DOMESTIC RELATIONS INFORMATION FORM Date: ____________________________ Husband Petitioner Cause No.: _______________________ Wife Respondent PARTIES: HUSBAND/FATHER WIFE/MOTHER Name: Age: Name Age: Address: Address: Date of Marriage: Date of Separation: DEPENDENT CHILDREN: Name Age This Marriage Prior Marriage Percent Residential Time Father % Since Mother % CHILD SUPPORT: 1. NET INCOME Husband/Father: $ Wife/Mother: SUPPORT $ 2. Tax Exemptions allocated as follows: ___________________________________________________________ 3. Exceptional support considerations: ____________________________________________________________ _________________________________________________________________________________________ 4. Child Support presently being paid $______________ per month; since ________________________________ American LegalNet, Inc. www.USCourtForms.com 5. Summary of proposed residential arrangements for the children: ______________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ YOU MUST ATTACH: 1. Proposed Child Support Order, Support Worksheets and current pay stubs. Form WPF DR 01-050. 2. Completed Financial Declaration. Form WPF DR 01-055 3. Proposed Parenting Plan, if disputed. MAINTENANCE: 1. Requested: 2. Presently being paid: $_________________ per month, for __________________________________ months. $_________________ per month, duration: ____________________________________ HUSBAND/FATHER INCOME: Employer/Other Source Length Gross Income Net Income Total Income WIFE/MOTHER INCOME: Employer/Other Source Length Gross Income Net Income Total Income FACTORS RELATING TO AWARD OF MAINTENANCE: ______________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ IF ATTORNEY FEES ARE AT ISSUE: 1. Incurred to Date $ Paid To Date $ 2. Ordered to Date $ Paid to Date $ 3. Requested to Date $ Estimate to Trial $ American LegalNet, Inc. www.USCourtForms.com PROPERTY DIVISION: ASSETS: Fair Market Value Debt Owed Net to Husband Net to Wife Real Estate: Home $ $ $ $ Other Real Property $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Household Goods $ $ $ $ Tools/Equipment $ $ $ $ Recreational/Hobby Equipment $ $ $ $ Husband $ $ $ $ Wife $ $ $ $ Investments $ $ $ $ Life Insurance Cash Value $ $ $ $ Husband $ $ $ $ Wife $ $ $ $ Husband $ $ $ $ Wife $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Vehicles (Year/Make): Business/Profession: Retirement: IAs T Ps 4 1 ’ ec R ’ S ’ 0 -Ks t : , , , . Receivables Other Assets: Debts: TOTALS Equalization: ($ ) ($ ) ($ ) ($ ) $ $ $ $ $ -$ divided by two (2) =$ Proposed Percentage Division: ________ % to Husband _________ % to Wife Effects of Proposed Division: $_________ to Husband $__________ to Wife American LegalNet, Inc. www.USCourtForms.com