
12. Property Valuations. Have you had written
appraisals or offers to purchase during the past 12
months on any of the assets listed on your completed
Schedule of Assets and Debts. If your answer is yes,
IDENTIFY THE DOCUMENT.
1. Personal History. State your full name, current
residence address and work address, social security
number, any other names you have used, and the dates
between which you used each name.
2. Agreements. Are there any agreements between you
and your spouse made before or during your marriage or
after your separation that affect the disposition of
ASSETS, DEBTS, or SUPPORT in this proceeding? If
your answer is yes, for each agreement, state the date
made and whether it was written or oral, and attach a
copy of the agreement or describe its content.
13. Property Held by Others. Is there any PROPERTY
held by any third party in which you have any interest or
over which you have any control? If your answer is yes,
indicate whether the property is shown on the Schedule
of Assets and Debts completed by you. If it is not,
describe and identify each such asset and state its
present value and the basis for your valuation, and
IDENTIFY THE PERSON holding the asset.
3. Legal Actions. Are you a party or do you anticipate
being a party to any legal or administrative proceeding
other than this action? If your answer is yes, state your
role and the name, jurisdiction, case number, and a brief
description of each proceeding.
14. Retirement and Other Benefits. Do you have an
interest in any disability, retirement, profit sharing, or
deferred compensation plan? If your answer is yes,
IDENTIFY each plan and provide the name, address,
and telephone number of the administrator and custodian
of records.
4. Persons Sharing Residence. State the name, age,
and relationship to you of each person at your present
address.
15. Claims of Reimbursement. Do you claim the legal
right to be reimbursed for any expenditures of your
separate or community property? If your answer is yes,
state all supporting facts.
5. Support Provided Others. State the name, age,
address, and relationship to you of each PERSON for
whom you have provided SUPPORT during the past 12
months and the amount provided per month for each.
16. Credits. Do you claim reimbursement credits for
payments of community debts since the date of
separation? If your answer is yes, IDENTIFY the source
of payment, the creditor, the date paid, and the amount
paid. State whether you have added to the debt since the
separation.
6. Support Received for Others. State the name, age,
address, and relationship to you of each PERSON for
whom you have received SUPPORT during the past
twelve months and the amount received per month for
each.
17. Insurance. IDENTIFY each health, life, automobile,
and disability insurance policy or plan that you now own
or that covers you, your children, or your assets. State
the policy type, policy number, and name of company.
IDENTIFY the agent and give the address.
7. Current Income. List all income you received during
the past 12 months, its source, the basis for its
computation, and the total amount received from each.
Attach your last three pay check stubs.
18. Health. Is there any physical or emotional condition
that limits your ability to work? If your answer is yes,
state each fact on which you base your answer.
8. Other Income. During the past three years have you
received cash or other property from any source not
identified in 7? If so, list the source, the date, and the
nature and value of the property.
19. Children's Needs. Do you contend your children
have any special needs? If so, identify the child with the
need, the reason for the need, its cost, and its expected
duration.
9. Tax Returns. Attach copies of all tax returns and
schedules filed by or for you in any jurisdiction for the
past three calendar years.
20. Attorney Fees. State the total amount of attorney
fees and costs incurred by you in this proceeding, the
amount paid, the source of money paid, and describe the
billing arrangements.
10. Schedule of Assets and Debts. Complete the
Schedule of Assets and Debts form served with these
interrogatories.
21. Gifts. List any gifts you have made without the
consent of your spouse in the past 24 months, their
value, and the recipients.
11. Separate Property Contentions. State the facts that
support your contention an asset or debt is separate
property.
FORM INTERROGATORIES
(Family Law)
Page two
1292.10 [New July 1, 1990]
WEST GROUP
Official Publisher