INTAKE INFORMATION
DIVORCE WITHOUT CHILDREN
WIFE:
Name: ___________________________ Address: _________________________
________________________________
County and State of Residence: _____________________________________________
How long resided in County: ________________
How long resided in Michigan: ________________
Date of birth: _____________________ State of birth: _________________________
Home telephone: ___________________ Work telephone: _______________________
Last Grade Completed: ____________ Advanced Degrees:________________________
Occupation: ________________________________________________________________
Employer: _______________________________________________________________
Name, address, telephone number
Gross Weekly Wage: ________________________
Driver License Number: __________________________________________________
Social Security Number: __________________________________________________
Eye Color ______ Hair Color _______ Height _______ Weight _____ Race: ________
Scars, tattoos, etc. _______________________________________
Wife's name prior to marriage: ________________ Wife's maiden name: ___________
Health (in general):________________________________________________________
HUSBAND:
Name: ___________________________ Address: _________________________
________________________________
County and State of Residence: _____________________________________________
How long resided in County: ________________
How long resided in Michigan: ________________
Date of birth: _____________________ State of birth: _________________________
Home telephone: ___________________ Work telephone: _______________________
Last Grade Completed: ____________ Advanced Degrees:________________________
Occupation: ________________________________________________________________
Employer: _______________________________________________________________
Name, address, telephone number
Gross Weekly Wage: ________________________
Driver License Number: __________________________________________________
Social Security Number: __________________________________________________
Eye Color ______ Hair Color _______ Height _______ Weight _____ Race: ________
Scars, tattoos, etc. _______________________________________
Health (in general):________________________________________________________
PLACE OF MARRIAGE: _________________________________________
City, County, State
WHO PERFORMED MARRIAGE: (CIRCLE ONE) Minister Priest Rabbi Judge Magistrate
DATE OF SEPARATION: ________________________________________
NUMBER OF MARRIAGE FOR WIFE: _____________ [FIRST SECOND, ETC.]
NUMBER OF MARRIAGE FOR HUSBAND: _____________ [FIRST SECOND
Is the wife now pregnant? _____________
PROPERTY:
Did the parties acquire any real estate during the marriage? _________
If so, do you still own it? __________________
If sold, have the proceeds been divided? ________________
If proposed to be sold, how will the proceeds be divided? ________________
If proposed to be sold, will the marital debts be deducted from the net sale proceeds prior to distribution of proceeds? ________________
If you still own real estate, complete the next question:
REAL ESTATE: ___________________________________________________________
Address
PENSIONS, IRAs, RETIREMENT PLANS:
Wife: ____________________________________________________________________
Husband: __________________________________________________________________
PERSONAL PROPERTY: [Rather than to attach a list, you may decide that you will have divided it by the time the Judgment is entered, and agree to a Judgment that states "The parties are awarded the personal property that is in the hands of the party on the date of judgment."]
MARITAL DEBTS: [These consist of all debts, no matter what the purpose, incurred during the marriage]. List Creditor, account # and present total debt. Attach an extra sheet, if necessary.
Creditor Acct # Debt Amount
____________________ _________________________ ___________
____________________ _________________________ ___________
____________________ _________________________ ___________
____________________ _________________________ ___________
____________________ _________________________ ___________
____________________ _________________________ ___________
____________________ _________________________ ___________
____________________ _________________________ ___________
ALIMONY: Is either party requesting or expecting alimony? YES _______ NO ________
[If yes, state the amount and the length of time]