Filled Out By:

Prepared for: and

Date:

(1) Full Name, Addresses, Phone Numbers of Parties:

(2) Date and Location of Marriage(please provide county):

(3) Age of Parties:

is years old (Date of Birth)

is years old (Date of Birth)

(4) Employment: (employer and Address of Parties)
Please list; names, addresses, and phone numbers

(5) Previous Marriages (husband to be, if any):

Date:

Location:

Divorce Date Final Judgement:

(6) Previous Marriages (wife to be if any):

Date:

Location:

Divorce Date Final Judgement:

(7) Schedule A (husband to be)

A. Annual Income:

B. Assets:

(1) Cash and Cash Equivalents:

(2) Marketable Securities:

(3) Mutual Funds:

(4) Retirement Accounts:

(5) Limited Partnerships:

(6) Corporations (etc.) :

(a) $

(b) $

(c) $

(d) $

Total

(7) Trusts :

(a) $

(b) $

(c) $

(d) $

Total

(8) Real Estate:

(a) $

(b) $

(c) $

(d) $

Total

(9)Automobiles, Trucks, Boats, Recreational Vehicles:

(a) $

(b) $

(c) $

(d) $

Total

(10) Personal Property: (i.e. jewelry, furniture, stereo, etc.):

(a) $

(b) $

(c) $

(d) $

Total

(11) Other (significant) :

(a) $

(b) $

(c) $

(d) $

Total

(12) Loans/Mortgages/Debt :

(a) $

(b) $

(c) $

(d) $

(e) $

(f) $

(g) $

Total

Total Assets (1-11)

Total Liabilities (12)

Total Net Worth:

(8) Schedule B(wife to be)

A. Annual Income:

B. Assets:

(1) Cash and Cash Equivalents:

(2) Marketable Securities:

(3) Mutual Funds:

(4) Retirement Accounts:

(5) Limited Partnerships:

(6) Corporations (etc.) :

(a) $

(b) $

(c) $

(d) $

Total

(7) Trusts :

(a) $

(b) $

(c) $

(d) $

Total

(8) Real Estate:

(a) $

(b) $

(c) $

(d) $

Total

(9)Automobiles, Trucks, Boats, Recreational Vehicles:

(a) $

(b) $

(c) $

(d) $

Total

(10) Personal Property: (i.e. jewelry, furniture, stereo, etc.):

(a) $

(b) $

(c) $

(d) $

Total

(11) Other (significant) :

(a) $

(b) $

(c) $

(d) $

Total

(12) Loans/Mortgages/Debt :

(a) $

(b) $

(c) $

(d) $

(e) $

(f) $

(g) $

Total

Total Assets (1-11)

Total Liabilities (12)

Total Net Worth: