NOTE: The following sample questionnaire is used with the New York Divorces Library. Other states have different terms of art (e.g., petition rather than complaint, respondent rather than defendant, etc.), and the grounds for divorce/dissolution, basis for jurisdiction and venue, and other matters are different than New York.


DIVORCES QUESTIONNAIRE

Name of Plaintiff (your client):

__a male (the Husband) __a female (the Wife)
[OR __a same-sex marriage -- between __two females __two males]
__employed __unemployed __on public assistance
__a "poor person"
Birth date:
Soc. Sec. No.:
Tele. No.:
e-mail (if available):
Income:
Net Worth:
Employment history:


Address:



Name of spouse:

__employed __unemployed __on public assistance
Birth date:
Soc. Sec. No.:
Tele. No.:
e-mail (if available):
Income:
Net Worth:
Employment history:


Address:



__Defendant has an attorney - name, address, phone no.:



Maiden name of Wife:

Place of marriage:

Date of marriage:

__marriage performed by minister or clergyman, or a leader of the Society for Ethical Culture [__Plaintiff has taken steps to remove barriers to remarriage]

Children: __NONE __1 __2 Number: ___
Name(s), addresses (during last five years), birth date(s), whether minors (under 21), and Soc. Sec. No(s).:







The Defendant probably will -
__sign a CONSENT to the divorce [__and waive service of papers other than Judgment]
__default (without signing a consent)
__definitely contest the divorce

Grounds for the divorce (check one or two) -
__NEW: no-fault divorce (relationship has broken down irretrievably for at least six months)
__living apart pursuant to a separation agreement (specifics include date of agreement, place and date of filing, index no. __only a memo was filed / __provisions are to survive Judgment)
__cruelty and inhuman treatment (list 3 acts)
__confinement in __prison/__mental institution (date and place of confinement, date of release)
__adultery (dates, places, details)
__living apart pursuant to a __decree or __judgment (place and date of filing, index no.)
__"constructive abandonment" (date, place)
__abandonment [or __lock-out] (specifics include date and place)
__this is an annulment, not divorce - based on:
__consent of the Plaintiff to the marriage was obtain by fraud (details of a promise which was a condition to the marriage and broken by the Defendant)
__consent of the Plaintiff to the marriage was obtain by force or duress (details)
__a former spouse of the Defendant is living and their marriage is still in force
__Plaintiff was under the age of consent at the time of the marriage
__a party was a mentally retarded or mentally ill person - which:
__a party has been incurably ill for five years - which:
__Defendant is physically incapable
Enter specifics:








__stipulation of settlement will probably be executed

__even though living apart pursuant to a separation agreement may not be a ground for divorce, a separation agreement (such as one executed within the last year) is to be incorporated in Judgment - date:

The residency requirement is satisfied by -
__Plaintiff's residence in NY for 2 years
__Defendant's residence in NY for 2 years
__marriage within NY plus 1 year residence by Plaintiff
__marriage within NY plus 1 year residence by Defendant
__having resided in NY as husband and wife plus 1 year residence by Plaintiff
__having resided in NY as husband and wife plus 1 year residence by Defendant
__the act upon which the divorce grounds are founded occurred in NY and __Plaintiff/__Defendant resided in NY 1 year
__the act occurred in NY and both parties reside in NY

County in which the divorce papers will be filed:

VENUE is based on -
__Plaintiff's residence in County
__Defendant's residence in County
__CPLR Sec. 509

__action is to be commenced by serving a Summons AND Complaint, as opposed to serving just a Summons With Notice

__a Family Court proceeding was commenced [__Family Court order is to be continued by Judgment] - County, index no. and order date:

Re maintenance of the Wife -
__Husband shall pay a specific amount to Wife
$________ per __week/__biweekly/__monthly/__other:
__Husband shall pay a "reasonable" amount
__no maintenance is sought

Re custody of minor children -
__Wife shall have custody
__Husband shall have custody
__joint custody but children will reside with Wife
__joint custody but children will reside with Husband
__joint custody without stating where children reside
__Complaint is to be silent re custody

__Husband / __Wife now has the children
Names and addresses of persons with whom each child resided in the past 5 years: __both Husband and Wife / __just Wife / __just Husband / __other:



Re child support -
__noncustodial parent shall pay specific amount for child support for each child: $________ per __week/__biweekly/__monthly/__other:
the non-custodial parent's share of the presumptively correct amount which the would be required to pay under DRL Sec. 240(1-b) is $________ - __no deviation / __deviation - reasons:

__prepare a Stipulation Re Child Support
Re child support enforcement services of the the Support Collection Unit:
__custodial parent waives such services [__but prepare an Income Deduction Order]
__custodial parent seeks such services for the first time
__custodial parent has a pending application for such services
__custodial parent already receives such services
__noncustodial parent to pay minimum child support ($25 per month)
__no child support is to be sought
__noncustodial parent shall pay a "reasonable" amount
__child support is based on a Family Court order
__additional periodic child support for __child care / __health care (not covered by insurance) / __education - specify:


__Defendant/__Plaintiff to provide health care insurance for children [__and spouse] - until: __21/_18/__other:
__Defendant/__Plaintiff to pay unreimbursed medical expenses - __all/__a percent
__prepare a Qualified Medical Child Support Order

Identify medical plans of Plaintiff -
Name of plan:
Address:
Identification Number:
Plan Administrator:
Coverage:

Name of plan:
Address:
Identification Number:
Plan Administrator:
Coverage:

Identify medical plans of Defendant -
Name of plan:
Address:
Identification Number:
Plan Administrator:
Coverage:

Name of plan:
Address:
Identification Number:
Plan Administrator:
Coverage:

Re visitation - __noncustodial parent shall have "reasonable" visitation
__noncustodial parent shall have visitation rights pursuant to a specific schedule [__Sat or Sun weekly vs __ Sat & Sun biweekly / alternate __Christian vs __Jewish holidays / ___ weeks in summer]
__visitation for noncustodial parent is not to be sought

__seek Court's determination of equitable distribution of marital property [__proposed equitable distribution to be set forth in an exhibit to Complaint]

Complaint is to seek -
__visitation rights for grandparents
__Defendant/__Plaintiff provide life insurance
__Defendant/__Plaintiff remit proceeds from a pension plan [__prepare a QDRO] - company and share:
__Defendant/__Plaintiff pay other's attorneys' fees [$________]
__Defendant/__Plaintiff pay lump sum [$________]
__award possession of marital residence [__to Wife or __to Husband] - identify marital residence:


Prepare -
__papers seeking pendente lite relief
__application to proceed as poor person
__net worth statements for Plaintiff and Defendant
__a statement of proposed equitable distribution
__a Notice of Settlement
__interrogatories

__Defendant is in military service

Will Defendant be served -
__WITHIN New York
__outside of New York
__by publication

How will process server identify Defendant -
__using a photograph
__Plaintiff will point out Defendant
__the process server personally knows Defendant
__Plaintiff provided a description


STIPULATIONS OF SETTLEMENT QUESTIONNAIRE

[Note: The Divorces Library lets you prepare comprehensive Stipulations of Settlement of actions for divorce/dissolution, either while you are preparing the suit papers or separately. This sample is for New York, and the terms, choices, etc. are different in other states.]


Name of Husband:
Phone No.:
Address:



Name of Wife:
Maiden name:
Phone No.:
Address:



You represent __Husband / __Wife

__other spouse has an attorney - name, address, phone no.:



Place of marriage:
Date of marriage:

__prepare A Stipulation of Settlement rather than a Separation Agreement
Plaintiff is __Wife / __Husband
__Defendant in military
__an answer has been filed
Name of Court:
Index/Case No.:
CHILDREN -
__no children __1 __2 Number: ___
Name(s) and age(s) and whether minor (unemancipated):





CUSTODY of minor children -
__Wife to have custody
__Husband to have custody
__joint custody
__but children reside with Wife
__but children reside with Husband
__without residing predominantly with either
__Agreement to be silent on subject

__recite that upon death of custodial parent, non-custodial parent shall have custody
CHILD SUPPORT -
__non-custodial parent to pay specific amounts for child support for each child -
$________ __weekly/ __biweekly/ __monthly/ __other:
Payments to end (if the child is NOT attending college) at age __18/ __21/ __other:
But if the child is ATTENDING COLLEGE payments to end at __22 __the same age as if not attending college __some other age:
__non-custodial parent to pay "reasonable" amounts
__no child support to be sought
__payments increase with Consumer Price Index (CPI)
__payments increase on specific dates - dates and payments:


Re payments for college -
__non-custodial parent to make additional payments while children in college -
$________ per _________ per child
__non-custodial parent to pay into a college fund -
$________ per _________ per child
__both parties to pay to college fund -
Husband - $________ per _________ per child
Wife - $________ per _________ per child
__non-custodial parent to pay __all/ __one-half of the college expenses - __but not more than __$________ per annum per child, or __cost of attending:
__college payments increase with CPI
__child support DEVIATES from PRESUMPTIVE AMOUNT: $
__non-custodial parent may claim tax exemptions for children
VISITATION -
__non-custodial parent to have visitation rights pursuant to a specific schedule
__Sat or Sun weekly vs __ Sat & Sun biweekly
__Christian vs __Jewish holidays
How many weeks in summer: [__consecutive]
__non-custodial parent to have "reasonable" visitation
__visitation for non-custodial parent not to be discussed
__"reasonable" visitation rights for grandparents
MOVING CHILDREN'S RESIDENCE -
__no restrictions
__visitation rights shall be adjusted
__moving from New York prohibited
__moving more than _____ miles prohibited
__other restrictions:

Restrictions on moving to terminate -
__when children reach majority
__on a specific date:
__remarriage of custodial parent
__health of custodial parent requires move
__Agreement to be silent re termination
MAINTENANCE PAYMENTS TO WIFE -
__Husband to pay specific amounts to Wife
$________ __weekly __biweekly __monthly __other:
__Husband to pay "reasonable" amounts
__no maintenance to be provided [__but Wife expressly may later apply to a court for maintenance]
__payments to terminate on specific date (other than death/remarriage) - date:
__payments increase with CPI
__payments increase on specific dates - specify:
MARITAL RESIDENCE (occupied prior to separation) -
Address:

The marital residence was -
__an apartment
__a __house/__condo/__coop owned by BOTH parties
__a __house/__condo/__coop owned by Husband
__a __house/__condo/__coop owned by Wife
__rented premises (other than an apartment)
Legal title to be
__transferred to Husband and Wife as tenants in common
__transferred to Wife
__transferred to Husband
__left unchanged
__transferee to pay lump sum for transferor's interest: $
__transferor to continue to pay expenses of marital residence - describe:

Possession of marital residence to be given to -
__Wife
__Husband
__marital residence is to be sold -
__but Wife may reside until the sale
__but Husband may reside until the sale
__neither may reside
__marital residence to be sold only if party in possession -
__vacates __remarries __cohabits with adult __children emancipated
Proceeds of sale of marital residence to be paid -
__equally by Husband and Wife
__to Wife
__to Husband
__$________ to Wife, balance to Husband
__$________ to Husband, balance to Wife
__other:

__a minimum acceptable sales price: $
Is marital residence affected by -
__an existing mortgage or similar instrument
__insurance premiums
__real estate taxes
__condo [__coop] charges or fees

These are to be paid by -
__Husband and Wife in equal shares
__Husband
__Wife
__other:
Minor repairs [__less than $________] to be paid by -
__parties equally
__Husband
__Wife
__other:
__Agreement to be silent on subject
__there is OTHER REAL ESTATE, the rights to which should be set forth in Agreement - describe property and rights:

DEBTS -
__there are marital debts to be listed and paid -
__by Husband
__by Wife
__some by Husband and some by Wife:

JOINT BANK ACCOUNTS -
__there are accounts containing funds
Approx. amount: $
To be paid to -
__Husband
__Wife
__Husband and Wife equally
__in some other fashion:
__some accounts have been drained by __Husband / __Wife
__Husband to pay Wife $________ to settle claims
__Wife to pay Husband $________ to settle claims
__all such claims are waived
__Agreement to be silent on subject
Identify the accounts:


INCOME TAXES -
__parties filed joint returns for prior year
__parties are GOING TO file joint returns
Refunds are to be paid to -
__Husband
__Wife
__parties equally
__in proportion to income
__other:
__Agreement to be silent on subject
Any deficiency (or taxes due) are to be paid by -
__Husband
__Wife
__parties equally
__in proportion to income
__party who caused the deficiency
__Agreement to be silent on subject
AUTOMOBILES - identify autos, who gets them (and any provision re expenses of autos):



LIFE INSURANCE -
Husband is to -
__maintain existing insurance
__maintain existing insurance and increase coverage
__procure new insurance (none exists)
__Agreement to be silent on subject

Amount of existing insurance: $
Amount of additional insurance to be procured: $
Total insurance to be maintained: $

The life insurance is to be for the benefit of -
__Wife, or if she dies children
__just Wife
__just children
__Wife to pay portion of insurance premiums - amount or share:

MEDICAL INSURANCE -
__Husband to maintain medical insurance for benefit of -
__Wife and children [__just minor children]
__just Wife
__just children [__just minor children]

__Husband to maintain "major medical" insurance (in addition to basic coverage)
__Husband need not maintain insurance if Wife's employer provides coverage
__requirement for insurance to end on a specific date:

Re the deductible under medical insurance -
__Husband pays deductible
__he pays half the deductible
__he pays some other portion:
__Wife (not Husband) pays deductible
__Agreement to be silent on subject
Should the same rule apply to -
__dental and orthodontic expenses
__all medical expenses not covered by insurance
If not, is anything to be provided:
LAST WILL AND TESTAMENT -
__Husband can freely dispose of his estate
__Husband must bequeath $________ to Wife, or if she dies to children
__Husband must bequeath ___% of his estate to Wife, or if she dies to children
__Husband must bequeath $________ to children directly
__Husband must bequeath ___% to children
__requirement ends on a specific date:
__Wife to be subject to same requirement as to her estate
MISCELLANEOUS -

__prepare a short form (easier to negotiate)

Month in which Agreement will be executed:

__other LUMP SUM PAYMENT to be made by __Husband / __ Wife - $

__Husband to pay Wife a portion of a PENSION PLAN
Company providing plan:
Wife's share - __50% / __other: ___% / __ formula based on duration of employment and marriage
__Agreement to contain representations re NET WORTH and INCOME
Husband's approx. income: $________
Husband's net worth: between $________ and $________
Wife's approx. income: $________
Wife's net worth: between $_______ and $________
__(if you represent Wife) Husband is to pay your fee: $

__if there is a material change in economic circumstances, either party may apply to a court for modification

__disputes to be resolved by arbitration - where:

__a previously executed prenuptial agreement is to be superseded - date of agreement:

Also prepare: __Memorandum of Agreement / __Financial Statements / __Deed to marital residence
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