EmailMe Form - Customized Information Questionnaire

Your First Name

Your MI

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 MI

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:

Wife

Husband

Are you and your Spouse in a same-sex marriage?

Yes

No

Are you the Divorce Petitioner?

Yes

No

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?

Yes

No

Have you resided in the State provided for the Residential Address for at least 6 or more months?

Yes

No

Has your spouse resided in State provided in the Spouse Residential Address for at least 6 or more months?

Yes

No

Has your Spouse resided at the place listed in the Spouse Residential Address at least 3 or more months?

Yes

No

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

Male

Female

Child 1 will reside with

Wife

Husband

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)