Escolar Documentos
Profissional Documentos
Cultura Documentos
www.premaritalmediation.com
Name _______________________________________________________
The financial information on the following pages is important for the validity of your premarital or
prenuptial agreement. If you need help in completing any item, please let us know.
If possible, please bring copies of this information to the mediation, along with documentation for the
items on the sheet (i.e., bank statement, appraisals, etc.). A copy of your Federal Income Tax return
for the past year and a recent copy of your pay stub or year-to-date income is also helpful.
ASSETS
Enter the value of each of the following items of property as precisely as you can. Also identify the
property as precisely as possible, including account numbers, names of banks, etc.
Fair market value
(if any)
A. Real Estate (Residence, Vacation Home,
and Rental/investment):
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$__________
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$__________
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$__________
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$__________
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Death Benefit
$__________
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Appraised or Fair
market value
$__________
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3
Fair market value
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$__________
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$__________
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$_________*
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TOTAL ASSETS
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$__________
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LIABILITIES
Amount Owed
$__________
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Amount owed
Owed to whom:
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$__________
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$__________
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$__________
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C. Student Loans:
D. Other Debts:
ANNUAL INCOME
Gross Salary
LAST YEAR
$_____________
$___________
Net Salary
(income minus taxes and social security)
_____________
____________
Dividend Income
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Interest Income
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Rental Income
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Other Income
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Mandatory Retirement
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IRA/Keogh/401K Contributions
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Mortgage Interest
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Property Taxes
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Child Care
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Health Insurance
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6
Support for aging parents
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NET INCOME
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