CLIENT QUESTIONNAIRE - PREMARITAL AGREEMENT Today’s Date _________________________ Anticipated Date of Marriage __________________ Information About You Your Name ______________________________ Date of Birth __________________________ Home Address (include county) ____________________________________________________ Telephone: Home ________________________ Business _____________________________
Employer _____________________________________________________________________ Employer Address ______________________________________________________________ Occupation ______________________________ Annual Income _______________________ Have you ever been married? _______ Yes ________ No If yes, list names, addresses and
telephone numbers of former spouses _______________________________________________ ______________________________________________________________________________ Do you have any children? _______ Yes __________No If yes, list names, genders, birth dates, birthplaces, and identities of natural parents of children ____________________________ ______________________________________________________________________________ ______________________________________________________________________________ Are you in good health? _______ Yes ________ No If no, list medical conditions requiring
attention _____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
==================================================================== Information About Your Prospective Spouse Prospective Spouse’s Name __________________________ Date of Birth__________________ Home Address (include county) ____________________________________________________
QUESTIONNAIRE - PREMARITAL AGREEMENT PAGE 1 OF 2
Telephone: Home ________________________
Business _____________________________
Employer _____________________________________________________________________ Employer Address ______________________________________________________________ Occupation ______________________________ Annual Income _______________________ Has your prospective spouse ever been married? _______ Yes ________ No If yes, list names,
addresses and telephone numbers of former spouses___________________________________ ______________________________________________________________________________ Does prospective spouse have any children? _______ Yes __________No If yes, list names, genders, birth dates, birthplaces, and identities of natural parents of children_________________ ______________________________________________________________________________ ______________________________________________________________________________ Is prospective spouse in good health? _______ Yes ________ No If no, list medical conditions
requiring attention______________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
==================================================================== Property Owned by Parties 1. Each party must attach a separate list regarding nature, extent and reasonable market value of property owned by each party prior to marriage. Include all real property (list current equity and reasonable market value), all cash on hand, all money on deposit with banking institutions, all CD’s, all stocks and bonds, any retirement benefit plans, any debts owed to you, itemize any lawsuits you are involved in and expected amount of damages related thereto. Also include personal property, such as automobiles, boats, jewelry, furniture, household items, etc. Each party must attach an itemization of property that each party wants to hold free and clear of any interest that other party may acquire by virtue of contemplated marriage. (Please consider whether you want to hold as separate property: future earnings from personal services, income from separate property, increase in value of separate property.)
2.
QUESTIONNAIRE - PREMARITAL AGREEMENT
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