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Directions: 1) This is a single session data entry form. Complete and review all your entries before clicking "Submit Now." 2) After reviewing your entries, click the "Submit Now" button at the bottom of the form to send your data. 3) Contact and inform your attorney that you submitted the requested information.
Enter Confidential-Master Information Form
Enter Financial Declaration Data
Enter Child Support Information

GENERAL

WIFE/MOTHER

HUSBAND/FATHER

CHILDREN

Confidential-Master Information Form
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SINGLE SESSION -- ENTER ALL DATA ON ALL FORMS AT ONE TIME
After entering ALL data, you must click the "Submit Now" button on the bottom of this form to send your data!

GENERAL INFORMATION	*Press Tab Key to Move From Field to Field
County Name
Date of Marriage (if applicable)
Where Married - County and State (if applicable)
Date of Separation (if applicable)
Number of Children (if applicable)
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WIFE/MOTHER'S INFORMATION (*If parties are not married, female's information)	*Press Tab Key to Move From Field to Field
NAME
Title of Wife (i.e., Ms. Mrs., Dr.)
Wife's First Name
Wife's Middle Name
Wife's Last Name
Wife's Nick Name
TELEPHONE
Wife's Day Phone
Wife's Evening Phone
Wife's Msg./Pager Phone
Wife's Fax Phone
MAILING ADDRESS
Wife's Mailing Address
Wife's Mailing City
Wife's Mailing State
Wife's Mailing Zip
RESIDENTIAL ADDRESS Leave blank if you wish to use your mailing address as your residential address.
Wife's Residential Address
Wife's Res. City
Wife's Res. State
Wife's Res. Zip
Wife's Res. County
EMPLOYMENT
Wife's Employer Name
Wife's Employer Phone
Wife's Employer Address
Wife's Employer City
Wife's Employer State
Wife's Employer Zip
VITAL STATISTICS/CONFIDENTIAL IDENTIFICATION INFORMATION
Wife's Soc. Sec. Number
Wife's Driver's Lic/ID
Wife's Birthdate
Wife's Race
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HUSBAND/FATHER'S INFORMATION (*If parties are not married, male's information)	*Press Tab Key to Move From Field to Field
NAME
Title of Husband (i.e., Mr., Dr.)
Husband's First Name
Husband's Middle Name
Husband's Last Name
Husband's Nick Name
TELEPHONE
Husband's Day Phone
Husband's Evening Phone
Husband's Msg./Pager Phone
Husband's Fax Phone
MAILING ADDRESS
Husband's Service Address
Husband's Service City
Husband's Service State
Husband's Service Zip
RESIDENTIAL ADDRESS Leave blank if you wish to use your mailing address as your residential address.
Husband's Residential Address
Husband's Res. City
Husband's Res. State
Husband's Res. Zip
Husband's Res. County
EMPLOYMENT
Husband's Employer Name
Husband's Employer Phone
Husband's Employer Address
Husband's Employer City
Husband's Employer State
Husband's Employer Zip
VITAL STATISTICS/CONFIDENTIAL IDENTIFICATION INFORMATION
Husband's Soc. Sec. Number
Husband's Driver's Lic/ID & State
Husband's Birthdate
Husband's Race
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CHILDREN INFORMATION
CHILD SUPPORT
Who Will Pay Child Support? (Husband/Wife)
Who Will Receive Child Support? (Husband/Wife/Neither)

OLDEST CHILD
Oldest Child's First Name
Oldest Child's Last Name
Oldest Child's Age
Oldest Child's Birthdate
Oldest Child's Soc. Sec. #
Oldest Child Resides with
Is Wife Oldest Child's Mother?
Is Husband Oldest Child's Father?
Oldest Child's Race
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2ND CHILD
2nd Child's First Name
2nd Child's Last Name
2nd Child's Age
2nd Child's Birthdate
2nd Child's Soc. Sec. #
2nd Child Resides with
Is Wife 2nd Child's Mother?
Is Husband 2nd Child's Father?
2nd Child's Race
3RD CHILD
3rd Child's First Name
3rd Child's Last Name
3rd Child's Age
3rd Child's Birthdate
3rd Child's Soc. Sec. #
3rd Child Resides with
Is Wife 3rd Child's Mother?
Is Husband 3rd Child's Father?
3rd Child's Race
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4TH CHILD
4th Child's First Name
4th Child's Last Name
4th Child's Age
4th Child's Birthdate
4th Child's Soc. Sec. #
4th Child Resides with
Is Wife 4th Child's Mother?
Is Husband 4th Child's Father?
4th Child's Race
5TH CHILD
5th Child's First Name
5th Child's Last Name
5th Child's Age
5th Child's Birthdate
5th Child's Soc. Sec. #
5th Child Resides with
Is Wife 5th Child's Mother?
Is Husband 5th Child's Father?
5th Child's Race
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NOTE: You MUST click the "Submit Now" button on the bottom of this form to send your data! Be sure to complete all the sections of this form as requested by your attorney before submitting your data.
Next >> Child Support

INCOME

DEDUCTIONS

EXPENSES

RESIDENTIAL

SupportCalc -- Child Support
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SINGLE SESSION -- ENTER ALL DATA ON ALL FORMS AT ONE TIME
After entering ALL data, you must click the "Submit Now" button on the bottom of this form to send your data!

Name of Father

Name of Mother

INCOME INFORMATION
	Father	Mother
Wages and Salaries
Interest and Dividend
Business Income
Spousal Maintenance Received
Other Income
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DEDUCTION INFORMATION	Your attorney can calculate monthly taxes for you. Leave tax information blank unless you have a specific amount from a paystub.
	Father	Mother
Income Taxes (*Optional)
FICA/Self Employment Taxes (*Optional)
Normal Business Expenses
State Industrial Insur.
Mand. Union/Prof. Dues
Pension Plan Payments
Spousal Maintenance Paid
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CHILDREN EXPENSE INFORMATION
	Father	Mother
Children's Health Insurance Premiums
Children's Uninsured Health Expenses
Day Care Expenses
Education Expenses
Long Distance Transportation Expenses
Other Special Expenses	Father	Mother
Describe
Describe
Describe
Other Ordinary Expenses	Father	Mother
Describe
Describe
Describe
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RESIDENTIAL INFORMATION
	With Father	With Mother
Child 1's Overnights
Child 2's Overnights
Child 3's Overnights
Child 4's Overnights
Child 5's Overnights
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GENERAL

EMPLOYMENT

INCOME

DEDUCTIONS

ASSETS

EXPENSES

DEBTS

Financial Declaration
To Return to Main Menu, Click Here
SINGLE SESSION -- ENTER ALL DATA ON ALL FORMS AT ONE TIME
After entering ALL data, you must click the "Submit Now" button on the bottom of this form to send your data!

GENERAL INFORMATION	*Press Tab Key to Move From Field to Field
Your Full Name
Occupation
Highest Year of Education Completed
Number of Dependents
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EMPLOYMENT	*Press Tab Key to Move From Field to Field
Are you presently employed?
If YES, complete CURRENT EMPLOYMENT
If NO, complete LAST EMPLOYMENT
CURRENT EMPLOYMENT
Begin Date of Employment
LAST EMPLOYMENT
Last Employment Date
Last Gross Monthly Earnings
Reason for Current Unemployment
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INCOME
GROSS MONTHLY INCOME	Husband/Father	Wife/Mother
Wages and Salaries
Interest and Dividend
Spousal Maintenance Received
Other Income
Year-To-Date Gross Income

BUSINESS INCOME	Husband/Father	Wife/Mother
Business Income
Business Expenses

MISCELLANEOUS INCOME

Child support received from other relationships	Husband/Father	Wife/Mother
Name:
Name:
Income of current spouse
Name:
Name:
Income of other adults in household
Name:
Name:
Income of children
Name:
Name:
Income from assistance programs
Name:
Name:
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DEDUCTIONS	Your attorney can calculate monthly taxes for you. Leave tax information blank unless you have a specific amount from a paystub.
	Husband/Father	Wife/Mother
Income Taxes (*Optional)
FICA/Self Employment Taxes (*Optional)
State Industrial Insur.
Mand. Union/Prof. Dues
Pension Plan Payments
Spousal Maintenance Paid
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ASSETS
Cash on Hand
On Depost in Banks
Stocks and Bonds
Cash Value of Life Insurance
Other
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MONTHLY EXPENSES

HOUSING
Rent, 1st mortgage or payments
Installment payments for other mortgages or encumbrances
Taxes and insurance if not in monthly payment
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UTILITIES
Heat (gas and oil)
Electricity
Water, sewer, garbage
Telephone
Cable
Other:
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FOOD AND SUPPLIES
Food for persons
Supplies (paper, tobacco, pets)
Meals eaten out
Other:
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TRANSPORTATION
Vehicle payments or leases
Vehicle insurance and license
Vehicle gas, oil, ord. maint.
Parking
Other transportation expenses
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HEALTH CARE
Insurance
Uninsured dental, orthodontic medical, eye care expenses
Other uninsured health care expenses
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PERSONAL EXPENSES
Clothing
Hair care/personal care
Clubs and recreation
Education
Books, newspapers magazines, photos
Gifts
Other:
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MISCELLANEOUS EXPENSES
Life Insurance (if not deducted from income)
Other:
Other:
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DEBTS

INSTALLMENT DEBTS
Creditor/Description of Debt	Balance	Month of Last Payment










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OTHER DEBTS AND MONTHLY EXPENSES NOT PREV. LISTED
Creditor/Desc. of Debt	Balance	Month of Last Pymt	Amt of Last Pymt
























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