation of "special circumstances". 34g. The non-custodial parent has AGREED to pay % (see the table above if there are no special circumstances), which is per month, on a not at allweeklybi-monthlymonthlyquarterlyannuallyother basis. 34h. This payment shall notshall be paid via an Income Deduction Order
Visitation Schedule
34u. Is the non-custodial parent allowed extended visitation during school holidays? Yes No 34v. For how long? 123456Other weeks in the SpringSummerFallWinterOther
34w. Who is responsible for the children's health insurance? MotherFatherBoth parents
34x. Who is responsible for un-reimbursed medical and life insurance costs? MotherFatherBoth parents
If you have property, or you or your spouse wish to claim alimony, continue to the next section.
Property Information
36. Who will close the joint accounts? Wife Husband
If you have real estate, or you or your spouse must decide if you are going to divide these properties between you, or sell them all.
Continue on to the next section
37. Are you going to divide your properties, or sell them? Divide: Sell:
CLICK HERE TO SKIP THE "SELLING PROPERT(IES)" SECTION AND CONTINUE FILLING OUT THE FORM
FILL OUT IF YOU ARE SELLING ALL YOUR PROPERTIES
Property #1 (the marital residence) 39a. Address (Street, City, State and Zip)
39b. Who will live in the marital residence until it is sold? Wife Husband
39c. Above a certain amount, a repair to this property is considered a major repair. For this house, what is that threshold?
39d. Who will be responsible for paying for any major repairs to this property? Wife Husband
39e. By what date must this property be placed on the market for sale? (MM/DD/YY)
39f. What is the minimum price have you and your spouse will accept for this property?
39g. When this house is sold, what percentage of the net sales proceeds will go to each party? Wife: % Husband: % Note: These two percentages must add up to 100%
IF YOU HAVE NO MORE PROPERTIES TO SELL, CLICK HERE
Property #2 40a. Address (Street, City, State and Zip)
40b. Above a certain amount, a repair to this property is considered a major repair. For this house, what is that threshold?
40c. Who will be responsible for paying for any major repairs to this property? Wife Husband
40d. By what date must this property be placed on the market for sale? (MM/DD/YY)
40e. What is the minimum price have you and your spouse will accept for this property?
40f. When this house is sold, what percentage of the net sales proceeds will go to each party? Wife: % Husband: % Note: These two percentages must add up to 100%
Property #3 41a. Address (Street, City, State and Zip)
41b. Above a certain amount, a repair to this property is considered a major repair. For this house, what is that threshold?
41c. Who will be responsible for paying for any major repairs to this property? Wife Husband
41d. By what date must this property be placed on the market for sale? (MM/DD/YY)
41e. What is the minimum price have you and your spouse will accept for this property?
41f. When this house is sold, what percentage of the net sales proceeds will go to each party? Wife: % Husband: % Note: These two percentages must add up to 100%
Property #4 42a. Address (Street, City, State and Zip)
42b. Above a certain amount, a repair to this property is considered a major repair. For this house, what is that threshold?
42c. Who will be responsible for paying for any major repairs to this property? Wife Husband
42d. By what date must this property be placed on the market for sale? (MM/DD/YY)
42e. What is the minimum price have you and your spouse will accept for this property?
42f. When this house is sold, what percentage of the net sales proceeds will go to each party? Wife: % Husband: % Note: These two percentages must add up to 100%
Additional Information
55. Is any alimony to be paid? Yes No 56. To whom? WifeHusbandNo alimony 57. Amount: per WeekMonthQuarterYear
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58. Would you like to receive your forms by e-mail? Yes No 59. E-mail address :
60. How did you find this web site?
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