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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. 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)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]__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 [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 / __HusbandCHILDREN - __no children __1 __2 Number: ___MAINTENANCE PAYMENTS TO WIFE - __Husband to pay specific amounts to WifeMARITAL RESIDENCE (occupied prior to separation) - Address:__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 JOINT BANK ACCOUNTS - __there are accounts containing fundsApprox. amount: $__some accounts have been drained by __Husband / __Wife INCOME TAXES - __parties filed joint returns for prior yearAUTOMOBILES - identify autos, who gets them (and any provision re expenses of autos): LIFE INSURANCE - Husband is to - MEDICAL INSURANCE - __Husband to maintain medical insurance for benefit of -LAST WILL AND TESTAMENT -__Wife and children [__just minor children] __Husband can freely dispose of his estateMISCELLANEOUS - __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:__Agreement to contain representations re NET WORTH and INCOME Husband's approx. income: $__________(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 |