DIVORCE WORKSHEET

Prepared by Dorian Rothschild on April 17, 2012

Name: Address: Phone: Date of Birth: SSN: Name of Spouse: Address: Phone: Date of Birth: SSN: Living Arrangements:

Dorian Rothschild 60 Arthur St. San Rafael, CA 94901 (415) 454-4545 April 27, 1981 123-45-6789 Vivian Rothschild 45 Palm Dr. Mill Valley, CA 94941 (415) 855-6677 October 17, 1984 123-45-6789

The parties have lived apart for under 6 months. Party Seeking Divorce: Mutual Agreement Date of Marriage: February 01, 2010

Previous Marriages: Neither party has been married before. Number of Years Living in Current State: 12 Employment Experience: Dorian Rothschild's Employment Experience: I worked as a sales manager at Provincial Furniture Inc from 1999 until 2004 and earned $40,000 per year. Then, in 2005, I transferred employment to RL Inc, and currently work as a market analyst there where I make $72,000 per year. Vivian Rothschild's Employment Experience: Vivian worked as an elementary school teacher at Kissinger Elementary School in Sacramento, CA, from 2000 to 2003 where she earned approximately $45,000 per year. Then she was promoted to the position of Principal of the elementary school where she continued to work until 2010 earning approximately $95,000 per year. In September of 2010, we were married, and Vivian quit her job in order to care
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for our soon-to-come child who was born in July of 2011. Educational History: Dorian Rothschild's Education: -High School Diploma -Associate's Degree in Business Administration, 1997, Contra Costa Community College Vivian Rothschild's Education: -High School Diploma, 1994 -Bachelor's Degree in Anthropological Studies, 1999, University of Delaware -Multiple Subject Teaching Credential, 2001, Dominican University Premarital Agreement: The parties do not have a premarital agreement. Information Regarding Children: Name of Child: Date of Birth: SSN: Parent(s): Pregnancy: There is no current pregnancy. Party Requesting Custody: Vivian Rothschild Temporary Child Support: Vivian Rothschild will seek temporary child support in the amount of $500.00 per month/per child. Temporary Spousal Support: Vivian Rothschild will request temporary spousal support in the amount of $1,000.00 per month. Child Support: Neither party is expected to seek child support. Alimony: Neither party is expected to seek alimony. Marital Home: Vivian Rothschild will remain in the home and Dorian Rothschild will be released from any mortgage commitments. Name Change:
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David Rothschild July 07, 2011 123-45-6789 Dorian and Vivian

Vivian Rothschild will change name to Vivian Harris. Financial Information:

ASSETS

You Other Real Estate House Checking Accounts Savings Accounts Certificates of Deposits Stocks Bonds IRAs Retirement Plans Pension Plans Life Insurance (Cash Value) Business Property Accounts Receivable Loans Vehicles Boats Household Goods Jewelry Clothing Sporting Equipment Collections Other Assets
TOTAL ASSETS $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20,000.00 $45,000.00 $0.00 $2,000.00 $5,000.00 $0.00 $0.00 $0.00 $72,000.00

Spouse
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $35,000.00 $0.00 $0.00 $0.00 $0.00 $36,000.00 $0.00 $0.00 $12,500.00 $2,000.00 $0.00 $0.00 $0.00 $85,500.00

Joint
$0.00 $550,000.00 $5,000.00 $25,000.00 $0.00 $15,000.00 $0.00 $0.00 $69,000.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $3,000.00 $0.00 $0.00 $667,000.00

LIABILITIES/DEBTS

Real Estate Mortgage Home Equity Loan Credit Card Debt Vehicle Loans Student Loans Other Debts

$0.00 $0.00 $0.00 $20,000.00 $0.00 $0.00

$0.00 $0.00 $5,500.00 $0.00 $0.00 $0.00

$250,000.00 $100,000.00 $0.00 $0.00 $0.00 $0.00

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TOTAL LIABILITIES

$20,000.00

$5,500.00

$350,000.00

Monthly Income: You Salary (gross) Bonuses/Commissions Investment Accounts Rental Property Other Income TOTAL INCOME Monthly Expenses: You Housing Auto (loans/expenses) Food Clothing Child Care & Education Payroll Taxes Property Taxes Insurance (life/disability) Insurance (property) Utilities Health Care/Medicine Recreation Student Loans Home Maintenance Alimony Child Support Charity Miscellaneous TOTAL EXPENSES
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $6,250.00 $0.00 $0.00 $0.00 $0.00 $6,250.00

Spouse
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Joint
$0.00 $0.00 $4,000.00 $0.00 $700.00 $4,700.00

Spouse
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $600.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $600.00

Joint
$1,900.00 $750.00 $1,200.00 $200.00 $0.00 $0.00 $175.00 $0.00 $120.00 $450.00 $0.00 $1,500.00 $0.00 $0.00 $0.00 $0.00 $0.00 $180.00 $6,475.00

Additional Information: _________________

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