Form 16(c)EZ (Rev. 01/11) The Family Court of the State of Delaware In and For New Castle Kent Sussex County EZ FINANCIAL REPORT/PRE-TRIAL ORDER Date Financial Report/Pre-Trial Order filed with the Court: Petitioner Name Street Address P.O. Box Number City/State/Zip Code Home Phone Attorney Name Work Phone D.O.B. v. Respondent Name Street Address P.O. Box Number City/State/Zip Code Home Phone Attorney Name Work Phone D.O.B. File Number Petition Number Date of Marriage Date of Separation Date of Divorce Check Relief requested by Parties: Petitioner (P) 1. Property Division 2. Permanent Alimony 3. Temporary Alimony 4. Child Support 5. Attorney's Fees and Costs 6. Custody 7. Visitation Respondent (R) I. FAMILY INFORMATION Names and dates of birth of minor children of the parties. Indicate with whom the child(ren) reside: Mother (M); Father (F), Shared (S), Other (O). Resides with Name D.O.B. M F S O M F S O M F S O M F S O M F S O M F S O Describe any financial obligations to other dependents, if any 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Form 16(c)EZ (Rev. 01/11) Petitioner (P) Respondent (R) II. PERSONAL INFORMATION EDUCATION Petitioner (P) Respondent (R) Describe employment history. (Include type of work, dates and length of employment, salary history and reason employment was terminated.) Petitioner (P) Respondent (R) III. EMPLOYMENT AND INCOME INFORMATION A. List annual gross income for last three (3) years, including both earned (employment) and unearned (interest, dividends, non-taxable reportable income, Federal and State tax refunds, other returns or investments, etc) ATTACH FEDERAL AND STATE RETURNS AND W-2 FORMS FOR PAST THREE (3) YEARS. Petitioner (P) Respondent (R) Year Amount Year Amount B. Indicate average monthly payroll deduction of each party during preceding twelve (12) months (if paid weekly, multiply by 52 and divide by 12; if paid on alternate weeks, multiply by 26 and divide by 12; if paid twice per month, multiply by 2). Petitioner (P) Respondent (R) 1. Federal 2. State 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Form 16(c)EZ (Rev. 01/11) 3. City 4. FICA 5. Other mandatory deductions such as union dues; required pension contributions; credit union payments. (list item and amount) 6. Other voluntary deductions such as life, health, and/or dental insurance; optional pension plan. (list item and amount) 7. Wage attachments 8. Monthly business expenses TOTAL DEDUCTIONS C. Identify all benefits provided by employer and state estimated value thereof (car, apartment, profit sharing, etc., but excluding health and/or insurance policies). Petitioner (P) Respondent (R) BENEFIT ESTIMATED VALUE BENEFIT ESTIMATED VALUE IV. EXPENSE INFORMATION A. Monthly expenses (1/12 of actual payments made during preceding twelve (12) months and present or projected costs based on recent experience). EXPENSE TYPE Rent Mortgage (tax, insurance, escrow) Car Payment/Transportation Expense Water Sewer Electric Gas and/or Oil Garbage Cable TV Telephone Cell Phone Groceries (including household & Personal items) Clothing Health Insurance Out-of-pocket medical expenses Medical expenses for Chid(ren) Child Support Child Care Costs Other mandatory deductions (list item and amount) Petitioner (P) Respondent(R) TOTAL EXPENSES V. DEBTS OF THE PARTIES Please complete the chart below with respect to each debt resulting from this marriage. If you have been making installment payments, identify which ones and how many you have made in the NOTES column. 3 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Form 16(c)EZ (Rev. 01/11) CREDITOR TITLE Joint (J) Petitioner (P) Respondent (R) J P R J P R J P R J P R J P R J P R J P R J P R J P R DATE INCURRED PAYMENT AMOUNT BALANCE DUE NOTES VI. ASSETS OF THE PARTIES REAL PROPERTY Address Address City/State/ Zip Code Date Acquired Title Held By Present Market Value Respondent (R) City/State/Zip Code Date Acquired Title Held By Present Market Value Petitioner (P) Respondent (R) Petitioner (P) Source of Down-payment Petitioner (P) Respondent (R) Source of Down-payment Petitioner (P) Respondent (R) CHECKING/SAVINGS ACCOUNTS BANK TITLE Joint (J) Petitioner (P) Respondent (R) J P R J P R J P R J P R J P R J P R J P R J P R J P R ACCOUNT NUMBER PRESENT BALANCE TITLED PROPERTY (DMV TITLE CERTIFICATE) TITLE MAKE, MODEL Joint (J) DATE & YEAR Petitioner (P) ACQUIRED Respondent (R) PRESENT VALUE 4 of 6 BALANCE DUE BASIS FOR NON MARITAL CLAIM (P) (R) American LegalNet, Inc. www.FormsWorkFlow.com Form 16(c)EZ (Rev. 01/11) J J J J J P P P P P R R R R R HOUSEHOLD FURNISHINGS AND PERSONAL PROPERTY ITEM PRESENT VALUE (P) (R) BASIS FOR NON MARITAL CLAIM (P) (R) HOUSEHOLD FURNISHINGS AND PERSONAL PROPERTY (CONT'D) OTHER Please list any asset not specified in any of the preceding categories and indicate present value, percentage claimed and, if applicable, the basis for the claim that the asset is non-marital property. TITLE Joint (J) Petitioner (P) ITEM PRESENT VALUE Respondent (R) J P R J P R J P R J P R J P R PENSION PLAN If you participate in a pension plan at your place of business or employment, please attach a copy of the plan and state the amount of your monthly contribution, the date that your pension matures, and the anticipated date of your retirement. Petitioner PLAN MONTHLY CONTRIBUTION DATE OF MATURATION RETIREMENT DATE Respondent PLAN MONTHLY CONTRIBUTION DATE OF MATURATION RETIREMENT DATE RETIREMENT PLAN If you have a retirement plan other than your pension plan at your place of employment and your Social Security 5 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Form 16(c)EZ (Rev. 01/11) benefits, please describe the plan (such as IRA, Plumbers Union, etc.) and state the present value and maturity date. BASIS FOR NONMATURITY MARITAL CLAIM PLAN DESCRIPTION PRESENT VALUE DATE (P) (R) (P) (R) BY SIGNING THIS DOCUMENT, BOTH PARTIES HEREBY CERTIFY, SUBJECT TO CIVIL AND CRIMINAL PENALTIES, THAT THEY HAVE ACCURATELY SET FORTH ALL THEIR INCOME, ASSETS AND DEBTS. Petitioner Date Respondent Date Petitioner Attorney Date Respondent Attorney Sworn to subscribed before me: Date Mediator/Notary Public So Ordered this Date: Commissioner/Judge Date 6 of 6 American LegalNet, Inc. www.FormsWorkFlow.com