Divorce Questionaire

For use as attorney-client work product only.

Today's Date:
Your Full Name:
Your Current Residence Address:
County:	Gwinnett or:
Your Home Telephone Number:
Address of Marital Residence:	Same As Your Current Residence Address Same As Your Spouse's Current Residence Address Or As Follows:
County of Marital Residence:	Gwinnett or:
Your Social Security Number:
Your Date of Birth:
Full Name of Spouse:
Spouse's Current Residence Address:
County:	Gwinnett or:
Spouse's Home Telephone Number:
Spouse's Social Security Number:
Spouse's Date of Birth:
Date of Marriage:
Date of Separation (REQUIRED TO FILE DIVORCE):

Children's Names:	Social Security Number:	Dates of Birth:

Number of Years children have resided at current address:	Since birth; OR (Specify Years)
Previous addresses of children during past five years:

CUSTODY/VISITATION:
Permanent Custody of Children to	Wife OR Husband
Standard Visitation to Non-Custodial Parent	Yes No OR As Follows:
Joint Legal And Physical Custody With Primary Custodian as:	Wife OR Husband
Joint Legal And Physical Custody With Neither Party As Primary Custodian As Long As Both Parties Reside In The Metro Atlanta Area:
CHILD SUPPORT: (The applicable percentage of gross income to be considered is: 1 child = 17% - 23%, 2 children = 23% - 28%, 3 children = 25% -32%, 4 children = 29% - 35%, and 5 or more children = 31% - 37%.)

$PER CHILD

PER MONTH
(1/2 Paid On The 1ST AND 1/2 Paid On The 15TH Of Each Month)

Pay Through Child Support Division
Pay Directly To Custodial Parent
Pay Through Income Deduction Order

Children's Medical And Dental Insurance:

Husband OR Wife Will Be Responsible For Maintaining Medical And Dental Insurance For The Minor Children	Uninsured Medical Expenses Will Be Paid By Husband OR Wife ORBoth Parties Equally
Life Insurance of $	To Be Carried For The Children By: Each Party Husband Only Wife Only

!Start here

College Expenses Will Be Paid % Husband And % By Wife OR Omit

ALIMONY:

Alimony Payable To Husband OR Wife or No Alimony to be paid

Amount Per Month: $

Maiden Name of Wife:
Wife Wants Maiden OR Previous Name Restored:	Yes No
Previous Name To Be Restored:
EMPLOYMENT INFORMATION:
Your Employer:
Work Address:
Work Telephone Number:
Position:
MONTHLY GROSS INCOME FROM SALARY OR WAGES:	$
Bonuses, commissions, allowances, tips, and similar payments (based on past 12-month average or time of employment if less than 1 year)	$
Business income from sources such as self employment, partnerships, close corporations and/or independent contracts (gross receipts minus ordinary and necessary business expenses required to produce income):	$
Disability/ unemployment/ workers' compensation:	$
Pension, retirement or annuity payments:	$
Social Security benefits:	$
Other public benefits (specify):	$
Spousal or child support from prior marriage:	$
Interest and dividends:	$
Rental income (gross receipts minus ordinary and necessary expenses required to produce income)	$
Income from Royalties, trusts or estates:	$
Gains derived from dealing in property (not including non-recuring gains):	$
Other income of a recurring nature (specify source):	$
TOTAL GROSS MONTHLY INCOME:	$
Spouse's Employer:
Work Address:
Work Telephone Number:
Position:
MONTHLY GROSS INCOME FROM SALARY OR WAGES:	$
Bonuses, commissions, allowances, tips, and similar payments (based on past 12-month average or time of employment if less than 1 year)	$
Business income from sources such as self employment, partnerships, close corporations and/or independent contracts (gross receipts minus ordinary and necessary business expenses required to produce income):	$
Disability/ unemployment/ workers' compensation:	$
Pension, retirement or annuity payments:	$
Social Security benefits:	$
Other public benefits (specify):	$
Spousal or child support from prior marriage:	$
Interest and dividends:	$
Rental income (gross receipts minus ordinary and necessary expenses required to produce income)	$
Income from Royalties, trusts or estates:	$
Gains derived from dealing in property (not including non-recuring gains):	$
Other income of a recurring nature (specify source):	$
TOTAL GROSS MONTHLY INCOME:	$
AUTOMOBILES:

Year	Make	Model	Titled In The Name Of	Sole Ownership To
				Husband
				Husband
				Wife
				Wife

PERSONAL TANGIBLE PROPERTY:
Amicably Divided	Husband OR Wife is entitled To All Items Remaining In The House As Of The Execution Of The Settlement Agreement
OTHER: (Provide list of items to go to each spouse)

Husband	Wife




















INTANGIBLE MARITAL ASSETS (MONEY, ACCOUNTS, STOCKS, BONDS, MUTUAL FUNDS, EQUITY IN LIFE INSURANCE POLICY, RETIREMENT ACCOUNTS, 401(k), ANNUITIES)

Description of Asset	Owned By:	Value	In Divorce To Be Awarded To:
1.	Husband Wife Joint	$	Husband Wife
2.	Husband Wife Joint	$	Husband Wife
3.	Husband Wife Joint	$	Husband Wife
4.	Husband Wife Joint	$	Husband Wife
5.	Husband Wife Joint	$	Husband Wife
6.	Husband Wife Joint	$	Husband Wife
7.	Husband Wife Joint	$	Husband Wife
8.	Husband Wife Joint	$	Husband Wife
9.	Husband Wife Joint	$	Husband Wife
10.	Husband Wife Joint	$	Husband Wife
11.	Husband Wife Joint	$	Husband Wife
12.	Husband Wife Joint	$	Husband Wife
13.	Husband Wife Joint	$	Husband Wife
14.	Husband Wife Joint	$	Husband Wife
15.	Husband Wife Joint	$	Husband Wife

LIST ALL "SEPERATE" "NONMARITAL" PERSONAL PROPERTY (PROPERTY OWNED BY ONE SPOUSE PRIOR TO MARRIAGE, OR INHERITED, OR ACQUIRED AS A GIFT SOLELY TO ONE SPOUSE DURING MARRIAGE):

Description of Property	Currently Titled in the Name of:	Estimated Value
	Husband Wife	$
	Husband Wife	$
	Husband Wife	$

DEBTS	Equitably Divided
Husband Shall Be Responsible For:	Wife Shall Be Responsible For:

Name of Creditor/ Credit Card/ Account Holder	Balance	Who is Legally Responsible to Creditor Now?
1.	$	Husband WifeJoint
2.	$	Husband WifeJoint
3.	$	Husband WifeJoint
4.	$	Husband WifeJoint
5.	$	Husband WifeJoint
6.	$	Husband WifeJoint
7.	$	Husband WifeJoint
8.	$	Husband WifeJoint
9.	$	Husband WifeJoint
10.	$	Husband WifeJoint
11.	$	Husband WifeJoint
12.	$	Husband WifeJoint
13.	$	Husband WifeJoint
14.	$	Husband WifeJoint
15.	$	Husband WifeJoint
16.	$	Husband WifeJoint
17.	$	Husband WifeJoint
18.	$	Husband WifeJoint
19.	$	Husband WifeJoint
20.	$	Husband WifeJoint

MARITAL RESIDENCE:

No Real Estate Owned By The Parties
Husband OR Wife To Assume All Rental Payments And Utilities And Retain Possession Of Leased Property

Marital Residence ToHusband OR Wife
If Party Retaining Marital Residence Defaults On Mortgage For 3 Months, Other Party Can Pay Default And Take Over Residence

Party Retaining Marital Residence HasMonths To Refinance Marital Residence To Remove The Other Party's Name, Or Residence Will Be Placed On The Market For Sale
All Proceeds Go To Party Who Retained Marital Residence Prior To Sale;
Or
$ From Proceeds Paid To Other Party

Marital Residence To Be Placed On The Market For Sale By The Day
of , 200; Proceeds Divided Equally

OTHER REAL ESTATE (SECOND HOME, LAND OR REAL PROPERTY OWNED BY ONE SPOUSE PRIOR TO MARRIAGE, OR INHERITED):

Property Address	Currently Titled in the Name of:	After Divorce will be Titled in the Name of:
	Husband Wife	Husband Wife
	Husband Wife	Husband Wife
	Husband Wife	Husband Wife

ADDITIONAL INFORMATION NEEDED FOR GEORGIA REPORT OF DIVORCE:
HUSBAND'S RACE:
White/ Caucasian Latino/ Hispanic Asian/ Pacific Islander	African-American/ Black Native American/ Indian Other:
Number of this Marriage for Husband: (1st, 2nd, 3rd)
WIFE'S RACE:
White/ Caucasian Latino/ Hispanic Asian/ Pacific Islander	African-American/ Black Native American/ Indian Other:
Number of this Marriage for Wife: (1st, 2nd, 3rd)
County and State Where Marriage License Issued: