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Rule 16-c Financial Report - Delaware
| Rule 16-c Financial Report Form. This is a Delaware form and can be used in Family Court Statewide . |
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Form 465 (Rev 03/12) The Family Court of the State of Delaware In and For New Castle Kent Sussex County RULE 16(c) FINANCIAL REPORT PROPERTY DIVISION, ALIMONY, COUNSEL FEES DATE OF MARRIAGE/CIVIL UNION: DATE OF SEPARATION: DATE OF DIVORCE: Petitioner's Name Street Address P.O. Box Number City/State/Zip Code Employer Name Employer Street Address City/State/Zip Code Years Employed Position or Occupation Work Phone Date of Birth Home Phone CASE NAME: FILE NUMBER: PETITION NUMBER: Respondent's Name Street Address P.O. Box Number City/State/Zip Code Employer Name Employer Street Address City/State/Zip Code Years Employed Position or Occupation Work Phone Date of Birth Home Phone Current Annual Income Current Annual Income $ Petitioner's Attorney $ Respondent's Attorney A. Names and dates of birth of minor children of the parties. Indicate with whom the child(ren) primarily reside: Petitioner (P); Respondent (R); Shared (S). Petitioner's Children (Minor) Resides With: Respondent's Children (Minor) Resides With (P) (P) (P) (P) (P) (R) (R) (R) (R) (R) (S) (S) (S) (S) (S) (P) (P) (P) (P) (P) (R) (R) (R) (R) (R) (S) (S) (S) (S) (S) B. Names and dates of birth of any adult children residing with either party. Indicate whether the child is enrolled in school Petitioner's Children (Adult) Enrolled in School? Respondent's Children (Adult) Enrolled in School? Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes Yes No No No No No 1 of 12 American LegalNet, Inc. www.FormsWorkFlow.com Form 465 (Rev 03/12) C. Describe your employment history for the past five years. Include the name of each employer, the dates of employment, and the last annual income with each employer, and the reason employment ended. Start with your most recent employer. Petitioner (P): Employer Dates of Employment Start Date End Date Ending Annual Income Reason for Leaving Respondent (R): Employer Dates of Employment Start Date End Date Ending Annual Income Reason for Leaving D. Do you have health/dental insurance benefiting you, your spouse and/or children of this marriage? Petitioner (P) Yes No Respondent (R) Yes No If so, please state the name of your insurance company, the group and member numbers and cost: Petitioner's Insurance Respondent's Insurance Insurance Company: Group Number: Member Number: Monthly Cost: $ Who is Covered? E. Insurance Company: Group Number: Member Number: Monthly Cost: $ Who is Covered? Does your employer offer a qualified and/or non-qualified pension plan? Yes No Respondent (R) Yes Petitioner (P) No Are you a participant in any pension and/or retirement plan at your current place of employment? Petitioner (P) Yes No Respondent (R) Yes No Were you a participant in any other pension and/or retirement plan(s) through previous employment? Petitioner (P) Yes No Respondent (R) Yes No If so, please state the name(s) of all plan(s), plan administrator(s), address(es) and phone number(s) in which you are a participant: (P) Plan Name (1) Street Address City/State/Zip Code Plan Name (2) Street Address City/State/Zip Code Plan Administrator Phone # Plan Administrator Phone # (R) Plan Name (1) Street Address City/State/Zip Code Plan Name (2) Street Address City/State/Zip Code Plan Administrator Phone # Plan Administrator Phone # 2 of 12 American LegalNet, Inc. www.FormsWorkFlow.com Form 465 (Rev 03/12) F. Do you have any other deductions from your pay (not including taxes), such as union dues, mandatory pension deductions or other? Petitioner (P) Yes No Respondent (R) Yes No If so, please identify the deduction and monthly cost (P) Deduction Monthly Cost (R) Deduction Monthly Cost $ $ $ $ $ $ $ $ G. Do you participate in or own any life insurance on your life? Petitioner (P) Yes No Respondent (R) If so, please state the following (P) Name of Plan (1) Yes No Policy Number Type* Beneficiary $ $ Face Value Cash Surrender Value $ $ Monthly Cost $ $ Basis for Non-Marital Claim: (2) Basis for Non-Marital Claim: (R) Name of Plan (1) Policy Number Type* Beneficiary $ Face Value Cash Surrender Value $ $ Monthly Cost Basis for Non-Marital Claim: (2) $ $ $ Basis for Non-Marital Claim: *Type: W= Whole Life T= Term E= Employer H. Do you claim any inability to pay support due to ill health, disability or extraordinary expenses which results in dependency upon the other party for support and/or impairment of earning capacity? Petitioner (P) Yes No Respondent (R) Yes No If yes, please provide below and the name and address of all treating physicians and state the nature of the disability (P) Nature of Disability (1) Street Address City/State/Zip Code Nature of Disability (2 If Different) Street Address City/State/Zip Code Treating Physician Phone # Treating Physician Phone # (R) Nature of Disability (1) Street Address City/State/Zip Code Nature of Disability (2 If Different) Street Address City/State/Zip Code Treating Physician Phone # Treating Physician Phone # I. Are you receiving any income from benefits such as Social Security retirement, Social Security Disability (SSDI), VA benefits, federal pension (CSRS or FERS), private disability or military pension? Yes No Respondent (R) Yes No Petitioner (P) If so, please indicate from where you receive the benefit(s) and the monthly amount: (P) Benefit Monthly Cost (R) Benefit Monthly Cost $ $ $ $ $ $ $ $ American LegalNet, Inc. www.FormsWorkFlow.com 3 of 12 Form 465 (Rev 03/12) J. During the last five (5) years, have you given, transferred, or entrusted your property (including cash) in excess of $1000.00 in the aggregate to anyone other than a party to this proceeding? Petitioner (P) Yes No Respondent (R) Yes No If so, please name the recipient of each item and describe the item and it's value: (P) Property Transferred Entrusted Recipient Value (R) Property Transferred Entrusted Recipient Value $ $ $ $ INCOME INFORMATION K. List annual gross income from all sources for the last 3 years, including estimated gross income for current year: (P) Petitioner (R) Respondent 3 years ago 2 years ago 1 year ago Current $ $ $ $ 3 years ago 2 years ago 1 year ago Current $ $ $ $ ASSETS OF THE PARTIES "Assets" include all assets (property) of any kind, including real estate, and tangible and intangible personal property (such as bank accounts, stocks, bonds, etc.). Unless you explain otherwise, it will be presumed that you are the sole legal owner of any asset(s) identified in your answers. If you are not the sole legal owner, please explain the nature and extent of your ownership, i
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