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					       Thank you for choosing Jones & Duff, LLC to help you through your separation
and divorce. This form was developed to help our experienced attorneys guide you
through the process and easily as possible. Divorce is never easy, but when you are
organized and thoughtful, the process can be much smoother.
       Fill out this form as best you can. When you meet with our attorneys, they will
go over it with you and answer any questions you have at that time.

1.     BASIC INFORMATION

Your Full Legal Name: ____________________________________________________

Your date of birth ______________________ Your Soc. Security # _________________

Number of this marriage for you (1st, 2nd, 3rd, etc.) _______________________________

Your Spouse’s Full Legal Name: ____________________________________________

Spouse’s date of birth __________________ Spouse’s Soc. Security # _______________

Number of this marriage for your spouse (1st, 2nd, 3rd, etc.) ________________________

Wife’s maiden name: ________________________ Name restored? Yes/No

Minor Children: (this only includes children of whom you and your spouse are both the
legal parents; it does not include your children or your spouse’s children from a previous
marriage.)
Full Name                                                            Date of Birth
__________________________________________________                   _________________

__________________________________________________                  _________________

__________________________________________________                  _________________

__________________________________________________                  _________________

__________________________________________________                  _________________

__________________________________________________                  _________________

Date and place of your marriage: _____________________________________________
Date of Separation: _______________________________________________________

Address at which you lived with your spouse: __________________________________

_______________________________________________________________________

Address where your spouse lives now: ________________________________________

________________________________________________________________________
Address where you live now: ________________________________________________

________________________________________________________________________


2.     PERSONAL PROPERTY

Personal property is your ‘stuff’. This includes the furniture and electronics in your
home, the china and silverware, your cars and other vehicles, jewelry, lawn equipment,
tools, and the other items in your home. It does not include bank accounts and other
investments or real estate. We will deal with these in another section. There may be
some of these personal property items that have a great deal of monetary value, and some
that aren’t worth much money but mean a lot to you. Think about the items in your home
and what you want to keep and what you might want your spouse to have. Be as specific
as you think is necessary, and use additional paper if you need to. Next to the description
of each vehicle/piece of property, please place a check indicating if the property should
go to the Husband or the Wife.

                                                            Vehicle Goes To:
Vehicle Description                                         Husband      Wife

______________________________________________              _________       ___________

______________________________________________              _________       ___________

______________________________________________              _________       ___________

______________________________________________              _________       ___________


                                                            Property Goes To:
Personal Property Description                               Husband      Wife

______________________________________________              _________       ___________

______________________________________________              _________       ___________
______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________

______________________________________________            _________      ___________


3.     REAL PROPERTY
       Real Property is the real estate you own. It may include a house or land. In the
“debt owed” column, list the mortgage, and any second mortgage or equity line balances.
Under H/W?, please indicate with a “H” for “husband” or a “W” for “wife” if you think
the husband or wife should ultimately get that house/piece of property.

Address of Property                         When Purchased         Debt Owed     H/W?

___________________________________ _________________ __________________

___________________________________ _________________ __________________

___________________________________ _________________ __________________

___________________________________ _________________ __________________

4.     BANK ACCOUNTS AND OTHER INVESTMENTS

       A.      Please list the bank accounts you have in your name only, your spouse’s
name only, and the accounts you hold jointly. For this and the other sub-sections below,
when you speak with our attorneys we will discuss whether these accounts are marital or
individual property, and how best to divide them.

                                            Type of        Name(s) on     Approx.
Bank                  Account No.           Account        Account        Balance

_________________ _________________ ___________ ___________ ____________

_________________ _________________ ___________ ___________ ____________

_________________ _________________ ___________ ___________ ____________

_________________ _________________ ___________ ___________ ____________

_________________ _________________ ___________ ___________ ____________

       B.     Please list any retirement accounts you have, and list whether they are
pension accounts, 401k accounts, IRAs, or any other type of account.

Description of                                             Name(s) on     Approx.
Account                              Account No.           Account        Balance

_____________________________ _________________ ___________ ____________

_____________________________ _________________ ___________ ____________

_____________________________ _________________ ___________ ____________

_____________________________ _________________ ___________ ____________
_____________________________ _________________ ___________ ____________

       C.      Please list any other investment accounts you have.

Description of                                              Name(s) on     Approx.
Account                              Account No.            Account        Balance

_____________________________ _________________ ___________ ____________

_____________________________ _________________ ___________ ____________

_____________________________ _________________ ___________ ____________

_____________________________ _________________ ___________ ____________

_____________________________ _________________ ___________ ____________


5.      CUSTODY AND VISITATION
        For each child listed above, please list which parent you think should have
primary physical custody of that child. This form assumes joint legal custody, and
standard visitation. We will discuss the details of the difference between physical and
legal custody, and what ‘standard’ visitation means when you meet with our attorneys.

Name of Child                                               Primary Custodian

_______________________________________________ ________________________

_______________________________________________ ________________________

_______________________________________________ ________________________

_______________________________________________ ________________________

_______________________________________________ ________________________

_______________________________________________ ________________________


6.      ALIMONY
        If you think alimony is appropriate, please list the monthly amount you think is
appropriate, and think about how you arrived at this number prior to your meeting. We
will discuss with you whether or not your situation is appropriate for an award of
alimony.
Amount: ________________________________________________________________

7.      DEBT
        Just like your property needs to be divided, your debt needs to be divided as well.
Please list the debts you owe, and indicate in the column marked “H/W?” who you think
should be responsible for this debt, with “H” indicating “husband” and “W” indicating
“wife”. We will discuss the legal ramifications of this when you come in to speak with
us.

A.    Mortgage and Equity Loans
      This includes any mortgages, second mortgages, and equity lines of credit you
may have.

Bank                           Loan No.               Approx. Bal.           H/W?

_______________________ _________________ _________________ ____________

_______________________ _________________ _________________ ____________

_______________________ _________________ _________________ ____________

_______________________ _________________ _________________ ____________

B.     Credit Card Debt
       Please list all the credit cards you are aware of, even if they are not in your name.
Under the “name” column, please indicate whose name is on the account. Under the
column marked “H/W?” please indicate who you think should be responsible for this
debt, with “H” indicating ‘husband” and “W” indicating “wife”.

Bank/Store                     Account No.            Name           Approx Bal. H/W?

_______________________ _________________ ___________ ___________ ______

_______________________ _________________ ___________ ___________ ______

_______________________ _________________ ___________ ___________ ______

_______________________ _________________ ___________ ___________ ______

_______________________ _________________ ___________ ___________ ______

_______________________ _________________ ___________ ___________ ______

_______________________ _________________ ___________ ___________ ______

_______________________ _________________ ___________ ___________ ______
_______________________ _________________ ___________ ___________ ______

C.     Other Debt
       Please list any other debts you may owe. This may include loans from friends or
family members, car loans, or any other money you may have borrowed. Under the
column marked “H/W?” please indicate who you think should be responsible for this
debt, with “H” indicating ‘husband” and “W” indicating “wife”.


Description of Debt                  Account No.           Amount Owed           H/W?

_____________________________ _________________ _________________ ______

_____________________________ _________________ _________________ ______

_____________________________ _________________ _________________ ______

_____________________________ _________________ _________________ ______

_____________________________ _________________ _________________ ______

_____________________________ _________________ _________________ ______

_____________________________ _________________ _________________ ______

_____________________________ _________________ _________________ ______

_____________________________ _________________ _________________ ______


8.     MISCELLANEOUS
       Please use this section to write down any additional concerns or questions you
might have for us.

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________
_______________________________________________________________________

        Thank you again for choosing Jones & Duff, LLC to help you with this matter,
and thank you for taking the time to fill out this form. It will greatly assist us in
organizing your file and ensuring that we understand exactly what your assets are and
what you hope to come away with. We will go over this form in detail at your meeting,
in addition to other matters that we may need to discuss. We promise to do our best to
see that your rights are protected and your needs are met during this process, and look
forward to meeting with you.

				
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