UNIFORM FAMILY LAW INTERROGATORIES

BACKGROUND AND PERSONAL HISTORY

1. NAME AND CONTACT INFORMATION

State your full name, current residence, telephone number, social security number, and date of birth; any names by which you have been known in the past; and, for any other person residing in your household, the full name, current residence, telephone number, social security number, date of birth, and any names by which that person has been known in the past.

2. EDUCATION AND TRAINING

Please provide the extent of your education, course of study, degrees obtained, and when obtained.

3. EMPLOYMENT

a. State the name and address of each employer you have had during the last 3 years, and list your job title at each such employment. If you have been self-employed at any time during those 3 years, so state and give months and years.

b. State the gross monthly income from each employer or source of income named in paragraph a.

c. State the monthly net take home income (or pay) from your current employment.

d. Have you engaged in any part-time employment in addition to your regular occupation within the past 3 years? (Y/N) ___. If yes, state whether you are still engaged in this part-time employment and state your monthly income from this employment.

e. Have you received overtime pay, commissions or bonuses within the last 3 years? (Y/N) ___. If yes, state below the monthly gross amount you have earned from overtime pay and the dollar amount of each commission and/or bonus received.

f. Attach your 6 most recent payroll stubs and your contract of employment.

4. DEFERRED COMPENSATION AND RETIREMENT BENEFITS

Are you or have you ever been a participant in a retirement plan (such as a pension, deferred compensation, profit-sharing, stock, investment, thrift savings, 401(k), OR military retirement plan), hereinafter referred to as “plan,” or are you receiving or have you ever received disability pay? (Y/N) ___. If yes:

a. Describe the nature of each plan.

b. Indicate whether each plan is qualified with the IRS.

c. State the name of the plan and the name and address of the trustee and the plan administrator.

d. State the date you began the employment that permitted you to participate in the plan and the number of years and months in which you have participated and are entitled to credit.

e. State the value of your interest as of the last valuation date and state that date.

f. Attach a copy of your current plan and your most recent plan statement.

g. State whether there is a survivor benefit available on the plan. If yes, state who is named the survivor of the plan.

5. HEALTH INSURANCE

Do you have health insurance available through your present employer? (Y/N) ___. Are you and any of your dependents currently enrolled? (Y/N) ___. If yes, indicate what conversion benefits are available to your spouse at the time of the dissolution of marriage, and indicate the persons presently covered and the cost for dependent coverage, if any.

a. Attach a copy of your current health plan.

b. Provide documentation from your employer that sets forth the following:

1. Cost to insure yourself only, if there is a cost;

2. Cost to insure your spouse; and

3. Cost to insure your child(ren).

4. Is the insurance (geographically) accessible to the children?

6. OTHER INCOME

Do you have any sources of income other than as described in Interrogatory No. 3? (Y/N) ___. If yes, state each source of income and the amount received from each source in this year and in each of the last 3 calendar years. Attach a copy of each document showing each additional source of income.

7. LIFE INSURANCE

Do you presently own or have an interest in any life insurance or annuity policy? (Y/N) ___. If yes, for each policy, state:

a. The name and address of the insurance company.

b. The type of policy, i.e., term, straight life, universal, whole life, tax deferred annuity or other.

c. Whether that insurance is connected with your employment.

d. The amount and date of any loan(s) taken on the policy.

e. The present cash surrender value of the policy, if any.

f. Cost to you, if any, on an annual basis.

g. The name of each beneficiary.

h. Attach a copy of each insurance policy.

i. Attach a copy of any beneficiary designation change made by you within the last 12 months.

8. EMPLOYMENT BENEFITS

In the past calendar year have you received, or do you expect to receive, any employment related benefits, such as a vehicle or vehicle allowance, stock options, pension or profit-sharing payments, vacation pay or expense account payments or reimbursements? (Y/N) ___. If yes, specify the benefits you received or expect to receive.

9. LEGAL DECISION-MAKING AND PARENTING TIME

a. Do you believe that you and your spouse can reach an agreement concerning legal decision-making and parenting time without the intervention of the court or conciliation services? (Y/N) ___.

b. How do you want to share parenting time between parents?

1. How do you want to divide the week?

2. How do you want to divide holidays?

3. How do you want to divide summer or other school recesses?

c. How do you propose making the following decisions regarding your child(ren)?

1. Physical/ medical matters.

2. Psychological/ psychiatric matters.

3. Legal matters.

4. Religious matters.

5. Educational matters.

6. Activities and/or sports.

d. Is there a child of the marital relationship with special needs, disabilities, psychological, psychiatric or other developmental handicaps? (Y/N) ___. If yes, state:

1. What are the child’s special needs?

2. What are the extraordinary expenses associated with caring for this child?

3. Is this child over the age of 18?

e. What, if any, concerns do you have about the other parent’s parenting skills?

f. For each answer you provided above, list each and every fact supporting your position.

10. DEPARTMENT OF CHILD SAFETY

Have you or has any person residing in your household ever been investigated by any agency in any state for any reason related to abuse or neglect of children? (Y/N) ___. If yes, state:

a. State and agency investigating;

b. Date of investigation;

c. Reason for investigation; and

d. Outcome/findings.

11. PERSONAL LIMITATIONS

Do you have any mental or physical limitations that would affect your ability to care for your minor child(ren)? (Y/N) ___. If yes, identify the limitations in detail.

12. DRIVING HISTORY

a. Has any jurisdiction ever revoked or suspended your driver’s license or placed you on probation? If yes, state:

1. Jurisdiction;

2. Approximate date(s); and

3. The reason for the revocation, suspension, or probation.

b. Have you had any moving violations in the last 3 years? (Y/N) ___. If yes, state:

1. Jurisdiction;

2. Approximate date(s); and

3. Nature of the moving violations.

13. EMPLOYMENT HISTORY

Have you ever been the subject of disciplinary complaints at any place of employment? If yes, provide explanation and details.

14. CRIMINAL HISTORY

Have you or has any person residing in your household ever been investigated or arrested for any criminal behavior? (Y/N) ___. If yes, state:

a. The individual.

b. Name and location of investigating and/or arresting agency.

c. Approximate date.

d. The alleged criminal behavior.

e. Disposition.

15. DOMESTIC VIOLENCE

a. Have you, your spouse, or any person residing in your household been investigated, arrested or a party to any litigation, in any court of this state or any other state in the United States, which relates to domestic violence? (Y/N) ___. If yes, state:

i. The individual.

ii. Name and location of investigating and/or arresting agency.

iii. Name and location of the court where the action was filed.

iv. Nature of the complaint.

v. Disposition.

vi. Expiration date of any resultant order.

b. Have you, your spouse, or any person residing in your household been subject to an order of any court of this state or any other state in the United States which limits or prohibits conduct or actions because of violence or physical abuse? (Y/N) ___. If yes, provide details regarding the order, including specific dates, names of the person subject to such order, other person(s) involved and any conditions, limitations or prohibitions contained in the order.

c. Have there ever been allegations of child abuse, neglect, abandonment or incorrigibility filed against you, your spouse, or any person residing in your household through the Department of Child Safety or a similar agency, by any law enforcement agency, or by any juvenile courts in any state of the United States? (Y/N) __________. If yes, provide details regarding the nature and disposition of said allegations or investigations, including specific dates, names of investigators and other person(s) involved.

16. RESIDENCE AND REAL ESTATE

Please complete the attached Real Estate Chart for each piece of real estate in which you have an interest.

17. SOLE AND SEPARATE PROPERTY

Do you own any property that you believe is your sole and separate property? (Y/N) ___. If yes:

a. Describe the property;

b. State the present location of the property;

c. State the value of your interest in the property on the date of marriage;

d. State the facts that support your belief that it is sole and separate property; and

e. Identify and attach every document in your custody, possession or control which supports your claim that the property is separate property.

f. Have you used any community funds to improve, protect, pay for or maintain the separate property? (Y/N) ___. If yes, identify dates, source and amounts of funds expended and identify and attach any documents that show the expenditures.

18. FINANCIAL INSTITUTIONS

a. If you have had funds on deposit in any financial institution and/or if you have owned any securities this year or within the past 3 years, complete the attached Financial Institution Accounts and Securities Charts.

b. Do you have any money on deposit in any account, in any name other than your own? (Y/N) ___. If yes, for each account, state:

1. Where the account is maintained.

2. The name under which the account is maintained.

3. The account number.

c. Within the past 12 months, have you transferred any assets to a third party or parties or institution, to be held for your benefit? (Y/N) ___. If yes, for each account, state

1. Where the account is maintained.

2. The name under which the account is maintained.

3. The account number.

d. Attach the statements and a copy of each check register for each account in which you have or had funds or to which you have transferred funds to be held for your benefit for the past 12 months.

e. Attach any statements showing any securities you own or have owned for the past 12 months.

19. SAFE DEPOSIT BOXES

Within the last 3 years, have you had access to any safe deposit box, safe or vault or other place of safekeeping (hereinafter “depository”)?(Y/N) ___. If yes, for each depository, state:

a. The name of the financial institution or branch or other location where the depository is located.

b. State whether each depository is open or closed as of the date of your answers to these interrogatories.

c. List present contents of each depository and identify any items removed within the last 3 years.

20. BUSINESS ENTITIES: CORPORATIONS, PARTNERSHIPS, AND SOLE PROPRIETORSHIPS

a. Identify every business entity (hereinafter “business”) in which you have any interest, whether equitable or legal, and identify the type of business (corporation, general partnership, limited partnership, joint venture, sole proprietorship).

b. With respect to each business listed, describe the type of records maintained in the last 5 years; e.g., general ledger, general journal, cash disbursements journal, etc.

c. Indicate the name, address, telephone number, and employee title of each individual or business that has possession, custody or control of the records above described.

d. Provide the name, address and telephone number of each individual or business that has possession, custody or control of the tax returns for each business listed for the last 3 years.

e. Provide the current “net worth” of each business listed and the date that “net worth” was derived. “Net worth” means total assets minus total liabilities. If you have an opinion, please provide the fair market value of the business as of this date.

f. With respect to each business listed, indicate your and your spouse’s interest in the business and the name and address of every other person or entity having an interest in any such business you have listed.

g. Attach a copy of the most recent federal income tax return for each business listed, with all relevant schedules and attachments.

21. LAW SUITS

During the last 3 years have either you or your spouse suffered an injury for which you believe you may receive compensation or have you been a party to any lawsuit? (Y/N) ___. If yes, give details below.

22. TAX RETURNS

Did you file federal and state income tax returns for the last 5 tax years? (Y/N) ___. If yes, as to each tax year state:

a. Whether it was a joint or separate return.

b. Who currently has a copy of that return.

c. Who prepared the return.

d. Attach a copy of your 5 most recent personal federal and state income tax returns with all relevant schedules, including all W-2 forms and 1099 forms.

23. FINANCIAL STATEMENTS

Has any financial statement, loan application, and/or credit application been prepared for you or by you or for any business entity listed in your answer to Interrogatory No. 20 within the past 3 years? (Y/N) ___. If yes, state:

a. The name and address of each person, firm, corporation, partnership, mercantile or trade agency, or other organization to whom they were submitted.

b. The date of each and every financial statement, loan application, and/or credit application.

c. Attach a copy of each financial statement or application.

24. ATTORNEYS’ FEES AND COSTS

State the terms and conditions of the employment of your attorney in this case, including the hourly rate or other basis for fees. Give full details of any agreement or understanding between you and your attorney in this case concerning fees and expenses, including information and specific amounts of any payments made to your attorney, the method of payment(s) and the source of the payment(s) in connection with this case. Attach the retainer agreement memorializing the employment of your attorney.

25. WITNESSES AND EXHIBITS

a. Do you intend to offer any documents into evidence at the time of hearing/trial of this case? (Y/N) ___. If yes, state:

1. The description, subject matter, form, name and number of each and every document;

2. The relevancy, in your opinion, of each and every document to the issues before the court.

b. Unless already disclosed pursuant to Rule 49 or 91 of these rules, list each witness you intend to call at the hearing/trial, and as to each such person:

1. State that person’s name, address, telephone number and the relevance of the expected testimony to the case;

2. Give the nature and substance of each such person’s expected testimony.

c. Have you employed or do you intend to employ any expert witness for purposes of supporting any of your allegations in this litigation and/or for purposes of testifying at the trial of this action? (Y/N) ___. If yes, unless already disclosed pursuant to Rule 49 or 91 of these rules, state or provide for each such expert:

1. The expert’s name, or other means of identification, last known complete address and telephone number;

2. The expert’s profession, job title, or occupation and the field in which that person is an expert;

3. Whether you intend to call the expert as a witness during the hearing/trial of this action;

4. At what address the expert is presently employed;

5. Attach a copy of each expert’s resume or curriculum vitae.

6. Attach a copy of any reports prepared by each expert.

26. SPOUSAL AFFIDAVITS AND INVENTORIES

a. If there are minor children common to the parties, complete an Affidavit of Financial Information and a Proposed Child Support Worksheet and/or if either party is asking for spousal maintenance, attorneys’ fees or costs, or for temporary orders to exclude a party from a residence, to divide community property or to order payment of debt, expenses or attorneys’ fees, complete an Affidavit of Financial Information .

b. Complete the attached inventory of securities and personal property owned by you, including vehicles, having a value greater than $200.00.