A Divorce Financial Worksheet

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: _____________________________

Date of expiration: __________________________

Policy limits: ________________

Boats:

Make: _________ Year: __________ VIN: ________________________

Where is boat docked: __________________

Name of Lender:________________

Loan Number: ______________________

Address of Lender: ______________________

______________________________________

Telephone number of lender ( )__________________

Boat Insurance:

Name of company: _____________________

Address of carrier: ______________________

______________________________________

Telephone number of carrier ( )__________________

Policy Number: _____________________________

Date of expiration: __________________________

Policy limits: ________________

Stocks - Bonds- Cash (Liquid assets):

Stocks:

1. Name of stock or fund: ____________________ Value: $_______________

Original Investment: $________________

Date Acquired: _____________

Source of Funds investment (Marital-- Pre-marital Inheritance) $________

How is investment Titled: ___________________

Name of Brokerage Company: ______________ Agent Name: ______________

Account Number: ______________________

Telephone number of Broker ( )__________________

Address of Broker: ______________________

______________________________________

Telephone number of Broker ( )__________________

2. Name of stock or fund: ____________________ Value: $_______________

Original Investment: $________________

Source of Funds for investment (Marital-- Pre-marital Inheritance) $________

Date Acquired: _____________

How is investment Titled: ___________________

Name of Brokerage Company: ______________ Agent Name: ______________

Account Number: ______________________

Telephone number of Broker ( )__________________

Address of Broker: ______________________

______________________________________

3. Name of stock or fund: ____________________ Value: $_______________

Original Investment: $________________

Source of Funds for investment (Marital-- Pre-marital Inheritance) $________

Date Acquired: _____________

How is investment Titled: ___________________

Name of Brokerage Company: ______________ Agent Name: ______________

Account Number: ______________________

Telephone number of Broker ( )__________________

Address of Broker: ______________________

______________________________________

4. Name of stock or fund: ____________________ Value: $_______________

Original Investment: $________________

Source of Funds for investment (Marital-- Pre-marital Inheritance) $________

Date Acquired: _____________

How is investment Titled: ___________________

Name of Brokerage Company: ______________ Agent Name: ______________

Account Number: ______________________

Telephone number of Broker ( )__________________

Address of Broker: ______________________

______________________________________

5. Bank Name: ____________________________

Account Number: ______________________ Checking or Savings ___________

Opening Balance: $________________ Current Balance: $______________

Closing Balance _______________ Date of Closing: _________________

Telephone number of Broker ( )__________________

Address of Bank: ______________________

_____________________________________

Telephone number of Bank ( )__________________

6. Bank Name: ____________________________

Account Number: ______________________ Checking or Savings ___________

Opening Balance: $________________ Current Balance: $______________

Closing Balance _______________ Date of Closing: _________________

Address of Bank: ______________________

_____________________________________

Telephone number of Bank ( )__________________

7. Bank Name: ____________________________

Account Number: ______________________ Checking or Savings ___________

Opening Balance: $________________ Current Balance: $______________

Closing Balance _______________ Date of Closing: _________________

Telephone number of Broker ( )__________________

Address of Bank: ______________________

_____________________________________

Telephone number of Bank ( )__________________

8. Safety Deposit Box:

Bank Name: ____________________________

Address of Bank: ______________________

_____________________________________

Telephone number of Bank ( )__________________

Contents: _____________________________

_____________________________

Who is in Possession of key: ______________________________

Who can sign for entry to box: ____________________________

Safety Deposit Box:

Bank Name: ____________________________

Address of Bank: ______________________

_____________________________________

Telephone number of Bank ( )__________________

Contents: _____________________________

_____________________________

Who is in Possession of key: ______________________________

Who can sign for entry to box: ____________________________

Personal Property:

PREMARITAL PROPERTY:

DESCRIPTION HOW ACQUIRED VALUE

10.

11.

12.

PREMARITAL PROPERTY:

DESCRIPTION HOW ACQUIRED VALUE

10.

11.

12.

13.

14.

15.

DISPUTED PROPERTY AS TO MARITAL OR NON-MARITAL:

DESCRIPTION HOW ACQUIRED VALUE

10.

Income:List all sources of your income including salary, alimony, child support, interest from

accounts, etc.,

Source: Amount (gross): Amount (net):

Income:List all sources of your spouses income including salary, alimony, child support, interest

from accounts, etc

DEBTS:

List all Liabilities:

Credit cards:

Card Issuer Account No Amount Owed Periodic Payments Sole-Joint

10.

Bank or other Loans:

Lender Name Loan No Amount Owed Periodic Payments Sole-Joint

Utilities:

Gas

Electric

Water

Miscellaneous charges including child care, medical insurance.etc.

IRS debt: Include year(s) and amount owed:

Information provided by:
Belli, Weil & Grozbean, P.C. located at
http://www.bwg-law.com