Kershek & Shular LLP Divorce Questionnaire Your Information Full Name Preferred Address (for correspondence) Home Phone Work Phone Fax Email Address Date of Birth Your Spouse's Information Full Name Preferred Address (for correspondence) Home Phone Work Phone Fax Email Address Date of Birth Marriage Information Date of Marriage Place of Marriage Date of Separation   State the reasons for seeking divorce: State any questions that you have:   Property/Earnings Information Briefly describe all of the property you and your spouse have accumulated during your marriage: Briefly describe the property that you owned at the time of your marriage: Briefly describe your current debts: State your occupation and monthly salary: State your spouse's occupation and monthly salary: Do you or your spouse have other sources of income? If so, please describe: What is the approximate value of your current liquid assets (bank accounts, certificates of deposit, mutual funds, cash etc)? :   Children Information For each child please state: Name, Date of Birth, City of Birth Do you expect that you and your spouse will disagree over possession of the children after divorce? If so, why?   Other Misc Information If you would like us to describe any other important information in the space below:                     Copyright 2004, Kershek & Shular LLP.