Confidential Dissolution Questionnaire

This is the form we like filled out before your first appointment. If you have not filled out an appointment, you may fill this out, and either schedule an appointment online or call us to schedule, or we can call you.

Confidential Dissolution Questionnaire - Part One

Initial Intake

Contact Information

(NOTE – we will likely be sending confidential materials to this account, so if you are uncertain whether it is secure, you should change the password)

Employment Information



(Note – use 4.33 multiplier to convert from weeks to months)

Spouse's Information


Retirement & Bank Information (i.e. Pensions, 401(k)s, IRA, Checking, Savings, etc.)


Other significant assets (i.e. boats, snowmobiles, burial plots, other titled assets,
valuable collections (other than miscellaneous household goods).


*i.e. miscellaneous marital, non-marital use, car, attorney’s fees, etc.
** Husband, wife, or split – if you don’t know yet, just put the way you expect it to be.
(Note – if your tax refunds get direct deposited into a bank account where you owe $$ to the bank and are not current, they can take it)
• Discuss parenting class
• Discuss asset division valuation date
• Deductibility of certain items for calculating child support.
• Overtime in calculating child support
• Child support withholding application - $25