Domestic Relations Information Form

DOMESTIC RELATIONS INFORMATION FORM: Form E (PCLR 16 and PCLSPR 94.04; 9/10) Date: ____________________________ Cause No.: _______________________ PARTIES: Husband Wife Petitioner Respondent PETITIONER Name: Address: Age: RESPONDENT Name Address: Age: Date of Marriage/Domestic Partnership/Cohabitation: Date of Separation: DEPENDENT CHILDREN: Name Age This Marriage Prior Marriage Percent Residential Time Petitioner % Respondent % Since CHILD SUPPORT:1. NET INCOME Petitioner: Respondent: SUPPORT $ $ 2. 3. 4. 5. Tax Exemptions allocated as follows: _____________________________________________________________________________ Exceptional support considerations: _______________________________________________________________________________ Child Support presently being paid $______________ per month; since ___________________________________________ Summary of proposed residential arrangements for the children: __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ ______________________________________________________________________________ Domestic Relations Information Form (Rev. 9/04; 9/09) American LegalNet, Inc. www.FormsWorkFlow.com Form E (PCLR 16 and PCLSPR 94.04) MAINTENANCE: 1. 2. ________________ per month, duration: ____________________________________ Presently being paid: $_________________ per month, for ___________________________ months. PETITIONER INCOME: Employer/Other Source Length Gross Income Net Income Total Income RESPONDENT INCOME: Employer/Other Source Length Gross Income Net Income Total Income FACTORS RELATING TO AWARD OF MAINTENANCE: __________________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ IF ATTORNEY FEES ARE AT ISSUE: 1. 2. 3. Incurred to Date Ordered to Date Requested to Date $ $ $ Paid To Date Paid to Date Estimate to Trial $ $ $ Domestic Relations Information Form (Rev. 9/10) Form E (PCLR 16 and PCLSPR 94.04) PROPERTY DIVISION: American LegalNet, Inc. www.FormsWorkFlow.com ASSETS: Real Estate: Home Other Real Property Fair Market Value Debt Owed Net to Petitioner Net to Respondent $ $ $ $ $ $ $ $ $ $ $ $ Vehicles (Year/Make): $ $ Household Goods Tools/Equipment Recreational/Hobby Equipment Business/Profession: Petitioner Respondent Investments Life Insurance Cash Value Retirement: Petitioner Respondent IRA's, TSP's, 401-K's, etc.: Petitioner Respondent Receivables Other Assets: $ $ $ Debts: TOTALS ($ $ ) $ $ $ ($ $ ) $ $ $ ($ $ ) $ $ $ ($ $ ) $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Equalization: Domestic Relations Information Form (Rev. 9/10) Form E (PCLR 16 and PCLSPR 94.04) $ -$ divided by two (2) =$ Proposed Percentage Division: ________ % to Petitioner _________ % to Respondent American LegalNet, Inc. www.FormsWorkFlow.com Effects of Proposed Division: $_________ to Petitioner $__________ to Respondent A copy of this form shall be served on opposing counsel/party and trial Judge not later than 2 working days prior to trial. The original shall be filed with the Clerk's Office. When this form is used for Settlement Conference purposes under PCLR 16, do not file the original with the Clerk's Office.) 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. Domestic Relations Information Form (Rev. 9/10) American LegalNet, Inc. www.FormsWorkFlow.com