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45 Jason Street , Arlington, Massachusetts 02476
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Massachusetts Divorce Resources

From the Law Office of Robert P. Murray

©2004 ALL RIGHTS RESERVED
Robert P. Murray, Esquire


Confidential Client Questionnaire

For those persons interested in having a consultation with me, you should call my office at 617.651.5044 to schedule an appointment. It is often helpful, and our time can be spent more efficiently, if you complete the following questionnaire prior to our meeting and bring it with you. This form may be printed out and filled in by hand. Click this link to open the PDF questionnaire.

In Re: Domestic Relations Matter of:

[Name]

Date Completed:

 

Because of the increasing importance of financial information in divorce cases since the enactment of M.G.L.A. Chapter 208 Section 34 and the adoption of the Child Support Guidelines, the collection of data about the assets, liabilities, needs and financial opportunities of the parties has become an important aspect of case preparation. You are the primary source for the collection of such data initially, although I often must build on client-provided information with investigation, discovery and other resources as the divorce case comes closer to a trial or hearing date. Even in uncontested, no-fault-with-agreement type divorces, the accuracy of financial disclosures by each party is important to enable the parties to make informed decisions. From the outset of the attorney-client relationship I request that the client provide me with as much detailed financial information as possible. The following is a detailed financial questionnaire which is a very effective method of instituting the search for compiling such information.

Please complete it as fully and comprehensively as possible. When completed, you should either mail it to my office in advance of our office conference or, if you prefer, bring it with you. If exact information is not known to you please provide your best estimate. If you subsequently realize that information provided on this form is incorrect, inaccurate or incomplete please contact this office and provide the corrected data. You may be asked at some future date to again complete this form or to provide more precise or up-to-date information.

Confidential information provided on this form is protected by the attorney-client privilege and is intended for my use only. Any information provided in this form which is detrimental to you will not be revealed by me to anyone without your consent unless it is in your best interests to do so in certain narrow and limited situations required or authorized by law. If you have any questions about the confidentiality of this information I will be pleased to answer them. Because this information is provided in confidence I ask that your answers be as truthful, complete and accurate as possible. If the requested information is inapplicable, write “N/A”. [Much of this questionnaire may not apply to you at all and, therefore, you can leave inapplicable sections blank.] If additional space is needed, please attach additional sheets. These are worksheets only, so neatness is unimportant, but legibility is.

GENERAL INFORMATION

Your Full Name (including full middle name):

 

Maiden name, if different from above:

 

Home Address:

 

Mailing Address: (if different)

 

Phone: Home:

 

Work:

 

Birth date:

Place of birth:

Citizenship:

 

How did you happen to choose this office or who referred you to this office?

FAMILY INFORMATION

Full name of spouse (including maiden name, if applicable):

 

Address of spouse:

 

Birth date of spouse:

Birth Place of Spouse:

 

Has your spouse retained an attorney?

If so, please state name and address of spouse’s attorney, if known:

 

Date and place of marriage:

 

Children born during the marriage:

Name(s): Date(s) of Birth:

 

 

 

 

 

If either you or spouse is paying or receiving child support to or from the other either voluntarily or under a court order or written agreement please provide the details:

If either you or your spouse was married prior to your present marriage, please provide details, including date of marriages and divorces (or death dates) as well as the place of any divorce:

If either you or your spouse has children by a prior marriage or children born out of wedlock, please list the children, their dates of birth, who has custody of the children and any amounts of support presently being paid for such children:

If either you or your spouse is currently paying alimony to a previous spouse either under a contract or a court order please provide the details:

If either you or your spouse has previously been involved in any type of court action or litigation involving a marital dispute please provide relevant information including:

Type of court action: (divorce, separate support, annulment, abuse, property dispute, Restraining Orders, etc.)

Court:

 

Current status of action:

Did you enter into any agreements with each other, and if so, please provide details:

You were represented by Attorney and, if so please provide name and address:

Are you aware of any court orders which are still outstanding?

 

If so, describe:

Date of last separation from your spouse:

 

Address at which you last lived together as husband and wife:

Describe circumstances of separation:

Did you and your spouse have any marriage counselling?

If the answer is yes provide a brief description of the counselling and state the name and address of the counsellor:

INCOME AND EMPLOYMENT INFORMATION

YOUSPOUSE
Occupation/Job Title:
Place of Employment
Gross Income: Weekly or
Bi-weekly or
Monthly

Fringe benefits: (Health and life insurance, travel expenses, tips, expense account, profit sharing, incentive plans, vehicle tuition assistance, employer pension contributions, housing and/clothing allowances etc.) Please specify, and indicate whether it is for you or for your spouse:

 

Other income: (Income from business, investments, child support, property settlements, sales, trusts, insurance, pensions, social security, welfare, unemployment compensation, workmen’s compensation etc.) Indicated whether it is your income or your spouse’s income. Approximate on a monthly basis and provide source:

 

Total Net Income (amount actually received, i.e. after taxes) Per Month:
You: $

Your Spouse: $

 

Attach (send or bring with you) copies of three (3) of your most recent pay stubs that you have available and a copy of last year’s W-2 form.

INCOME FROM A BUSINESS [If Applicable]

If either you or your spouse operate a business, individually, jointly or in association with others, please answer the following questions:

Name of business:

 

Address:

Is this business incorporated: If so, in what state?

 

Is this business a partnership? If so, list the known partners and attach or forward a copy of the partnership agreement if you have access to it:

Describe your interest and/or the interest of your spouse in this business:

What is the nature of this business?

 

Who maintains the financial records of this business?

 

In what bank or banks are business receipts deposited and business accounts maintained?

 

Who is empowered to write checks on the business account? You?

Your spouse?

Others: (List)

 

Do you have access to any recent tax returns filed by this business?

 

If you do, please attach copies of three (3) years returns to this form or forward to this office.

Do you know if this business has borrowed any funds, sought credit or filed any loan applications in the last three years? Institutions or other lenders from which funds were borrowed or sought, and the purpose of such loans:

If you have access to any loan or credit applications filed by or on behalf of this business please attach them to this form or forward them to this office.

What was the annual gross income of this business last year? $

 

What was the annual net income of this business last year? $

 

Do you have an estimate of the value of this business? $

 

What is your estimate of the value of the business based on?

 

Does this business own real estate?

If yes, identify the real estate:

Please attach or forward any financial documents relating to this business in your possession.

ASSETS OWNED BY EITHER OR BOTH SPOUSES

As to each asset please indicate if it is owned by you or your spouse, or is jointly owned by both of you, or is partly owned by one or both of you with other persons.

Real Estate:

Property # 1 (Describe):

 

Location:

 

Description of buildings on this property: (i.e., Single-family, multi-family, commercial, etc.)

Owned by:

Date acquired:

Purchase price: $

 

Source of funds used for down payment?

 

Original Amount of mortgage: $

 

Bank holding mortgage:

 

Current balance due on mortgage: $

 

Second mortgages or home equity loans – Balance Due: $

 

Does this real estate produce income?

If answer is yes, state the monthly amount of rents collected: $

 

List all persons currently occupying or using this property:

 

Current annual real estate tax: $

 

Current assessed value of the property: $

 

Property # 2 (Describe):

 

Location:

 

Description of buildings on this property: (i.e., Single-family, multi-family, commercial, etc.)

Owned by:

 

Date acquired:

Purchase price: $

 

Source of funds used for down payment?

 

Original Amount of mortgage: $

 

Bank holding mortgage:

 

Current balance due on mortgage: $

 

Second mortgages or home equity loans – Balance Due: $

 

Does this real estate produce income?

If answer is yes, state the monthly amount of rents collected: $

 

List all persons currently occupying or using this property:

 

Current annual real estate tax: $

 

Current assessed value of the property: $

 

If you have copies of the deeds, mortgages, loan applications, tax bills, assessment notices or any documents relating to this property please forward them to this office.

Bank Accounts: Please list all bank accounts owned by you and/or your spouse. This includes all checking accounts, savings accounts, individual retirement accounts, money market accounts, certificates of deposit, credit union accounts, Christmas Club accounts, building and loan accounts, etc. [Again, use additional Sheets, if necessary]

Bank NameAccount #Type of Acct.Names on Acct.Current Bal.

Vehicles: Please indicate the make, model and year of any motor vehicle, plane, motorcycle or boat owned by either you and/or your spouse:

MakeModelYearOwned ByGaraged atFair Mkt Value

If there are any loans, liens, mortgages or other outstanding debts on any of these vehicles or boats please list the creditors and the amounts due:

 

Investments: Please list all stocks, bonds or other investments owned by you and/or your spouse:

Name of InvestmentNumber of SharesOwnerTotal Value

Trusts: Do you know of any money or property held in trust for you or your spouse?

If your answer is yes please identify the trust and the trustee. If you have any documents relating to this trust please attach them to this form or forward them to this office.

Insurance: Please list any policies of insurance maintained by you or your spouse and provide as much information about these policies as you have access to. If you have any documents relating to these policies please attach them to this form or forward them to this office.
For each insurance policy please list: Type (Life, Medical, etc.), Insurance Company, Name of Insured, Policy Number, Name of Beneficiary, and Present Cash Value, if any.

Pension, Retirement or Annuity Plans: Please list all retirement plans in which you or your spouse have an interest. If you have any records, statements or other documents relating to such plans attach copies to this form or forward them to this office:

For each Plan, please indicate: Person Covered by Plan, Plan Administrator, Beneficiary

Military Benefits: If you or your spouse are entitled to benefits, now or in the future, because of service in the military please describe such benefits. This includes military pensions, disability benefits, veterans benefits, tuition benefits etc. If you have access to any records or documents regarding such military benefits please attach them to this form or forward them to this office.

Civil Service Benefits: If you or your spouse are entitled to civil service benefits because of employment by a federal, state or municipal agency, now or in the future, please describe. If you have any records or documents in regard to such benefits please attach copies to this form or forward to this office. Such benefits include pensions, disability pensions or any other type of benefit arising from such employment:

Other assets: Please describe any other personal assets owned by you or your spouse jointly or individually and (if you know) state who owns them and the approximate value(s) of each:

Jewelry:

 

Furs:

 

Artworks:

 

Holiday decorations:

 

Stereo equipment:

 

Trophies:

 

Baseball card collections:

 

Sports items collections:

 

Comic book collections:

 

Plate collections:

 

Stamp collections:

 

Coin collections:

 

Matchbook collections:

 

Antique Toy collections:

 

Antique vehicle collections:

 

Doll collections:

 

Musical instruments collections:

 

Other collectables:

 

Books:

 

Family photos:

 

Tools:

 

V.C.R.s:

 

Television sets:

 

Cameras:

 

Lawnmowers:

 

Snowblowers:

 

Pets:

 

Season tickets to sporting and cultural events:

 

Club memberships:

 

Time-sharing rights:

 

Cemetery lots:

 

Leases:

 

Oil or mineral rights:

 

Parking rights:

 

Linens:

 

Household furnishings:

 

Antique furniture:

 

Ordinary furniture:

 

Royalties:

 

Copyrights:

 

Trademarks:

 

Promissory notes:

 

Computers:

 

Printers:

 

Software:

 

Savings Bonds:

 

Safe Deposit Box:

 

Other Antiques:

 

Miscellaneous Other Assets:

 

Do either you or your spouse have a license to practice any profession or business?

If your answer is yes, please describe:

Do either you or your spouse have any legal claims now pending against any other person or institution?

If your answer is yes, please describe:

Do either you or your spouse have the right to participate in any stock-option plan, profit-sharing plan or the right to any deferred compensation?

If your answer is yes, please state the details:

Do either you or your spouse have any actual or potential interest in a legacy or inheritance which has not yet been distributed from an estate?

If your answer is yes, please describe:

Do you or your spouse have any interest in a sale of property which is now pending or being offered, either as buyer or seller?

If yes, please provide complete details.

Do either you or your spouse have any cash in excess of $500 which is not deposited in any bank or financial institution?

If your answer is yes please describe:

Please list any other asset owned by either you or your spouse, or in which either of you has an interest, which has not been listed previously on this form:

EXPENSES

Please estimate your expenses and those of your spouse, to the best of your knowledge. If either you or your spouse has custody of minor children the maintenance of such children should be included in this list of expenses. Please list expenses on a weekly basis (for monthly expenses, first divide by 4.3 and insert the result in the table below)

Expenses are estimated:

Expense Item:

ExpenseYouSpouse
Rent
Mortgage
Heat
Electric
Water
Food
Telephone
Clothing
House Supplies
Household Maint./Repairs
Laundry
Vehicle Gas, Oil, Maint. & Insurance
Vehicle Loan Payments
Medical/Dental Expenses
Medical/Dental Insurance
Life/Disability Insurance
Other Loan Payments
Other Travel/Transportation
Pension/Retirement Plans
Entertainment
Club Memberships
Charitable Contributions
Vacations
Other (Specify)
Other (Specify)

LIABILITIES

Please list the amount of all outstanding liabilities of you or your spouse. Please indicate if the liability is joint or individual and state to whom the obligation is owed.

Mortgage Balance Due:

 

Second Mortgage or Home Equity Loan Balance Due:

 

Vehicle Loan(s): Balance Due: Monthly Payment:
1.

2.

3.

 

Home Improvement Loan:

 

Education Loans:

 

Line of Credit:

 

Other Bank Loans:

Credit Card(s):

Name of CardAccount #Balance DueMonthly PaymentWho is Making the Payment

Loans from Friends or Family members:

Other Outstanding Liabilities:

Other Financial Information that you think is pertinent that has not been shown above: