Divorce Questionnaire

STEP I

Please fill out and print the questionnaire to begin your process. If you can not fill it out at one sitting, please go as far as you can, print the questionnaire with the answers you have up to that point, and finish filling it out by hand. Please fill out the form in its entirety. If there is a question that does not pertain to you, write None.

Please enclose a check or money order for your $200 deposit made out to ‘A Complete Divorce ™’. The final $200.00 balance will be due when your final papers are prepared. The filing fee will be paid at the time of filing your documents. Make sure you make a note of any special needs such as services from the state, medical assistance, etc.

As soon as we receive your completed questionnaire, we will insert your information into the forms and mail you your first sets of completed forms for your review and signature to begin your process.

Mail to: A Complete Divorce, 37 S Reserve Ave, Fond du Lac, WI 54935

QUESTIONNAIRE

Wife Personal Information			Husband Personal Information
Last Name		Last Name
First Name		First Name
Middle Name		Middle Name
Maiden Name		Maiden Name
Address		Address
City, State, Zip		City, State, Zip
County		County
E-Mail Address		E-Mail Address
Home Phone		Home Phone
Social Security No.		Social Security No.
Birthdate	Age	Birthdate	Age

Employment Information		Employment Information

Employer Name		Employer Name
Address		Address
City, State, Zip		City, State, Zip
Phone		Phone
Occupation		Occupation
Pay Rate		Pay Rate
Monthly Income		Monthly Income
How Paid		How Paid
This marriage is Number		This marriage is Number
Last marriage terminated		Last marriage terminated
Terminated By		Terminated By
County		County
State		State
Date		Date

This Marriage Facts

Date of Marriage
City of Marriage
State of Marriage
Date of Separation

	Is Wife Pregnant Yes No
This Marriage Court Facts

Petitioner or
Joint Petitioner-Wife
Respondent or
Joint Petitioner-Husband

Who has lived in county for30daysand state for 6 months	State County

Real Estate Property
Address
City, State, Zip
	Are You Selling Home Yes No
	Party to Keep Home Wife HusbandNeither	Amount to pay other party

Auto
Husband
Wife


Children Born During The Marriage

Custody of Children Joint Custody Wife Sole Custody Husband Sole Custody Placement of Children Placement Wife Placement Husband Shared Placement W's % H's %

Names	Birthdate	Age	Social Security #	Living With





Attach Additional List if Necessary

Child Support this Family
Is Child Support Paid	Wife Yes No	Husband Yes No
How Much
Case #

Other Child Support Obligations
	Wife Yes No	Husband Yes No
How Much
Case #


Medical Insurance Who Covers Family	Wife Yes No	Husband Yes No

State Aid	Wife Yes No	Husband Yes No
Explain

Debts
Creditor	Purpose	Balance	Monthly	Who Pays

STEP II

Mail completed questionnaire with a check or money order for $200.00 to:

A Complete Divorce

37 S Reserve Ave

Fond du Lac, WI 54935

If there any questions, please call 1-800-676-6576