A NATIONALLY RECOGNIZED LAW FIRM
A
Divorce Financial Worksheet
(provided by Belli, Weil & Grozbean,
P.C.)
Stuart H. Grozbean
This information sheet will serve as a valuable asset whether assisting us in
the preparation of your case or for your personal record keeping.
There are many instances when you go through the information sheet that you will
need to skip over certain sections because it does not apply to you or that you
need to get additional information. In order for this packet to be of benefit to
you it is crucial that you be as accurate as possible. There maybe some
information, i.e., values that you don't know.
Name:__________________________________
Address:________________________________
________________________________
Telephone Number: (Home)______________________
Telephone Number: (Work)______________________
Telephone Number: (Cellular)______________________
Telephone Number: (Pager)______________________
Date of Birth:_______________ Place of Birth:___________________________________
Social Security Number:____________________
Date of Marriage: _________________
Place of Marriage: ________________
Type of Ceremony (Religious or Civil): ___________________
Name of Spouse:_____________ (Maiden Name) _________________
Spouse Date Of Birth: __________Place of Birth: ___________________________________
Spouse's Social Security Number:_______________________
If this is not your first marriage:
Name of former spouse: ____________________________
Date of marriage: ________________
Date of divorce: ____________ Court granting divorce:________________ Case No._________
Grounds of divorce: ______________Are you receiving ____ or paying alimony_____?
Amount $ ______________
If this is not your first marriage:
Name of former spouse: _______________________
Date of marriage: ________________
Date of divorce: ____________ Court granting divorce:________________ Case No._________
Grounds of divorce: ________________ Are you receiving ____ or paying alimony_____?
Amount $ ______________
If this is not your spouses first marriage:
Name of their former spouse: ____________________________
Date of marriage: ________________
Date of divorce: ____________ Court granting divorce:________________ Case No._________
Grounds of divorce: ______________Are they paying alimony_____?
Amount $ ______________
If this is not your first marriage:
Name of their former spouse: ________________________
Date of marriage: ________________
Date of divorce: ____________ Court granting divorce:________________ Case No._________
Grounds of divorce: ________________ Are they paying alimony_____?
Amount $ ______________
Children:
1. Name of Child:_______________________ Date of Birth:________________
2. Name of Child:_______________________ Date of Birth:________________
3. Name of Child:_______________________ Date of Birth:________________
4. Name of Child:_______________________ Date of Birth:________________
5. Name of Child:_______________________ Date of Birth:________________
6. Name of Child:_______________________ Date of Birth:________________
If you have a child that is not by this marriage then list below:
1 Name of Child:____________________ Date of Birth:________________
Child living with: __________ If paying or receiving support $__________
2 Name of Child:____________________ Date of Birth:________________
Child living with: __________ If paying or receiving support $__________
3. Name of Child:____________________ Date of Birth:________________
Child living with: __________ If paying or receiving support $__________
Your educational background including name of institution date of degree if any:
1. __________________________
2. __________________________
3. __________________________
Your spouses educational background including name of institution date of degree if any:
1. __________________________
2. __________________________
3. __________________________
Your employment history:
Name of Employer: ___________________________
1. Employer Address: ____________________________
____________________________
Years at current employment: ____years - Position______________ Salary: $_________
If less than 3 years:
1. Name of Employer: ___________________________
Employer Address: ____________________________
____________________________
Years at above employment: ____years - Position______________ Salary: $_________
2. Name of Employer: ___________________________
Employer Address: ____________________________
____________________________
Years at above employment: ____years - Position______________ Salary: $_________
Pensions:
Your Pension:
1. Type of Retirement: _________Year Started: _____Amount:$_________
How is investment Titled: ___________________
Name of fund and/ or Company: ________________________________
Account Number: ______________________
Telephone number of Broker or Bank ( )__________________
Address of Broker or Bank: ______________________
______________________________________
Telephone number of Broker or Bank carrier ( )__________________
Vested : (Yes)________ No ___________
If not vested: Date of vesting:______________
2. Type of Retirement: _________Year Started: _____Amount:$_________
How is investment Titled: ___________________
Name of fund and/ or Company: ________________________________
Account Number: ______________________
Telephone number of Broker or Bank ( )__________________
Address of Broker or Bank: ______________________
______________________________________
Telephone number of Broker or Bank carrier ( )__________________
Vested : (Yes)________ No ___________
If not vested: Date of vesting:______________
3. Type of Retirement: _________Year Started: _____Amount:$_________
How is investment Titled: ___________________
Name of fund and/ or Company: ________________________________
Account Number: ______________________
Telephone number of Broker or Bank ( )__________________
Address of Broker or Bank: ______________________
______________________________________
Telephone number of Broker or Bank carrier ( )__________________
Vested : (Yes)________ No ___________
If not vested: Date of vesting:______________
Spouses employment history:
Name of Employer: ___________________________
3. Employer Address: ____________________________
____________________________
Years at current employment: ____years - Position______________ Salary: $_________
If less than 3 years:
1. Name of Employer: ___________________________
Employer Address: ____________________________
____________________________
Years at above employment: ____years - Position______________ Salary: $_________
4. Name of Employer: ___________________________
Employer Address: ____________________________
____________________________
Years at above employment: ____years - Position______________ Salary: $_________
Spouses pension:
1. Type of Retirement: _________Year Started: _____Amount:$_________
How is investment Titled: ___________________
Name of fund and/ or Company: ________________________________
Account Number: ______________________
Telephone number of Broker or Bank ( )__________________
Address of Broker or Bank: ______________________
______________________________________
Telephone number of Broker or Bank carrier ( )__________________
Vested : (Yes)________ No ___________
If not vested: Date of vesting:______________
2. Type of Retirement: _________Year Started: _____Amount:$_________
How is investment Titled: ___________________
Name of fund and/ or Company: ________________________________
Account Number: ______________________
Telephone number of Broker or Bank ( )__________________
Address of Broker or Bank: ______________________
______________________________________
Telephone number of Broker or Bank carrier ( )__________________
Vested : (Yes)________ No ___________
If not vested: Date of vesting:______________
3. Type of Retirement: _________Year Started: _____Amount:$_________
How is investment Titled: ___________________
Name of fund and/ or Company: ________________________________
Account Number: ______________________
Telephone number of Broker or Bank ( )__________________
Address of Broker or Bank: ______________________
______________________________________
Telephone number of Broker or Bank carrier ( )__________________
Vested : (Yes)________ No ___________
If not vested: Date of vesting:______________
Real Estate:
1. Address of Property: ______________________
______________________________________
How is Property Titled: ___________________
Source of Funds for down payment (Marital- Pre-marital Inheritance) _________
Mortgage: Name of Lender:________________
Loan Number: ______________________
Amount of Loan: $_________________ Balance of Loan: $_______________
Address of Lender: ______________________
______________________________________
Mortgage: Name of Lender Second or Home Equity:________________
Loan Number: ______________________
Amount of Loan: $_________________ Balance of Loan: $_______________
Address of Lender: ______________________
______________________________________
Telephone number of lender ( )__________________
2. Address of Property: ______________________
______________________________________
How is Property Titled: ___________________
Source of Funds for down payment (Marital- Pre-marital Inheritance) _________
Mortgage: Name of Lender:________________
Loan Number: ______________________
Address of Lender: ______________________
______________________________________
Telephone number of lender ( )__________________
Amount of Loan: $_________________ Balance of Loan: $_______________
Mortgage: Name of Lender Second or Home Equity:________________
Loan Number: ______________________
Amount of Loan: $_________________ Balance of Loan: $_______________
Address of Lender: ______________________
______________________________________
Telephone number of lender ( )__________________
3. Address of Property: ______________________
______________________________________
Source of Funds for down payment (Marital- Pre-marital Inheritance) _________
How is Property Titled: ___________________
Mortgage: Name of Lender:________________
Loan Number: ______________________
Telephone number of lender ( )__________________
Amount of Loan: $_________________ Balance of Loan: $_______________
Address of Lender: ______________________
______________________________________
Mortgage: Name of Lender Second or Home Equity:________________
Loan Number: ______________________
Amount of Loan: $_________________ Balance of Loan: $_______________
Address of Lender: ______________________
______________________________________
Telephone number of lender ( )__________________
4. Address of Property: ______________________
______________________________________
Telephone number of lender ( )__________________
Source of Funds for down payment (Marital- Pre-marital Inheritance) _________
How is Property Titled: ___________________
Mortgage: Name of Lender:________________
Loan Number: ______________________
Amount of Loan: $_________________ Balance of Loan: $_______________
Address of Lender: ______________________
______________________________________
Telephone number of lender ( )__________________
Mortgage: Name of Lender Second or Home Equity:________________
Loan Number: ______________________
Amount of Loan: $_________________ Balance of Loan: $_______________
Address of Lender: ______________________
______________________________________
Telephone number of lender ( )__________________
Homeowner Insurance:
Name of company: _____________________
Address of carrier: ______________________
______________________________________
Telephone number of carrier ( )__________________
Policy Number: _____________________________
Date of expiration: __________________________
Policy limits: ________________
Umbrella Insurance:
Name of company: _____________________
Address of carrier: ______________________
______________________________________
Telephone number of carrier ( )__________________
Policy Number: _____________________________
Date of expiration: __________________________
Policy limits: ________________
Automobiles:
1. Make: _________ Year: __________ VIN: ________________________
Amount Paid: $_____________ Balance of Loan: _____________
Source of Funds for down payment (Marital- Pre-marital Inheritance) $________
Who is driving the vehicle: ____________________
Name of Lender:________________
Loan Number: ______________________
Address of Lender: ______________________
______________________________________
Telephone number of lender ( )__________________
2. Make: _________ Year: __________ VIN: ________________________
Amount Paid: $_____________ Balance of Loan: _____________
Source of Funds for down payment (Marital- Pre-marital Inheritance) $________
Who is driving the vehicle: ____________________
Name of Lender:________________
Loan Number: ______________________
Address of Lender: ______________________
______________________________________
Telephone number of lender ( )__________________
3. Make: _________ Year: __________ VIN: ________________________
Amount Paid: $_____________ Balance of Loan: _____________
Source of Funds for down payment (Marital- Pre-marital Inheritance) $________
Who is driving the vehicle: ____________________
Name of Lender:________________
Loan Number: ______________________
Address of Lender: ______________________
______________________________________
Telephone number of lender ( )__________________
Automobile Insurance:
Name of company: _____________________
Address of carrier: ______________________
______________________________________
Telephone number of carrier ( )__________________
Policy Number: _____________________________