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211 2nd Street NW
Austin MN 55912
USA

507-434-9665

Marriage Dissolution Client Information Form

Marriage Dissolution

Please send copies of the following:

  • Three month’s worth of pay-stubs for you and your spouse

  • Tax returns for the previous 3 years

  • Recent retirement plan account statements

  • Brokerage account statements

  • Recent statements showing balance of debts on credit cards or other secured or unsecured debts

  • Appraisal and tax statement for homestead

  • Legal description for homestead or any other properties

  • Breakdown of health insurance coverage

Consultation Date:
Consultation Date:
Referred By:
Referred By:
Client Information
1. Full Name: *
1. Full Name:
List all names including maiden name.
4. Address: *
4. Address:
5. Phone Number 1: *
5. Phone Number 1:
6. Phone Number 2:
6. Phone Number 2:
10. Birthdate: *
10. Birthdate:
15. Are you presently in the military service?
16. Name of a person (other than your spouse) who is most likely to always know where you can be reached:
16. Name of a person (other than your spouse) who is most likely to always know where you can be reached:
17. Phone Number:
17. Phone Number:
19. Address for receiving mail (if different than home address):
19. Address for receiving mail (if different than home address):
Your Employment Information
20. Are you currently employed? *
If yes, proceed to question 21. If no, skip to question 29.
22. Employer Address:
22. Employer Address:
25. How often do you get paid?
$
$
List overtime, bonuses, commissions, and other employment.
List company name, company address, and length of employment.
31. Check the following income you receive or expect to receive:
Spouse's Personal Information
32. Full Name: *
32. Full Name:
34. Would they like their name to be changed after the dissolution?
35. Present Street Address: *
35. Present Street Address:
36. Phone Number 1: *
36. Phone Number 1:
37. Phone Number 2:
37. Phone Number 2:
40. Date of Birth: *
40. Date of Birth:
45. Is your spouse currently in the military service
47. Phone Number:
47. Phone Number:
49. Address for receiving mail if different then home address:
49. Address for receiving mail if different then home address:
Spouse's Employment Information
50. Is your spouse currently employed? *
If yes, proceed to question 51. If no, skip to question 59.
52. Employer Address:
52. Employer Address:
55. How often do they get paid?
$
$
List overtime, bonuses, commissions, and other employment.
List company name, company address, and length of employment.
61. Check the following income your spouse receives or expects to receive
Children born or adopted into this marriage
Do not list children from previous marriages or other relationships.
62. Do you have minor children from this marriage? *
If yes, proceed to question 63. If no, skip to question 72.
List full name, age, date of birth, and social security number.
64. Who do the children live with now?
65. Legal custody should be awarded:
66. Physical custody should be awarded:
67. Do you expect a contest over who should have custody of the children?
69. Do either of you have any non-joint minor children?
List full name, age and date of birth.
71. Are there any daycare costs?
Marital Information
72. Did you sign a pre-marital agreement? *
73. Date of marriage: *
73. Date of marriage:
75. Are you living together?
76. If no, date of separation:
76. If no, date of separation:
77. Are you or your spouse pregnant?
78. Is your spouse the parent of the children born into the marriage?
82. Is there a history of domestic abuse in your marriage relationship?
83. Has there ever been an Order for Protection in place?
Information about other marriages or relationships:
85. Were you previously married?
If yes, proceed to question 86. If no, skip to question 93.
86. When were you divorced?
86. When were you divorced?
per:
per:
per:
per:
Information regarding your spouse's prior marriage or relationships
93. Was your spouse previously married?
If yes, proceed to question 94. If no, skip to question 102.
94. Are there any minor children from their previous marriage?
If yes, proceed to question 100. If no, proceed to question 101.
List Full Name, Age, Date of birth and Social Security Number. Do not list children from previous marriages or other relationships.
per:
per:
per:
per:
Health Insurance
Check all that apply.
102. Medical insurance, provided by you, covers:
103. Dental insurance, provided by you, covers:
104 Optical insurance, provided by you, covers:
105. Other insurance, provided by you, covers:
106. Medical insurance, provided by spouse, covers:
107. Dental insurance, provided by spouse, covers:
108. Optical insurance, provided by spouse, covers:
109. Other insurance, provided by spouse, covers:
Assets
We will need a copy of a deed or mortgage containing the legal description for each parcel of real property.
Homestead:
110. Do you own your homestead? *
If yes, proceed to question 111. If no, proceed to question 129.
111. Address:
111. Address:
112. Do you have a copy of a deed to this property?
114. Purchase date:
114. Purchase date:
118. Name on title:
118. Name on title:
123. Does the payment include taxes?
125. Does the payment include insurance?
126. Are the house payments delinquent?
Other Real Estate:
129. Do you have other real estate? *
If yes, proceed to question 130. If no, skip to question 148. If more than 1, email additional information to forms@donnallylaw.com.
130. Address:
130. Address:
131. Do you have a copy of a deed to this property?
133. Purchase date:
133. Purchase date:
137. Name on title:
137. Name on title:
142. Does the payment include taxes?
144. Does the payment include taxes?
145. Are the house payments delinquent?
Retirement Account Plan
List type of plan (IRA 401k, Keogh, Profit Sharing, ESOP, SEP, PAYSOP, etc), name, and value.
Debts
149. Does anyone owe you or your spouse money?
List the debt, who incurred it and balance owed.
Vehicles
Type of vehicle, name on title, amount owed, who will retain during the divorce.
Miscellaneous
154. Did you or your spouse bring money into the marriage?
157. Do you have any personal injury or worker's compensation claims pending?
158. Does your spouse have any personal injury or worker's compensation claims pending?
159. Have you received any settlements or rewards?
160. Has your spouse received any settlements or rewards?
*We recommend printing this form before submitting.