Confidential Divorce Questionnaire Template Page 2
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4Abraham & Zoticus, PC
Confidential Divorce Questionnaire
Page 2
5.
Are
y ou
c urrently
e mployed?
Y es
N o
If
y es,
p lease
p rovide:
a.
Name
o f
e mployer
Length
o f
e mployment
b.
Street
a ddress
c.
City,
S tate,
Z ip
d.
Telephone
n umber
Fax
n umber
e.
What
i s
y our
m onthly
g ross
s alary?
$
Take
h ome?
f.
What
i s
y our
j ob
t itle?
6.
Where
i s
y our
s pouse
l iving
a nd
w hat
i s
y our
s pouse's
t elephone
n umber?
a.
Address
b.
City,
S tate,
Z ip
c.
Home
t elephone
n umber
d.
How
l ong
i n
O regon?
7.
Is
y our
s pouse
c urrently
e mployed?
Y es
N o
If
y es,
p lease
p rovide:
a.
Name
o f
e mployer
Length
o f
e mployment
b.
Street
a ddress
c.
City,
S tate,
Z ip
d.
Telephone
n umber
Spouse's
j ob
t itle?
e.
What
i s
y our
s pouse's
m onthly
g ross
s alary?
$
Take
h ome?
$
8.
Do
y ou
h ave
a ny
c hildren?
Y es
N o
If
s o,
p lease
g ive
f ull
n ame,
d ate
o f
b irth
a nd
s ex
o f
e ach
c hild,
a nd
i ndicate
w hether
the
c hild
w as
b orn
o f
t his
m arriage
o r
o f
a
f ormer
m arriage
o f
y our
s pouse
o r
y ou.
Full
N ame
Sex
Birth
d ate
Age
Ours
Mine
Spouse's
Are
y ou
o r
i s
y our
s pouse
n ow
p regnant?
Y es
N o
9.
Answer
o nly
i f
y ou
a re
i nquiring
a bout
a
d ivorce.
I f
y ou
a re
a lready
d ivorced
and
a re
n ow
s eeking
a
m odification,
s kip
t his
q uestion
a nd
a nswer
q uestion
#10.
a.
Are
y ou
s eparated
f rom
y our
s pouse?
Y es
N o
Date
o f
s eparation:
b.
Were
a ny
o f
t he
c hildren
l iving
i n
y our
h ousehold
a t
t he
t ime
y ou
a nd
y our
spouse
s eparated?
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Parent category: Life