LIVE CHAT

Property Questionnaire

REAL PROPERTY

First Name:
Last Name:
Phone:
Email:
City:
State:
Zip:
Primary Residence (Homestead)
Address
Description of improvements, if any
Legal description (from deed)
Date purchased: Who is on Title:
Purchase price
Current fair market value as of (date)
(value)
Mortgage company
Mortgage account number (if any)
Outstanding mortgage balance as of (date)
(balance)
Second lien
Outstanding second lien balance as of (date)
(balance)
Monthly payments
Current net equity in property as of (date)
(balance)
Choose One Award to HusbandAward to WifeSell
Choose One AgreedProposed
Other Real Property Interest
Address
Description of improvements, if any
Legal description (from deed)
Date purchased
Purchase price
Current fair market value as of (date)
(value)
Mortgage company
Mortgage account number (if any)
Outstanding mortgage balance as of (date)
(balance)
Second lien
Outstanding second lien balance as of (date)
(balance)
Monthly payments
Current net equity in property as of (date)
(balance)
Choose One Award to HusbandAward to WifeSell
Choose One AgreedProposed
MINERAL INTERESTS
Name of mineral interest/lease/well
Type of interest
Legal description (from deed or division order)
County of location
Name of producer/operator
Current Value as of (date) (balance)
How Acquired When By Whom
Choose One Award to HusbandAward to WifeSell
Choose One AgreedProposed
Name of mineral interest/lease/well
Type of interest
Legal description (from deed or division order)
County of location
Name of producer/operator
Current Value as of (date) (balance)
How Acquired When By Whom
Choose One Award to HusbandAward to WifeSell
Choose One AgreedProposed
CASH AND ACCOUNTS WITH FINANCIAL INSTITUTIONS
Cash on hand as of (date)
(amount)
Traveler's checks on hand as of (date)
(amount)
Money orders on hand as of (date)
(amount)
Name of financial institution
Type of account
Name account held in
Account number
Date account was opened
Persons named on withdrawal cards
Account balance as of: (date) (amount)
Choose One Award to HusbandAward to WifeClose
Choose One AgreedProposed
Name of financial institution
Type of account
Name account held in
Account number
Date account was opened
Persons named on withdrawal cards
Account balance as of: (date) (amount)
Choose One Award to HusbandAward to WifeClose
Choose One AgreedProposed
Name of financial institution
Type of account
Name account held in
Account number
Date account was opened
Persons named on withdrawal cards
Account balance as of: (date) (amount)
Choose One Award to HusbandAward to WifeClose
Choose One AgreedProposed
Name of financial institution
Type of account
Name account held in
Account number
Date account was opened
Persons named on withdrawal cards
Account balance as of: (date) (amount)
Choose One Award to HusbandAward to WifeClose
Choose One AgreedProposed
BROKERAGE/MUTUAL FUND ACCOUNTS (include accounts not previously disclosed herein)
Name of brokerage firm/mutual fund
Address of brokerage firm
Name account held in
Name of account (and names of subaccounts, if any)
Account number (and numbers of subaccounts, if any)
Total account value as of: (date) (value)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name of brokerage firm/mutual fund
Address of brokerage firm
Name account held in
Name of account (and names of subaccounts, if any)
Account number (and numbers of subaccounts, if any)
Total account value as of: (date) (value)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name of brokerage firm/mutual fund
Address of brokerage firm
Name account held in
Name of account (and names of subaccounts, if any)
Account number (and numbers of subaccounts, if any)
Total account value as of: (date) (value)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
STOCKS, BONDS, OPTIONS AND OTHER INVESTMENT INSTRUMENTS
Name of security/investment
Type of security/investment (common stock/preferred stock/bond, etc.)
Type of security/investment (common stock/preferred stock/bond, etc.)
Certificate numbers
Name in which held
In possession of
Date of initial ownership
Name of exchange on which listed
Brokerage house
Brokerage house account number
Present location of certificate(s)
Is the security pledged as collateral? YesNo
If so, to whom or to what entity?
Market value as of: (date)
(value)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name of security/investment
Type of security/investment (common stock/preferred stock/bond, etc.)
Type of security/investment (common stock/preferred stock/bond, etc.)
Certificate numbers
Name in which held
In possession of
Date of initial ownership
Name of exchange on which listed
Brokerage house
Brokerage house account number
Present location of certificate(s)
Is the security pledged as collateral? YesNo
If so, to whom or to what entity?
Market value as of: (date)
(value)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed

RETIREMENT ACCOUNTS

Retirement Accounts/SEP/401(k):
Name of plan
Financial institution
Name account held in
Account number
Payee of survivor benefits
Designated beneficiary
Total account balance:
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name of plan
Financial institution
Name account held in
Account number
Payee of survivor benefits
Designated beneficiary
Total account balance:
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name of plan
Financial institution
Name account held in
Account number
Payee of survivor benefits
Designated beneficiary
Total account balance:
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed

Company Retirement Benefits:

Defined Contribution Plans
Exact name of plan
Name, address, and phone number of plan administrator
Name of employee
Name of employer
Starting date of creditable service/Beginning date of participation in plan
Percentage employee is vested
Designated beneficiary
Payee of survivor benefits
Description of other benefits
Balance of account as of date of marriage:
Is there a loan or offset against the plan? YesNo
If so, how much?
Date any such loan or withdrawal was made
Total account balance as of: (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Exact name of plan
Name, address, and phone number of plan administrator
Name of employee
Name of employer
Starting date of creditable service/Beginning date of participation in plan
Percentage employee is vested
Designated beneficiary
Payee of survivor benefits
Description of other benefits
Balance of account as of date of marriage:
Is there a loan or offset against the plan? YesNo
If so, how much?
Date any such loan or withdrawal was made
Total account balance as of: (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Defined Benefit Plans
Exact name of plan
Name, address, and phone number of plan administrator
Name of employee
Name of employer
Starting date of creditable service/Beginning date of participation in plan
Percentage employee is vested
Designated beneficiary
Description of other benefits
Accrued benefit as of date of marriage
Value of plan as of: (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Exact name of plan
Name, address, and phone number of plan administrator
Name of employee
Name of employer
Starting date of creditable service/Beginning date of participation in plan
Percentage employee is vested
Designated beneficiary
Description of other benefits
Accrued benefit as of date of marriage
Value of plan as of: (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Uniformed Services
Branch of service
Name of service member
Current Rank/Pay grade of service member
Starting date of creditable service
Status of service member ActiveReserveRetired
Payee of survivor benefits
Description of other benefits
Monthly benefit payable
Value of plan as of: (date)
(value)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Branch of service
Name of service member
Current Rank/Pay grade of service member
Starting date of creditable service
Status of service member ActiveReserveRetired
Payee of survivor benefits
Description of other benefits
Monthly benefit payable
Value of plan as of: (date)
(value)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Other Retirement Accounts
Exact name of plan
Name, address, and phone number of plan administrator
Name of employee
Name of employer
Starting date of creditable service/Beginning date of participation in plan
Percentage employee is vested
Designated beneficiary
Payee of survivor benefits
Description of other benefits
Balance of account as of date of marriage
Is there a loan or offset against the plan? YesNo
If so, how much?
Date any such loan or withdrawal was made
Total account balance as of (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Exact name of plan
Name, address, and phone number of plan administrator
Name of employee
Name of employer
Starting date of creditable service/Beginning date of participation in plan
Percentage employee is vested
Designated beneficiary
Payee of survivor benefits
Description of other benefits
Balance of account as of date of marriage
Is there a loan or offset against the plan? YesNo
If so, how much?
Date any such loan or withdrawal was made
Total account balance as of (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed

EMPLOYEE-RELATED BENEFITS

Stock Options and Restricted Stock

Stock Options
Name of company
Date of option/grant
Vesting schedule
Number of options
Are the options exercisable? YesNo
Are the options registered? YesNo
Current stock price
Strike price
Current net market value as of (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Restricted Stock
Name of company
Date of grant
Restriction schedule
Number of shares
Are the stocks registered? YesNo
Current stock price
Current market value as of (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Bonuses
Name of company
Name or description of bonus
Date of bonus expected to be paid
Time period covered by bonus
Anticipated amount of bonus
Form of bonus to be paid
Name of company
Name or description of bonus
Date of bonus expected to be paid
Time period covered by bonus
Anticipated amount of bonus
Form of bonus to be paid
OTHER EMPLOYEE-RELATED BENEFITS
Name of company
Name or description of benefit
Date benefit is expected to be paid
Time period covered by benefit
Anticipated amount of benefit
Form of benefit to be paid
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name of company
Name or description of benefit
Date benefit is expected to be paid
Time period covered by benefit
Anticipated amount of benefit
Form of benefit to be paid
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
LIFE INSURANCE AND ANNUITIES:
Insurance Company
Policy No.
Type of policy
Name of insured
Name of owner
Beneficiary
Date of issue
Face amount or death benefit
Amount of premiums
Due dates of premiums
Is there a loan against this policy? YesNo
If so, how much?
Date any such loan or withdrawal was made
Cash surrender value as of (date)
(value)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Insurance Company
Policy No.
Type of policy
Name of insured
Name of owner
Beneficiary
Date of issue
Face amount or death benefit
Amount of premiums
Due dates of premiums
Is there a loan against this policy? YesNo
If so, how much?
Date any such loan or withdrawal was made
Cash surrender value as of (date)
(value)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
CLOSELY HELD BUSINESS INTERESTS/CORPORATIONS/PARTNERSHIPS
Name of business
Type
Date of initial ownership
Name of owner
Shares, units or percentage of ownership
Estimated fair market value
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name of business
Type
Date of initial ownership
Name of owner
Shares, units or percentage of ownership
Estimated fair market value
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name of business
Type
Date of initial ownership
Name of owner
Shares, units or percentage of ownership
Estimated fair market value
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
CONTENTS OF SAFE DEPOSIT BOX/HOME SAFE/STORAGE FACILITY:
Name and location of facility
Account/box number/unit number
Names of persons with access to contents
Terms and length of lease
Items in safe-deposit box or storage unit
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name and location of facility
Account/box number/unit number
Names of persons with access to contents
Terms and length of lease
Items in safe-deposit box or storage unit
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
MOTOR VEHICLES, BOATS, AIRPLANES, CYCLES, TRAILERS, RVs, ETC.:
Description (year, make, and model)
Vehicle identification no.
Exact name on certificate of title
In possession of
Date purchased
Purchase price
Does vehicle have a loan against it? AgreedProposed
If yes, state amount of loan
Exact name of creditor
Fair Market value
Net equity
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Description (year, make, and model)
Vehicle identification no.
Exact name on certificate of title
In possession of
Date purchased
Purchase price
Does vehicle have a loan against it? AgreedProposed
If yes, state amount of loan
Exact name of creditor
Fair Market value
Net equity
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Description (year, make, and model)
Vehicle identification no.
Exact name on certificate of title
In possession of
Date purchased
Purchase price
Does vehicle have a loan against it? AgreedProposed
If yes, state amount of loan
Exact name of creditor
Fair Market value
Net equity
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Description (year, make, and model)
Vehicle identification no.
Exact name on certificate of title
In possession of
Date purchased
Purchase price
Does vehicle have a loan against it? AgreedProposed
If yes, state amount of loan
Exact name of creditor
Fair Market value
Net equity
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed

MISCELLANEOUS PERSONAL PROPERTY:

HOUSEHOLD FURNITURE, FURNISHINGS & FIXTURES:
Description Estimated value Award To Agreed or Proposed
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CLOTHING, JEWELRY, AND ITEMS OF PERSONAL ADORNMENT:
Description Estimated value Award To Agreed or Proposed
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MISCELLANEOUS SPORTING GOODS AND FIREARMS:
Description Estimated value Award To Agreed or Proposed
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ELECTRONICS AND COMPUTERS, OFFICE EQUIPMENT AND FURNITURE:
Description Estimated value Award To Agreed or Proposed
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ANTIQUES, ARTWORKS AND COLLECTIONS:
Description Estimated value Award To Agreed or Proposed
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CLUB MEMBERSHIPS:
Name of club
Name membership held in
Type
Debt
Current Value
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name of club
Name membership held in
Type
Debt
Current Value
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name of club
Name membership held in
Type
Debt
Current Value
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
TRAVEL AWARDS/FREQUENT FLYER MILEAGE ACCOUNTS, ETC.:
Exact name of airline/program
Account number
Current number of miles/points
Name of owner
Value of account
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Exact name of airline/program
Account number
Current number of miles/points
Name of owner
Value of account
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Exact name of airline/program
Account number
Current number of miles/points
Name of owner
Value of account
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Exact name of airline/program
Account number
Current number of miles/points
Name of owner
Value of account
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Exact name of airline/program
Account number
Current number of miles/points
Name of owner
Value of account
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
SPORTS AND CULTURAL TICKETS AND MEMBERSHIPS
Type
Cost
Number of seats
Debt
Value
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Type
Cost
Number of seats
Debt
Value
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
LIVESTOCK/PETS:
Description
Value
Choose One Award to HusbandAward to WifeSplit Visitation Schedule YN
Choose One AgreedProposed
Description
Value
Choose One Award to HusbandAward to WifeSplit Visitation Schedule YN
Choose One AgreedProposed
Description
Value
Choose One Award to HusbandAward to WifeSplit Visitation Schedule YN
Choose One AgreedProposed
Description
Value
Choose One Award to HusbandAward to WifeSplit Visitation Schedule YN
Choose One AgreedProposed
MONEY OWED TO EITHER HUSBAND OR WIFE
Name of debtor
Debtor's relationship to you
Is debt evidenced in writing? YesNo
Is debt secured? YesNo
If so, with what is the debt secured?
When was the money loaned?
When is the debt due to be paid?
How much was the original loan balance?
Current loan amount owed as of (date) (amount)
Name of debtor
Debtor's relationship to you
Is debt evidenced in writing? YesNo
Is debt secured? YesNo
If so, with what is the debt secured?
When was the money loaned?
When is the debt due to be paid?
How much was the original loan balance?
Current loan amount owed as of (date) (amount)
Name of debtor
Debtor's relationship to you
Is debt evidenced in writing? YesNo
Is debt secured? YesNo
If so, with what is the debt secured?
When was the money loaned?
When is the debt due to be paid?
How much was the original loan balance?
Current loan amount owed as of (date) (amount)
CONTINGENT ASSETS AND CLAIMS
Description: Estimated Value
Description: Estimated Value
Description: Estimated Value
ANY OTHER ASSETS
Description
Location
Value
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Choose One AgreedProposed
Description
Location
Value
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Description
Location
Value
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Description
Location
Value
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed

Part 2

CLAIMS OF ECONOMIC CONTRIBUTION/REIMBURSEMENT BY ONE SPOUSE TO THE OTHER
Estate with claim
Estate against which claim is made
Nature of claim
Value
Estate with claim
Estate against which claim is made
Nature of claim
Value
Estate with claim
Estate against which claim is made
Nature of claim
Value
Estate with claim
Estate against which claim is made
Nature of claim
Value

Part 3
UNSECURED COMMUNITY LIABILITIES

CREDIT AND DEBIT CARDS AND CHARGE ACCOUNTS:
Name and type of account
Financial institution/issued by
Account number
Minimum monthly payment
Name(s) on account
Signatures on credit card application
Name(s) of authorized users
Balance transferred from (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name and type of account
Financial institution/issued by
Account number
Minimum monthly payment
Name(s) on account
Signatures on credit card application
Name(s) of authorized users
Balance transferred from (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name and type of account
Financial institution/issued by
Account number
Minimum monthly payment
Name(s) on account
Signatures on credit card application
Name(s) of authorized users
Balance transferred from (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name and type of account
Financial institution/issued by
Account number
Minimum monthly payment
Name(s) on account
Signatures on credit card application
Name(s) of authorized users
Balance transferred from (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name and type of account
Financial institution/issued by
Account number
Minimum monthly payment
Name(s) on account
Signatures on credit card application
Name(s) of authorized users
Balance transferred from (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Name and type of account
Financial institution/issued by
Account number
Minimum monthly payment
Name(s) on account
Signatures on credit card application
Name(s) of authorized users
Balance transferred from (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
UNSECURED LOANS OWED TO OTHER PEOPLE:
Loan payable to
Loan made by
Original loan amount
Balance as of (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
Loan payable to
Loan made by
Original loan amount
Balance as of (date)
(balance)
Choose One Award to HusbandAward to WifeSplit
Choose One AgreedProposed
FEDERAL, STATE AND LOCAL TAX LIABILITY:
Entity owed
Tax year
WIFE
Amount owed as of
Entity owed
Tax year
HUSBAND
Amount owed as of
CONTINGENT LIABILITIES (e.g., lawsuits against either party, guaranty either party may have signed):
Name of creditor
Name of person primarily liable
Guaranteed by
Nature of contingency
Amount of contingent liability WIFE
HUSBAND
OTHER LIABILITIES NOT PREVIOUSLY LISTED IN THIS INVENTORY
Description
Amount owed as of (date)
(balance)
Description
Amount owed as of (date)
(balance)
Description
Amount owed as of (date)
(balance)
Description
Amount owed as of (date)
(balance)

Part 4
TRUST, ESTATE, AND CUSTODIAL ASSETS

ASSETS HELD BY EITHER PARTY FOR THE BENEFIT OF ANOTHER
Name of person holding assets
Description of assets
Name and title of fiduciary (e.g., executor, trustee)
Name of owner of beneficial interest
Value of assets as of (date)
(value)
Name of person holding assets
Description of assets
Name and title of fiduciary (e.g., executor, trustee)
Name of owner of beneficial interest
Value of assets as of (date)
(value)
Name of person holding assets
Description of assets
Name and title of fiduciary (e.g., executor, trustee)
Name of owner of beneficial interest
Value of assets as of (date)
(value)
Name of person holding assets
Description of assets
Name and title of fiduciary (e.g., executor, trustee)
Name of owner of beneficial interest
Value of assets as of (date)
(value)
ASSETS HELD BY ANOTHER FOR THE BENEFIT OF EITHER PARTY OR FOR THE CHILDREN
Name of person holding assets
Description of assets
Name and title of fiduciary (e.g. executor, trustee)
Name of owner of beneficial interest
Value of assets as of (date)
(value)
Name of person holding assets
Description of assets
Name and title of fiduciary (e.g. executor, trustee)
Name of owner of beneficial interest
Value of assets as of (date)
(value)
CUSTODIAL ACCOUNTS UNDER UNIFORM TRANSFERS TO MINORS ACT:
Name of financial institution
Type of account
Name of account
Account number
Date account was opened
Persons named on withdrawal cards
Name of minor
Account balance as of (date)
(balance)

Part 5
SEPARATE PROPERTY AND SEPARATE LIABILITIES

SEPARATE PROPERTY AND LIABILITIES OF WIFE:
Description When Acquired How Acquired Estimated Value
SEPARATE PROPERTY AND LIABILITIES OF HUSBAND:
Description When Acquired How Acquired Estimated Value
Please leave this field empty.