Information of Children

INFORMATION OF CHILDREN

Name of child #1: D.O.B.: 00/00/2000 Age: Sex: M / F SS#:

Name of child #2: D.O.B.: 00/00/2000 Age: Sex: M / F SS#:

Name of child #3: D.O.B.: 00/00/2000 Age: Sex: M / F SS#:

Present Address:

The minor child(ren) has/have lived with ? for the past 5 years.

How many children were born to or adopted by this marriage?

How many of your children are now adults that belong to this marriage?

During the marriage, has the wife given birth to a child, and the husband is not the biological father? If so, please specify the names of any non-marital children born during the marriage: None.

Check what you type of custody and placement you would want to see:

[ ] Mother gets sole custody (decision-making) and primary physical residential placement (residence).

[ ] Father gets sole custody and primary physical residential placement.

[ ] Father and Mother get joint custody. Primary physical placement with Mother.

[ ] Father and Mother get joint custody. Primary physical placement with Father.

[ ] Father and Mother get joint custody. Shared physical placement with both parents. 50/50 20/80 etc.

The [ ] Mother [ ] Father shall pay [ ] 50% [ ] 100% [ ] ?% for the children’s [ ] health insurance, [ ] co-pays [ ] office visits [ ] day care [ ] tuition [ ] extra-curriculum expenses

[ ] summer camps [ ] other school expenses Note: If there are limits or caps on the above costs, for each cost type out how much for the children for each monthly that cap will be.

Do you want the life insurance policies to continue? [ ] Yes [ X ] No. If yes, enter the name and number of the policies.

What if any comments or special directions would you want Attorney Romero to know or make sure is in a proposed marital settlement agreement (Known as an MSA)?

Do you have any special concerns you would like addressed regarding the children? If so, in very detailed specific form, type out your concerns and possible solutions:

Will one of the parties be paying support and/or alimony? [ ] Yes [ ] No. If so type:

Check one:

[ ] Mother pays support.

[ ] Father pays support.

[ ] Neither pays support.

[ ] Other: {please explain}

Exact child support dollar amount per month: $ 0.00 (17% of payor’s ALL gross monthly income for one child 25% for two children 29% for three children.)

Enter the exact date you wish for the support to commence: Month: Day: Year:

Payor’s Full Name: Payor’s Employer Name: Full Street Address: City: State: Zip Code: Payroll Office Address: (if different) Full Telephone number: Payroll Full Fax number: Payroll email:

Let us know which one you want:

[ ] Mother claims [name of child goes here] child tax deductions and credits.

[ ] Father claims [name of child goes here] child tax deductions and credits.

[ ] Mother claims [name of child goes here] child tax deductions and credits on even tax years.

[ ] Father claims [name of child goes here] child tax deductions and credits on odd tax years.

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