SEPARATION AND PROPERTY SETTLEMENT AGREEMENT QUESTIONNAIRE

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SEPARATION AND PROPERTY SETTLEMENT AGREEMENT QUESTIONNAIRE Powered By Docstoc
					                                   The Law Corner
                                    211 E. Six Forks Road, Suite 205
                                     Raleigh, North Carolina 27609
Telephone: (919) 424-8319                                                   Facsimile: (919) 424-8320

   SEPARATION AND PROPERTY SETTLEMENT AGREEMENT QUESTIONNAIRE

         We will use the information you supply in this Questionnaire to prepare a Separation and Property
Settlement Agreement. You should complete this worksheet in as much detail as possible. If you do not have
the information needed to complete any part, attempt to obtain such information from your spouse or from
other sources.

         Once the Separation and Property Settlement Agreement is executed, it becomes binding on both
parties and its provisions can only be changed by mutual consent through a written and signed modification.
Only in some instances can the court change a provision of the Agreement.

         Indicate your preferences and desires and state which terms you consider non-negotiable. Be fair and
be reasonable. We will discuss the proposed provisions with you and will negotiate with your spouse, or your
spouse's attorney, in the event of controversy. It may become necessary to go to court to defend your
interests if a reasonable compromise cannot be reached.

        Should any questions or problems arise, please do not hesitate to call at (919) 424-8319 or leave a
message. You may also transmit a message or documentation via facsimile at (919) 424-8320. We consider it
our pleasure to represent you and look forward to working with you in this matter.

       Please be thorough with your answers and do any investigation into figures that is necessary. An
incomplete questionnaire makes this process more difficult.


                                           MARITAL DATA

1. Date and Place of Marriage: ___________________________________________________________

2. Date of Separation: ________________________________________________

3. Children:

  Names:                                                         DOB:

________________________________________________                 ______________________

________________________________________________                 ______________________

________________________________________________                 ______________________

________________________________________________                 ______________________

________________________________________________                 ______________________


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                            PERSONAL INFORMATION OF CLIENT

1. Full Legal Name:_______________________________________________________________________

2. Address:______________________________________________________________________________

City: ___________________________________________________________________________________

County ______________________________________ State_________________ Zip__________________

3. Home Telephone: (_______) _____________________________________________________________

4. Email: _______________________________________________________________________________

5. Employer:____________________________________________________________________________

6. Years Employed:_______________ Social Security No._______________________________________

7. Annual Salary? _________________

8. Does the employer provide any of the following:

Retirement fund?       Yes____; No____ Vested $____________

Pension fund?          Yes____; No____ Vested $____________

Stock purchase?        Yes____; No____ Vested $____________

401K Plan?             Yes____; No____ Vested $____________

Other:__________________________________________________________________________________

9. Any military pension?____________ $___________/month

10. Reason for Separation: _________________________________________________________________

                              PERSONAL INFORMATION OF SPOUSE

1. Full Name of Spouse:____________________________________________________________________

2. Address:______________________________________________________________________________

City: ___________________________________________________________________________________

County ______________________________________ State_________________ Zip__________________

3. Telephone: (_______) _____________________________________________________________

4. Email: _______________________________________________________________________________

5. Employer’s Name and Address: ___________________________________________________________

_______________________________________________________________________________________

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6. Years Employed:_______________ Social Security No._______________________________________

7. Annual Salary? _________________

8. Does the employer provide any of the following:

Retirement fund?        Yes____; No____ Vested $____________

Pension fund?           Yes____; No____ Vested $____________

Stock purchase?         Yes____; No____ Vested $____________

401K Plan?              Yes____; No____ Vested $____________

Other:_________________________________________________

9. Any military pension?____________ $___________/month

10. Are there past retirement accounts? _______________________________________________________

11. Any life insurance, if so, what amount on whom: ____________________________________________

                                                ALIMONY

We will explain the law applicable to alimony during your consultation. A Waiver of Alimony is usually
irrevocable.

1. Do you wish to waive post separation support or alimony? __________________

2. If alimony is to be paid, indicate who will pay and an estimate of the amount needed:

Husband _________________ $_____________________________

Wife ____________________ $_____________________________

3. It is customary to continue existing medical insurance coverage on a covered spouse. Please indicate who
will be responsible for medical insurance coverage and how you would like expenses not covered by
insurance paid:

_____Husband_____Wife to maintain health insurance through date of ____divorce ____separation.

_____Husband_____Wife will pay __________percent of un-reimbursed medical expenses.

                                       PROPERTY SETTLEMENT

1. Address of marital home (include county):

_______________________________________________________________________________________

_______________________________________________________________________________________

Property purchased in (year)___________ by Client_______ by Spouse_____ by both ___________


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Property is deeded in the name of: Client _______ Spouse_____ both parties ___________

Disposition of Property:

_____ Current possession to Client _____________Spouse_________________ until:

_______________________________________________________________________________________

_____ Sell and divide proceeds _________________% to Client and ____________% to Spouse

_____ Possession only to Client ______________ or Spouse ______________________until:

_______________________________________________________________________________________

Other (please specify) _____________________________________________________________________

Current FMV of property: $__________________________

Property to be listed for $____________________________

Property to be sold for $_____________________________

Current mortgage balance as of ____________________is $___________________________

Exemption this year to be claimed by Client ______ Spouse ______

House Related Expenses:

To be paid by Client _______ Spouse _______:

_____ Mortgage payments, including principal and interest

_____ Property taxes & assessments

_____ Insurance costs

_____ Utilities

_____ Maintenance/repair costs

Until:

______ Date of divorce

______ 30 days from date of sale

______ Other (please specify) _____________________

Is there a second home?____________________________________________________________________

Is there any rental property? ________________________________________________________________

Are there any time shares?__________________________________________________________________

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                                    DIVISION OF MOTOR VEHICLES:

_______ There are no jointly titled vehicles

_______ Each spouse keeps vehicle titled in his/her name

Client will have the following vehicles and car payments will be made by

Client_____ Spouse_____

  Year           Make             Model              Name(s) on Title Now

a.__________ _____________ _______________ ____________________________________________

b.__________ _____________ _______________ ____________________________________________

Spouse will have the following vehicles and car payments will be made by

Client_____ Spouse_____

 Year            Make            Model              Name(s) on Title Now

c.__________ _____________ _______________ ____________________________________________

d.__________ _____________ _______________ ____________________________________________

Amount owed on each vehicle is as follows:

Name of Lender                             Account Number                     Balance due               Monthly

a.______________________________ ___________________________ $______________ $__________

b.______________________________ ___________________________ $______________ $__________

c.______________________________ ___________________________ $______________ $__________

d.______________________________ ___________________________ $______________ $__________

How is your automobile insurance titled:

____________ Jointly

____________ Each person has a separate policy



                                    DIVISION OF UNSECURED DEBTS:

Please list all debts regardless if they are separate or joint debts as of the date of separation or anticipated
date of separation. For each debt, designate whether the debt is a joint obligation or a separate liability.


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The Client shall assume sole responsibility for repaying the balance owing, including interest, of the
following:

    Name of Lender               Account Number                     Balance due              Liable Party




The Spouse shall assume sole responsibility for repaying the balance owing, including interest, of the
following:



    Name of Lender               Account Number                     Balance due              Liable Party




                                             DIVISION OF ASSETS:

List all stocks, bonds, bank accounts (savings and checking) certificates of deposit, etc.

Please list these assets regardless if you have already agreed to a division. Be specific.

_______ There are no jointly titled assets

_______ Each spouse keeps assets in his/her name



The Client will be entitled to the following jointly held assets:

Type of Asset                Account Number                 Name of Bank/Broker          Current Value




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The Spouse will be entitled to the following jointly held assets:

Type of Asset               Account Number                 Name of Bank/Broker      Current Value




                                 DIVISION OF PERSONAL PROPERTY:

Household furnishings, appliances, etc. to be divided as follows:

______ Each spouse keeps what is in his/her possession (Only if you are currently separated)

______ The parties will be entitled to items listed below:

                      CLIENT                                                SPOUSE




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                                         SEPARATE PROPERTY:

Separate property” means all real and personal property acquired by a spouse before marriage or after the
date of separation, or acquired by a spouse by bequest, devise, descent, or gift during the course of the
marriage.

                      CLIENT                                                   SPOUSE




                                             CHILD CUSTODY

If you and your spouse have minor children, you should complete this section.

A decision must be made concerning the form of custody arrangement that you and your spouse decide will
be in the best interest of your child(ren). The options are basically as follows (check the option you and your
spouse elect):

Is there any reason why the biological parents would not share JOINT LEGAL CUSTODY? (This covers
decision making pertaining to health, education and religion.)

What visitation rights will the non-custodial parent have?

_____ Sole Custody-visitation. Under this arrangement, one spouse has custody of the minor child(ren) and
the other has visitation rights.

_____ Joint or shared custody. Under this arrangement, each parent has approximately equal time with the
child(ren). This works best if there is a set structure that is in the best interest of the child(ren).

Do you both agree that each parent is a fit and proper person to have custody and visitation rights with the
child(ren)? If not, explain.

Work out an agreeable visitation or temporary custody schedule for the noncustodial spouse. You should
plan such schedule taking into consideration the work schedules of each party and the schedules and needs of
the child(ren). The minimum visitation schedule should include a period of time on alternate weekends, at
holidays, birthdays, Father’s Day, Mother’s Day and summer vacation.

Do you wish to have the following special provisions?

_____ Right of first refusal

_____ Noncustodial parent to pay for transportation costs for visitation.


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_____ Neither parent allowed to take a child out of the U.S. without prior written consent.

_____ Sixty (60) days’ written notice to the other party before moving residence.

_____ Neither party to stay overnight with person of opposite sex to whom they are not related.

_____ Both parents to have equal access to medical and school records.

_____ Each party to notify the other if a child is ill.

_____ Each party authorized to seek emergency medical care.

_____ Parents to confer on important matters such as discipline, education, religion, special events, etc.

_____ Any other special provision:

                                              CHILD SUPPORT

What is your gross income?

What is your spouse’s gross income?

Who provides health insurance and what is the cost between single and family coverage?

What are the monthly daycare costs?

                                                  Other Issues

Please write a short summary of anything else you think we should know.

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________




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               PERSONAL PROPERTY DIVISION


Item   Value                    Husband     Wife


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