MATRIMONIAL WORKSHEET

Please fully complete the following information if you are seeking a divorce.

YOUR INFORMATION

Please complete the following information.
Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
County
Home Phone
Work Phone
Date of Birth
State of Birth
Race
Highest level of Education
Number of this marriage (first marriage, second marriage, etc.)
If previously married, how many ended by death?
If previously married, how many ended by divorce or annulment?
Annual Gross Income
Social Security #
SPOUSE

Please complete the following information for your spouse.
Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
County
Date of Birth
State of Birth
Race
Highest Level of Education
Number of this marriage (first marriage, second marriage, etc.)
If previously married, how many ended by death?
If previously married, how many ended by divorce or annulment?
Annual Gross Income
Social Security #
Wife's maiden name

(if applicaple)
Date of Marriage

This is when you and your current spouse were married.
City/Town
County
State
Was your marriage performed by a clergyman, minister, or leader of the Society for Ethical Culture?
Approximate date of Separation
Grounds for Divorce

Grounds for divorce in New York State are the following:
Residence at time of Abandonment, Cruel and Inhuman Treatment, etc.
Date of Abandonment, Cruel and Inhuman Treatment, etc.
YOUR CHILDREN
Children

For each child, please include (1) Name (2) Date of Birth (3) Custody (4) Social Security #
Child Support Paid to:
Amount of Child Support
**If you have a familiy Court Order of Support and/or Custody, please email or fax a copy to: RKehoe127@aol.com OR (518) 465-2210
Other Addresses for Children within the last five years
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Other Addresses for Children within the last five years
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Mother's Health Insurance Information
Group Health Plan
Address
I.D. #
Plan Administrator
Type of Coverage
Father's Health Insurance Information
Group Health Plan
Address
I.D. #
Plan Administrator
Type of Coverage
HOME INFORMATION
Marital Home
Value of Home (if owned)
Outstanding Mortgage
Post divorce occupancy of marital home
** END. PLease submit this information by pressing the "continue" button below. After submitting and confirming your information, you will be redirected to RandallKehoeLaw.com. Mr. Kehoe will soon be contacting you regarding this issue.

MATRIMONIAL WORKSHEET

MATRIMONIAL WORKSHEET

YOUR INFORMATION

SPOUSE

YOUR CHILDREN

**If you have a familiy Court Order of Support and/or Custody, please email or fax a copy to: RKehoe127@aol.com OR (518) 465-2210

Mother's Health Insurance Information

Father's Health Insurance Information

HOME INFORMATION

** END. PLease submit this information by pressing the "continue" button below. After submitting and confirming your information, you will be redirected to RandallKehoeLaw.com. Mr. Kehoe will soon be contacting you regarding this issue.