Divorce Agreement Page 2

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Weekly Gross Income $
Weekly Net (Take Home Pay) $
Deductions:
$
(Taxes, pensions, union dues and medical insurance for children only.)
Residence owned or rented?
Highest Grade Completed in School:
3. Date of Marriage:
By Whom Married:
Please indicate whether judge, minister, magistrate, etc.)
4. Place of Marriage:
City/Township
County
State
5. Previous married name of wife, if any:
Maiden Name:
6. Number of this marriage for Plaintiff _______ Defendant ___________
7. Wife's name restored, and if so, what name?
(If filing party is wife, there is no charge for restoration of prior name. However, if filing party is husband, we charge a
$35.00 processing fee to have prior name restored).
8. How long have you been a resident of your county? _______ years
9. How long have you been a resident of Michigan? _______ years
10. Date you last lived together as husband and wife: ____________, 200__. (Estimate if necessary)
Please list name, age(s) of birth of all minor children OF marriage:
NAME
AGE
S.S.#
DATE OF BIRTH
11. Is wife pregnant? ____ Yes ____ No (to the best of your knowledge)
ANY children born during the marriage other than above? Explain below:
12. Address where each child is currently living:
13. Address where the children have lived for the last five (5) years, and with whom they lived at each address:
14. Has there ever been a custody matter regarding any of the minor children in a court of this state or another
state? ______ If yes, state where and what was involved:
15. Is there any person other than you and your spouse who has physical custody of any of your children or
who claims to have custody or visitation rights regarding any minor child in this case? ______ If yes, give
details and attach copies of any court orders:
16. Name any person other than you and your spouse in whose custody the minor children may be found or
kept during this divorce:
17. Who will have custody of the minor child or children in this divorce action?
______ Mother ______ Father ______ Joint physical and legal

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