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Are you currently working with an attorney, mediator and or financial advisor? If yes please provide their name, firm name, phone number and email address. *

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Is your intent to retain the marital home and if so, will your spouse be entitled to a portion of the equity in the home? Please Select Yes No

Do you currently have a mortgage? Please Select Yes No

What type of mortgage do you have? Please Select Conventional FHA VA USDA Jumbo Other

If an equity buyout is required, do you have funds available elsewhere to settle the equity division or will you need to access the equity in the home via financing? Please Select Funds available elsewhere Access equity in home

Are you currently on the title to the home and have you been for at least 12 months? Please Select Yes No

Have you had the home appraised to establish value? Please Select Yes No

Have you had the home inspected to identify any deferred maintenance that will need to be taken into consideration when establishing the equity division? Please Select Yes No

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Are you currently employed? Please Select Yes No

Are you a business owner or self-employed with an ownership share of 25% or more? Please Select Yes No

If you are not currently employed, do you plan to return to the workforce? Please Select Yes No

Will you rely on child support to qualify? Please Select Yes No

Will you rely on alimony to qualify? Please Select Yes No

Will you rely on a co-borrower to qualify? Please Select Yes No

Do you have retirement income? Please Select Yes No

If you are 62 years of age or older, do you have non-retirement assets you plan to use for qualifying? Please Select Yes No

Will you be obligated to pay child support or alimony? Please Select Yes No

Do you own any other real estate that will need to be dispositioned? Please Select Yes No

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