EQUITABLE DISTRIBUTION QUESTIONNAIRE

In the course of your property distribution or equitable distribution case, it is necessary that we obtain detailed infroamtion regarding the assets and liabilities which have accumulated during the course of the marriage. To assist our office in gathering this information, please fill out the below form with specific details regarding your finances. We understand that some of this information may be unknown or unavailable to you, however, it is important that do your best to complete this form as thoroughly as possible. In addition, please be sure to provide us with the documents listed in the "Checklist of Documents for Equitable Distribution."

We have provided instructions for each schedule of property as guidance, however, please let us know if you have any questions or need any assistance completing this form.

Name*

First NameLast Name

Email*

example@example.com

Date of Marriage*

Date

Are you legally separated* from your spouse?*

*To be considered legally separated from your spouse, you need to be living in different homes, and at least one of you needs to intend that the separation be permanent. In general, you are not legally separated if your relationship has ended but you still live in the same home, or if you live in separate homes without the intent to be permanently separated (for example, for work purposes).

If Yes, Date of Separation?

Date

In completing this schedule, it is important that you list each and every parcel of real estate that was acquired by you or your spopuse during the course of your marriage which was still owned by either of your on the date of your separation. Please provide copies of all deeds deeds of trust, and notes related to any real estate set out in this schedule, as well as copies of any tax appraisals and tax bills.

If you are uncertain of a dollar amount requested and you are providing an estimate as to the value or the balance of any mortgage or lien, please indicate that your figure is an estimate. If you have a copy of any appraisal, regardless of how long ago the appraisal was performed, please send this to us. If you have any statements detailing the amount of the mortgage payments, such as a payment book, or a tax statement showing the amount of interest paid, or the amount of income received, please provide these documents as well.

In the event it is necessary to subpoena or request further documentation, please state the mortgage holder's name and address and a phone number for any contact person that you have dealt with at the institution in the past. This will facilitate obtaining subpoenaed informatino, and provide for a more accurate record of the value of the property and any outstanding indebtedness related to the property.

If you or your spouse have made any improvements to the real estate, such as an addition, renovations, etc., please descrive the improvement, when the improvement was made, and to what extent you and your spouse made individual efforts or contributed funds for the improvement.

1). Type of Real Property (Residence, Business, Rental): blanks
Address:   Street Address   Address Line 2   City   State   Zip
Date of Purchase:
Purchase Price:

First Mortgage Holder:
Monthly Payment:
Balance Owed as of Date of Separation:

Second Mortgage Holder:
Monthly Payment:
Balance Owed as of Date of Separation:

Equity Line Holder:
Monthly Payment:
Balance Owed as of Date of Separation:

Taxes Due (Indicate tax year(s)):
Amount of Tax Due:

Current Market Value:
Basis of Value (i.e. appraisal, realtor, recent refinance, etc.):
Tax Value:

Any Improvements:
Type of Improvement(s):
Cost of Improvement(s):
Date of Improvement:
Individual contributions to purchase price or improvements by either party?

2). Type of Real Property (Residence, Business, Rental): blanks
Address:   Street Address   Address Line 2   City   State   Zip
Date of Purchase:
Purchase Price:

First Mortgage Holder:
Monthly Payment:
Balance Owed as of Date of Separation:

Second Mortgage Holder:
Monthly Payment:
Balance Owed as of Date of Separation:

Equity Line Holder:
Monthly Payment:
Balance Owed as of Date of Separation:

Taxes Due (Indicate tax year(s)):
Amount of Tax Due:

Current Market Value:
Basis of Value (i.e. appraisal, realtor, recent refinance, etc.):
Tax Value:

Any Improvements:
Type of Improvement(s):
Cost of Improvement(s):
Date of Improvement:
Individual contributions to purchase price or improvements by either party?

3). Type of Real Property (Residence, Business, Rental): blanks
Address:   Street Address   Address Line 2   City   State   Zip
Date of Purchase:
Purchase Price:

First Mortgage Holder:
Monthly Payment:
Balance Owed as of Date of Separation:

Second Mortgage Holder:
Monthly Payment:
Balance Owed as of Date of Separation:

Equity Line Holder:
Monthly Payment:
Balance Owed as of Date of Separation:

Taxes Due (Indicate tax year(s)):
Amount of Tax Due:

Current Market Value:
Basis of Value (i.e. appraisal, realtor, recent refinance, etc.):
Tax Value:

Any Improvements:
Type of Improvement(s):
Cost of Improvement(s):
Date of Improvement:
Individual contributions to purchase price or improvements by either party?

It is necessary that we have detailed informaiton regarding any motor vehicles owned by you or your spouse on the date of your separation. The information requested will facilitate in the transfer of the vehicle from one spouse to the other, if necessary, and will provide sufficient information to determine the N.A.D.A. or K.B.B. value. Please provide any statemetns you may have setting our verification of your monthly statements and loan balance, as well as individual contributions you have made to the acquisition of a motor vehicle.

1). Year: blanks Make: blank Model:
Approximate Mileage and Condition:
VIN No.:
Serial No.
Type (2-door, 4-door, truck, SUV, station wagon, hatchback, etc.):
Name(s) on Title:
Primary Driver:
Date Purchased:
Purchase Price:
Current Market Value:
Lienholder:
Monthly Payments:
Balance Owed as of Date of Separation:

2). Year: blanks Make: blank Model:
Approximate Mileage and Condition:
VIN No.:
Serial No.
Type (2-door, 4-door, truck, SUV, station wagon, hatchback, etc.):
Name(s) on Title:
Primary Driver:
Date Purchased:
Purchase Price:
Current Market Value:
Lienholder:
Monthly Payments:
Balance Owed as of Date of Separation:

3). Year: blanks Make: blank Model:
Approximate Mileage and Condition:
VIN No.:
Serial No.
Type (2-door, 4-door, truck, SUV, station wagon, hatchback, etc.):
Name(s) on Title:
Primary Driver:
Date Purchased:
Purchase Price:
Current Market Value:
Lienholder:
Monthly Payments:
Balance Owed as of Date of Separation:

4). Year: blanks Make: blank Model:
Approximate Mileage and Condition:
VIN No.:
Serial No.
Type (2-door, 4-door, truck, SUV, station wagon, hatchback, etc.):
Name(s) on Title:
Primary Driver:
Date Purchased:
Purchase Price:
Current Market Value:
Lienholder:
Monthly Payments:
Balance Owed as of Date of Separation:

Please list the name of each financial institution which holds your account(s). Indicate the type of account (checking, savings, money market, c.d., etc.) and state the exact name on the account, whether it is in your name and your spouse's name jointly, your name only, your spouse's name only, or your name and a third party's name. Please also provide monthly statements from your date of separation to the present and continue to retain statements and provide our office with copies until your matter is resolved. Also, specify any separate contributions you or your spouse has made to that account after the date of separation.

1). Name of Bank: blanks
Name(s) on Account:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

2). Name of Bank: blanks
Name(s) on Account:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

3). Name of Bank: blanks
Name(s) on Account:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

4). Name of Bank: blanks
Name(s) on Account:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

5). Name of Bank: blanks
Name(s) on Account:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

6). Name of Bank: blanks
Name(s) on Account:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

Please state the name of each investment account and which financial institution holds your account(s). Indicate the type of account and state the exact name on the account, whether it is in your name and your spouse's name jointly, your name only, your spouse's name only, or your name and a third party's name. Please also provide monthly statements from your date of separation to the present and continue to retain statements and provide our office with copies until your matter is resolved. Also, specify any separate contributions you or your spouse has made to that account after the date of separation.

1). Name of Financial Institution: blanks
Name(s) on Account:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Marriage:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

2). Name of Financial Institution: blanks
Name(s) on Account:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Marriage:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

3). Name of Financial Institution: blanks
Name(s) on Account:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Marriage:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

4). Name of Financial Institution: blanks
Name(s) on Account:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Marriage:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

5). Name of Financial Institution: blanks
Name(s) on Account:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Marriage:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

6). Name of Financial Institution: blanks
Name(s) on Account:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Marriage:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

Please state the name of each retirement account or plan (i.e. 401(k), IRA, Pension Plan, Deferred Comp., etc.) and which financial institution holds your account(s). Indicate the type of account and state the exact name on the account, whether it is in your name and your spouse's name jointly, your name only, your spouse's name only, or your name and a third party's name. Please also provide monthly statements from your date of separation to the present and continue to retain statements and provide our office with copies until your matter is resolved. Also, specify any separate contributions you or your spouse has made to that account after the date of separation.

1). Name of Financial Institution: blanks
Name(s) on Account/Plan:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Marriage:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

2). Name of Financial Institution: blanks
Name(s) on Account/Plan:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Marriage:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

3). Name of Financial Institution: blanks
Name(s) on Account/Plan:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Marriage:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

4). Name of Financial Institution: blanks
Name(s) on Account/Plan:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Marriage:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

5). Name of Financial Institution: blanks
Name(s) on Account/Plan:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Marriage:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

6). Name of Financial Institution: blanks
Name(s) on Account/Plan:
Type of Account:
Last four (4) Digits of Account No.:
Balance as of the Date of Marriage:
Balance as of the Date of Separation:
Post Date of Separation Contributions:

Please complete the following information for any term or whole life insurance policy. If you have copies of the policy(ies) and/or statements as of the date of separation, please provide them. If you are aware of any outstanding loans secured by the policy, please provide this information as well.

1). Insurance Company: blanks
Type of Policy (Whole Life, Term, etc.):
Person Insured: blank
Policy No.:
Owner:
Face Value (Death Benefit):
Beneficiary:
Cash Value as of Date of Separation:
Post Date of Separation Contributions:

2). Insurance Company: blanks
Type of Policy (Whole Life, Term, etc.):
Person Insured: blank
Policy No.:
Owner:
Face Value (Death Benefit):
Beneficiary:
Cash Value as of Date of Separation:
Post Date of Separation Contributions:

3). Insurance Company: blanks
Type of Policy (Whole Life, Term, etc.):
Person Insured: blank
Policy No.:
Owner:
Face Value (Death Benefit):
Beneficiary:
Cash Value as of Date of Separation:
Post Date of Separation Contributions:

4). Insurance Company: blanks
Type of Policy (Whole Life, Term, etc.):
Person Insured: blank
Policy No.:
Owner:
Face Value (Death Benefit):
Beneficiary:
Cash Value as of Date of Separation:
Post Date of Separation Contributions:

Please state whether you or your spouse have any business interests and specify whether the business is a corporation, partnership or sole proprietorship, and the office or position which is held by you or your spouse. If you have minimal informaiton regarding any business interests of your spouse, please provide the basic information listed on this schedule so we are able to identify additional financial information necessary to properly value the business.

1). Name of Business: blanks
Address:   Street Address   Address Line 2   City   State   Zip
Type of Business (i.e. corporation, partnership, sole proprietorship):
No. of Shares:
Percentage of Ownership:
Position Held:
Current Market Value:

2). Name of Business: blanks
Address:   Street Address   Address Line 2   City   State   Zip
Type of Business (i.e. corporation, partnership, sole proprietorship):
No. of Shares:
Percentage of Ownership:
Position Held:
Current Market Value:

3). Name of Business: blanks
Address:   Street Address   Address Line 2   City   State   Zip
Type of Business (i.e. corporation, partnership, sole proprietorship):
No. of Shares:
Percentage of Ownership:
Position Held:
Current Market Value:

Please list all debts which you or your spouse incurred during the marriage and which existed on the date of separation. Please provide any statements evidencing this debt from your date of separation to the present.

1). Name of Creditor:
Name(s) of Debtor:
Secured or Unsecured Debt:
Balance Due as of Date of Separation:
Interest Rate:
Monthly Payment:
Reason for Debt:

2). Name of Creditor:
Name(s) of Debtor:
Secured or Unsecured Debt:
Balance Due as of Date of Separation:
Interest Rate:
Monthly Payment:
Reason for Debt:

3). Name of Creditor:
Name(s) of Debtor:
Secured or Unsecured Debt:
Balance Due as of Date of Separation:
Interest Rate:
Monthly Payment:
Reason for Debt:

4). Name of Creditor:
Name(s) of Debtor:
Secured or Unsecured Debt:
Balance Due as of Date of Separation:
Interest Rate:
Monthly Payment:
Reason for Debt:

5). Name of Creditor:
Name(s) of Debtor:
Secured or Unsecured Debt:
Balance Due as of Date of Separation:
Interest Rate:
Monthly Payment:
Reason for Debt:

6). Name of Creditor:
Name(s) of Debtor:
Secured or Unsecured Debt:
Balance Due as of Date of Separation:
Interest Rate:
Monthly Payment:
Reason for Debt:

Please keep in mind that the balances and/or values of your assets and debts, and our file of documents, will need to be updated prior to any mediation or trial dates. This process will be much easier if you keep these types of documents filed or stored in a convenient area, so that when we are preparing for mediation or future hearings, you can locate them easily.

Please upload copies of the following documents using the File Upload option below:

File Upload

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EQUITABLE DISTRIBUTION QUESTIONNAIRE

SCHEDULE A. REAL ESTATE

SCHEDULE B: MOTOR VEHICLES

SCHEDULE C: BANK ACCOUNTS

SCHEDULE D: INVESTMENTS (NON-RETIREMENT)

SCHEDULE E: RETIREMENT ACCOUNTS

SCHEDULE F: LIFE INSURANCE

SCHEDULE G: BUSINESS INTERESTS

SCHEDULE H: DEBTS

CHECKLIST OF DOCUMENTS TO PROVIDE