Decree/order Information Form

YOU:
FULL LEGAL NAME:*
Email*
ADDRESS:*
Street Address APT # City State ZIP Code
TELEPHONE NUMBER:.
BIRTH DATE:
AGE:
RACE:
PLACE OF BIRTH (CITY & STATE):
DRIVER'S LICENSE NUMBER:
STATE:
EMPLOYER:
TELEPHONE NUMBER:
ADDRESS:
Street Address City State ZIP Code
THE OTHER PARTY:
FULL LEGAL NAME:*
ADDRESS:
Street Address APT # City State ZIP Code
TELEPHONE NUMBER:.
BIRTH DATE:
AGE:
RACE:
PLACE OF BIRTH (CITY & STATE):
DRIVER'S LICENSE NUMBER:
STATE:
EMPLOYER:
TELEPHONE NUMBER:
ADDRESS:
Street Address City State ZIP Code
VISITATION:
STANDARD:
[Ist, 3rd & 5th WEEKENDS, THURSDAYS DURING THE SCHOOL TERM, ALTERNATING HOLIDAYS, AND EXTENDED SUMMER VISITATION]
SPECIFIC VISITATION - PLEASE SPECIFY:
DO YOU OR THE OTHER PARTY HAVE CHILDREN FROM A PREVIOUS MARRIAGE? IF SO, HOW MANY AND ARE YOU OR THE OTHER PARTY OBLIGATED TO PAY SUPPORT?
CHILD SUPPORT:
Who Pays?
How Much?
Please see Child Support Info. Sheet attached for an explanation of the Employer's Wage Withholding Order.
Employer's Wage Withholding Order suspended?
- Yes
- No
HEALTH INSURANCE:
Who Provides?
(Uninsured Expenses are shared equally unless agreed otherwise)
INFORMATION ON CHILDREN:
FULL LEGAL NAME:
SEX:
- Male
- Female
BIRTH DATE:
DRIVER'S LICENSE NUMBER:
PLACE OF BIRTH:
CITY, STATE:
COUNTY:
WHERE DOES HE/SHE LIVE NOW? (ADDRESS):
DOES THIS CHILD HAVE A DISABILITY? IF SO, EXPLAIN:
FULL LEGAL NAME:
SEX:
- Male
- Female
BIRTH DATE:
DRIVER'S LICENSE NUMBER:
PLACE OF BIRTH:
CITY, STATE:
COUNTY:
WHERE DOES HE/SHE LIVE NOW? (ADDRESS):
DOES THIS CHILD HAVE A DISABILITY? IF SO, EXPLAIN:
PROPERTY BOUGHT DURING MARRIAGE

LAND:

(PLEASE SUPPLY LEGAL DESCRIPTION AND STREET ADDRESS BELOW AND TELL US WHO WILL BE AWARDED THE PROPERTY OR IF IT WILL BE PUT UP FOR SALE. YOU MUST SUPPLY US WITH A COPY OF YOUR DEED OF TRUST FOR EACH PROPERTY.)

INSURANCE:
(TYPE OF COVERAGE, AMOUNT, WHO OR WHAT IS COVERED)
CARS AND TRUCKS:
(YEAR, MODEL, MAKE, VIN AND WHO GETS CAR/TRUCK)
RETIREMENTJPENSION:
(DESCRIPTION, CURRENT BALANCE, IN WHOSE NAME AND IS RETIREMENT/PENSION TO BE SPLIT WITH SPOUSE)
BANK ACCOUNTS:
(BANK, TYPE OF ACCOUNT, ACCOUNT #, WHOSE NAME)
SEPARATE PROPERTY:

(ALL GIFTS, INHERITANCES AND ANYTHING YOU OWNED PRIOR TO THE MARRIAGE)
YOURS:
SPOUSES:
BILLS TO BE PAID:
NAME OF ACCOUNT: ACCT NO: WHO WILL BE RESPONSIBLE? YOU/SPOUSE