Customized Information Questionnaire
Your First Name
Your Last Name
Your Telephone Number
Your Date of Birth
Your Place of Birth (City, County, State)
Your Mailing Address
Your Residential Address
Spouse First Name
Spouse Last Name
Spouse Telephone Number
Spouse Date of Birth
Spouse Place of Birth (City, County, State)
Spouse Mailing Address
Spouse Residential Address
Divorce Petitioner is:
Are you and your Spouse in a same-sex marriage?
Are you the Divorce Petitioner?
Your Email Address (email address where F4DO is authorized to deliver final documents)
Date of Marriage
Place of Marriage (City, County, State)
Date parties ceased to live together as husband & wife (parties may have remained in same home but when did the parties ceased to live there together as husband and wife?)
Have you resided at the Residential Address for at least 3 or more months?
Have you resided in the State provided for the Residential Address for at least 6 or more months?
Has your spouse resided in State provided in the Spouse Residential Address for at least 6 or more months?
Has your Spouse resided at the place listed in the Spouse Residential Address at least 3 or more months?
Number of Minor Children (age 18 or under) born or adopted during time of the marriage (IF YOU HAVE MORE THAN 1 - PLEASE SUBMIT INFORMATION FOR EACH CHILD ON A SEPARATE PAGE)
Child 1 First Name
Child 1 MI
Child 1 Last Name
Child 1 Date of Birth
Child 1 Place of Birth (City, County, State)
Child 1 will reside with
Address of Real Estate Property to be retained by Spouse
Year, Make, Model, VIN Automobile to be retained by Spouse
ASSETS 1 - Address of Real Estate Property to be retained by You
ASSETS 2 - Year, Make, Model, VIN Automobile to be retained by You.
ASSETS 3 - Household furniture, furnishing, appliances in your possession.
ASSETS 4 - Jewelry, Antiques, Art, Coin Collections, etc. in your possession. (Describe)
ASSETS 5 - Boats, Trailers in your possession. (Describe)
ASSETS 6 - Checking, Savings, Credit Union, Other Accounts in your possession. (Account name, Account number, bank, branch)
ASSETS 7 - Cash in your possession (Amount)
ASSETS 8 - Life Insurance, Loans, Stocks, Bonds, Secured Notes, Mutual Funds, Retirement/Pensions, Profit Sharing, Annuities, IRAs, Deferred Compensation, Accounts Receivables, Unsecured Notes, Partnership Interests, Other Business Interests. (Describe)
ASSETS 9 - Other assets
TOTAL ASSETS (Add ASSETS 1 THRU 9 and provide the total dollar amount here)
DEBTS - Student Loan, Taxes, Child Support Arrearages, Unsecured Loans, Credit Cards, Other Debts. (Describe each & provide the amount for each)
TOTAL DEBTS (Add all Debts above and provide the total dollar amount here)