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A Divorce Financial Worksheet
(provided by Belli, Weil & Grozbean, P.C.)

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     

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

PREMARITAL PROPERTY:

                                        DESCRIPTION    HOW ACQUIRED        VALUE  
                    
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

                                                            
DISPUTED  PROPERTY AS TO MARITAL OR NON-MARITAL:

                                        DESCRIPTION    HOW ACQUIRED        VALUE  
                    
1.

2.

3.

4.

5.

6.

7.
                              
8.

9.

10.

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

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

1.

2.

3.

4.

Income:List all sources of your spouses income including salary, alimony, child support, interest
from accounts, etc
                  
1.

2.

3.

4.


DEBTS:

List all Liabilities:

Credit cards:

   Card Issuer         Account No             Amount Owed       Periodic Payments  Sole-Joint     

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.
            

Bank or other  Loans: 

Lender Name       Loan No                Amount Owed       Periodic Payments    Sole-Joint     
                                                            
     
1.

2.

3.

4.

Utilities:   

 Gas  

 Electric 


Water


Miscellaneous charges including child care, medical insurance.etc.

1.

2.

3.

4.

5.

6.

7.






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

1.
   
2.

3.





Information provided by:
Belli, Weil & Grozbean, P.C.

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