Request for Information

Request for Information
Case Information
Name of Court
Case No.
Petitioner
Respondent
Petitioner Information

Information About the Parties
Gender

MaleFemale
Petitioner's Name
Mailing Address
Email
example@example.com
Please provide at least one
Social Security Number
Date of Birth

MonthDayYear
Family Law Attorney
Has Family Law Attorney Withdrawn from Case

YesNo
Attorney Name
Attorney Email
example@example.com
Attorney Telephone

Respondent Information

Information About the Parties
Gender

MaleFemale
Participant Name
Mailing Addresss
Email
example@example.com
Telephone
Social Security Number
Date of Birth

MonthDayYear
Date
Family Law Attorney
Has Family Law Attorney Withdrawn from Case

YesNo
Attorney Name
Attorney Email
example@example.com
Attorney Telephone

Marital Information
Date of Marriage

MonthDayYear
Date of Separation

MonthDayYear
Date of Bifurcated Judgment/Termination of Marital Status (only)

MonthDayYear
Date of Final Judgment of Dissolution

MonthDayYear
Date of Final Judgment of Separation

MonthDayYear

Retirement Plan (1) Information:

For each retirement plan that is subject to division between the parties and within the scope of our services please provide the following:
Exact Name of the Retirement Plan
Name of Company/Union/Governmental Entity
Mailing Address
Phone Number
Date of Hire

MonthDayYear
Date
Date of Plan

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Is the Participant receiving benefit payments from the Plan?

YesNo
Provide the approximate amount payable
Provide the form of payment (i.e., survivor annuity, single life annuity)
If benefits are payable to a survivor or beneficiary following the participant’s death—provide the following:
Name of the survivor/beneficiary
Relationship to the participants
This retirement plan contains separate property from employment/contributions BEFORE marriage

YesNo
This retirement plan contains separate property from employment/contributions AFTER separation

YesNo
Provide other facts/information you would like us to know that may impact the division of this retirement plan
Do you have any additional plans

YesNo

Retirement Plan (2) Information:

For each retirement plan that is subject to division between the parties and within the scope of our services please provide the following:
Exact Name of the Retirement Plan
Name of Company/Union/Governmental Entity
Mailing Address
Telephone No.
Date of Hire

MonthDayYear
Date
Date of Plan

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Is the Participant receiving benefit payments from the Plan?

YesNo
Provide the approximate amount payable
Provide the form of payment (i.e., survivor annuity, single life annuity)
If benefits are payable to a survivor or beneficiary following the participant’s death—provide the following:
Name of the survivor/beneficiary
Relationship to the participants
This retirement plan contains separate property from employment/contributions BEFORE marriage

YesNo
This retirement plan contains separate property from employment/contributions AFTER separation

YesNo
Provide other facts/information you would like us to know that may impact the division of this retirement plan
Do you have any additional plans

YesNo

Retirement Plan (3) Information:

For each retirement plan that is subject to division between the parties and within the scope of our services please provide the following:
Exact Name of the Retirement Plan
Name of Company/Union/Governmental Entity
Mailing Address
Phone Number
Date of Hire

MonthDayYear
Date
Date of Plan

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Is the Participant receiving benefit payments from the Plan?

YesNo
Provide the approximate amount payable
Provide the form of payment (i.e., survivor annuity, single life annuity)
If benefits are payable to a survivor or beneficiary following the participant’s death—provide the following:
Name of the survivor/beneficiary
Relationship to the participants
This retirement plan contains separate property from employment/contributions BEFORE marriage

YesNo
This retirement plan contains separate property from employment/contributions AFTER separation

YesNo
Provide other facts/information you would like us to know that may impact the division of this retirement plan
Do you have any additional plans

YesNo

Retirement Plan (4) Information:

For each retirement plan that is subject to division between the parties and within the scope of our services please provide the following:
Exact Name of the Retirement Plan
Name of Company/Union/Governmental Entity
Mailing Address
Phone Number
Date of Hire

MonthDayYear
Date
Date of Plan

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Is the Participant receiving benefit payments from the Plan?

YesNo
Provide the approximate amount payable
Provide the form of payment (i.e., survivor annuity, single life annuity)
If benefits are payable to a survivor or beneficiary following the participant’s death—provide the following:
Name of the survivor/beneficiary
Relationship to the participants
This retirement plan contains separate property from employment/contributions BEFORE marriage

YesNo
This retirement plan contains separate property from employment/contributions AFTER separation

YesNo
Provide other facts/information you would like us to know that may impact the division of this retirement plan
Do you have any additional plans

YesNo

Retirement Plan (5) Information:

For each retirement plan that is subject to division between the parties and within the scope of our services please provide the following:
Exact Name of the Retirement Plan
Name of Company/Union/Governmental Entity
Mailing Address
Phone Number
Date of Hire

MonthDayYear
Date
Date of Plan

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Is the Participant receiving benefit payments from the Plan?

YesNo
Provide the approximate amount payable
Provide the form of payment (i.e., survivor annuity, single life annuity)
If benefits are payable to a survivor or beneficiary following the participant’s death—provide the following:
Name of the survivor/beneficiary
Relationship to the participants
This retirement plan contains separate property from employment/contributions BEFORE marriage

YesNo
This retirement plan contains separate property from employment/contributions AFTER separation

YesNo
Provide other facts/information you would like us to know that may impact the division of this retirement plan
Do you have any additional plans

YesNo

Retirement Plan (6) Information:

For each retirement plan that is subject to division between the parties and within the scope of our services please provide the following:
Exact Name of the Retirement Plan
Name of Company/Union/Governmental Entity
Mailing Address
Phone Number
Date of Hire

MonthDayYear
Date
Date of Plan

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Is the Participant receiving benefit payments from the Plan?

YesNo
Provide the approximate amount payable
Provide the form of payment (i.e., survivor annuity, single life annuity)
If benefits are payable to a survivor or beneficiary following the participant’s death—provide the following:
Name of the survivor/beneficiary
Relationship to the participants
This retirement plan contains separate property from employment/contributions BEFORE marriage

YesNo
This retirement plan contains separate property from employment/contributions AFTER separation

YesNo
Provide other facts/information you would like us to know that may impact the division of this retirement plan
Do you have any additional plans

YesNo

Retirement Plan (7) Information:

For each retirement plan that is subject to division between the parties and within the scope of our services please provide the following:
Exact Name of the Retirement Plan
Name of Company/Union/Governmental Entity
Mailing Address
Phone Number
Date of Hire

MonthDayYear
Date
Date of Plan

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Is the Participant receiving benefit payments from the Plan?

YesNo
Provide the approximate amount payable
Provide the form of payment (i.e., survivor annuity, single life annuity)
If benefits are payable to a survivor or beneficiary following the participant’s death—provide the following:
Name of the survivor/beneficiary
Relationship to the participants
This retirement plan contains separate property from employment/contributions BEFORE marriage

YesNo
This retirement plan contains separate property from employment/contributions AFTER separation

YesNo
Provide other facts/information you would like us to know that may impact the division of this retirement plan
Do you have any additional plans

YesNo

Retirement Plan (8) Information:

For each retirement plan that is subject to division between the parties and within the scope of our services please provide the following:
Exact Name of the Retirement Plan
Name of Company/Union/Governmental Entity
Mailing Address
Phone Number
Date of Hire

MonthDayYear
Date
Date of Plan

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Is the Participant receiving benefit payments from the Plan?

YesNo
Provide the approximate amount payable
Provide the form of payment (i.e., survivor annuity, single life annuity)
If benefits are payable to a survivor or beneficiary following the participant’s death—provide the following:
Name of the survivor/beneficiary
Relationship to the participants
This retirement plan contains separate property from employment/contributions BEFORE marriage

YesNo
This retirement plan contains separate property from employment/contributions AFTER separation

YesNo
Provide other facts/information you would like us to know that may impact the division of this retirement plan
Do you have any additional plans

YesNo

Retirement Plan (9) Information:

For each retirement plan that is subject to division between the parties and within the scope of our services please provide the following:
Exact Name of the Retirement Plan
Name of Company/Union/Governmental Entity
Mailing Address
Phone Number
Date of Hire

MonthDayYear
Date
Date of Plan

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Is the Participant receiving benefit payments from the Plan?

YesNo
Provide the approximate amount payable
Provide the form of payment (i.e., survivor annuity, single life annuity)
If benefits are payable to a survivor or beneficiary following the participant’s death—provide the following:
Name of the survivor/beneficiary
Relationship to the participants
This retirement plan contains separate property from employment/contributions BEFORE marriage

YesNo
This retirement plan contains separate property from employment/contributions AFTER separation

YesNo
Provide other facts/information you would like us to know that may impact the division of this retirement plan

Retirement Plan (10) Information:

For each retirement plan that is subject to division between the parties and within the scope of our services please provide the following:
Exact Name of the Retirement Plan
Name of Company/Union/Governmental Entity
Mailing Address
Phone Number
Date of Hire

MonthDayYear
Date
Date of Plan

MonthDayYear
Date
Date of Termination

MonthDayYear
Date
Is the Participant receiving benefit payments from the Plan?

YesNo
Provide the approximate amount payable
Provide the form of payment (i.e., survivor annuity, single life annuity)
If benefits are payable to a survivor or beneficiary following the participant’s death—provide the following:
Name of the survivor/beneficiary
Relationship to the participants
This retirement plan contains separate property from employment/contributions BEFORE marriage

YesNo
This retirement plan contains separate property from employment/contributions AFTER separation

YesNo
Provide other facts/information you would like us to know that may impact the division of this retirement plan
Do you have any additional plans

YesNo

Document Upload

Upload the following documents (secure upload)
Copy of Judgment and/or Marital Settlement Agreement

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Copy of Deal Memo

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Copy of Pleading from Case (Showing Case Information)

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Copy of Joinder Pleadings

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Copy of Death Certificate, if applicable

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Copy of Retirement Plan Statements

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Copy of Retirement Pay Stub

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Copy of Distribution Election Form

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Signed Authorization and Release Form

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Signed Retainer Agreement

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Signed Credit Card Authorization Form

Cancelof
Other

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Should be Empty:

Request for Information

Case Information

Petitioner Information

Family Law Attorney

Respondent Information

Family Law Attorney

Marital Information

Retirement Plan (1) Information:

Retirement Plan (2) Information:

Retirement Plan (3) Information:

Retirement Plan (4) Information:

Retirement Plan (5) Information:

Retirement Plan (6) Information:

Retirement Plan (7) Information:

Retirement Plan (8) Information:

Retirement Plan (9) Information:

Retirement Plan (10) Information:

Document Upload