FAMILY QUESTIONNAIRE
1. INFORMATION ABOUT CLIENT:
Name
Address
Telephone (no dashes)
Email Address
Occupation
Average Monthly Gross Income (before taxes and payroll deductions are taken out; income includes bonuses and commissions)
2. INFORMATION ABOUT SPOUSE
Name
Address
Telephone (no dashes)
Email Address
Occupation
Average Monthly Gross Income (before taxes and payroll deductions are taken out; income includes bonuses and commissions), if known.
Do they already have counsel?
Please List Counsel’s Information
3. INFORMATION ON MARRIAGE/RELATIONSHIP
Are you currently married?
If so, when were you married?
In what state and county were you married?
If married, are you currently living apart from your spouse?
If so, what date did you begin living separate and apart from your spouse (date of separation)?
4. DO YOU HAVE CHILDREN FROM THIS RELATIONSHIP? If yes:
Name
Date of Birth
Where are they residing?
Are they in daycare?
If so, how much is the tuition per week?
Who pays the tuition?
If living apart, briefly describe who has custody of the child(ren) and the visitation schedule:
5. ASSETS (include fair market value)
Real Property
In the spaces below, please add the following information for each Real Property.
i. Address, Name on Title, and How title is held (this will usually be one of the following: husband and wife, joint tenants, joint tenants with rights of survivorship, life estate)
ii. Address, Name on Title, and How title is held (this will usually be one of the following: husband and wife, joint tenants, joint tenants with rights of survivorship, life estate)
iii. Address, Name on Title, and How title is held (this will usually be one of the following: husband and wife, joint tenants, joint tenants with rights of survivorship, life estate)
Vehicles, Motorcycles, Water Vessel
In the spaces below, please add the following information for each Vehicle, Motorcycle and Water Vessel.
i. Year, Make, Model
ii. Year, Make, Model
iii. Year, Make, Model
Stocks
In the spaces below, please add the following information for Stocks.
i. Stocks
ii. Stocks
iii. Stocks
Bank Accounts
In the spaces below, please add the following information for Bank Accounts; for each account.
i. Name of Bank Account, Amount in account, if known
ii. Name of Bank Account, Amount in account, if known
iii. Name of Bank Account, Amount in account, if known
Life Insurance Policy
In the spaces below, please add the following information for Life Insurance Policy.
i. Life Insurance Policy
ii. Life Insurance Policy
iii. Life Insurance Policy
Retirement Accounts (IRA, 401K, Other Retirement or Pension Accounts)
In the spaces below, please add the following information for Retirement Accounts.
i. Retirement Accounts
ii. Retirement Accounts
iii. Retirement Accounts
Businesses
In the spaces below, please add the following information for Businesses.
i. Businesses
ii. Businesses
iii. Businesses
6. DEBTS (include amount of debt)
Mortgages (include property address the mortgage is associated with)
Line of Equity
Credit Cards
Personal Loans
7. INSURANCE
Do you currently have medical / dental / vision insurance?