Divorce & Legal Separation Settlement Questionnaire — NewLeaf Document Services

Confidential · Phase 2

Divorce & Legal Separation Settlement Questionnaire

Phase 2 — Written Settlement Agreement · Divorce & Legal Separation · NewLeaf Document Services

LDA #23-003 · Placer County · Registered & Bonded

Phase 2 — You're in the home stretch.
This questionnaire collects the information JoHanna needs to draft your written Settlement Agreement — whether you are filing for divorce or legal separation. Please complete every section as thoroughly as possible. The more detail you provide, the faster your MSA can be prepared. If you are unsure of an exact amount — your best estimate is fine.

Before you begin, please have ready: your case number, both parties' current addresses, account information, vehicle information, property details, and any retirement account statements.

This questionnaire is confidential and for current clients only.

NON-ATTORNEY DISCLOSURE: JoHanna C. Cody is a registered California Legal Document Assistant, not an attorney, and NewLeaf Document Services is not a law firm. I can prepare documents at your specific direction. I cannot give you legal advice, choose forms for you, tell you what to ask the court for, or predict how a judge will rule. Those choices belong to you. For legal advice, please consult a licensed California attorney.

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Case Information

Petitioner full legal name *

Respondent full legal name *

Case number *

County filed in *

Petitioner current address

Respondent current address

Your full legal name * (the person filling this out)

Your phone *

Your email *

Did the respondent file a Response (FL-120) with the court?

Yes No Not sure

💡 Please upload a copy of everything filed with the respondent's response using the upload field at the end of this form.

Date Petitioner exchanged preliminary disclosures

💡 This is the date you completed and exchanged your FL-140, FL-142, and FL-150 "homework" with your spouse.

Date Respondent exchanged preliminary disclosures

Would you like to extend the final date of divorce?

Yes No

💡 Some parties choose to extend for tax, insurance, or personal reasons. JoHanna will note this in the judgment package.

Have you and your spouse discussed how you plan to file taxes for the current tax year?

💡 Tax filing status depends on your marital status as of December 31. For how this applies to you, please check with a tax professional.

Will the respondent restore a former name?

Yes No

Spousal Support

Spousal support arrangement *

Monthly support amount

Start date

Duration / end date

Payment method

Step-down schedule? (if support decreases over time)

Yes No — fixed amount

Automatic termination events

Support terminates upon recipient's remarriage

Support terminates upon death of either party

Support terminates upon recipient's cohabitation in a marriage-like relationship

💡 Check the termination events you and your spouse have agreed to include.

Additional notes on spousal support (optional)

💡 Reserving the right means neither party receives support now, but either party may ask the court for it in the future. If this reflects your agreement, JoHanna will include reservation language in the MSA.

Children & Child Support

Do you have minor children together? *

Yes No

The Children

Enter each minor child below. Age fills in automatically from the date of birth.

Child 1

Full legal name

Date of birth

Age

Child 2 (if applicable)

Full legal name

Date of birth

Age

Child 3 (if applicable)

Full legal name

Date of birth

Age

Child 4 (if applicable)

Full legal name

Date of birth

Age

Child 5 (if applicable)

Full legal name

Date of birth

Age

Child 6 (if applicable)

Full legal name

Date of birth

Age

More than six children? (list any additional children here)

Custody Order Type

Is this a new custody order or a modification of an existing order?

New — no existing order Modification of existing order

⚠️ Please upload a copy of the existing custody order using the upload field at the end of this form so JoHanna can review it before preparing the modification.

Are there any other custody or visitation proceedings involving these children in any other court or state?

Yes No

💡 Please provide the court name, state, and case number so JoHanna can include them on the court forms.

Legal custody *

Physical custody

Petitioner timeshare percentage

Respondent timeshare percentage

Where do the children primarily live right now?

Child Support

Child support arrangement *

Monthly support amount

Paid by

First payment due date

Petitioner gross monthly income

Respondent gross monthly income

How should support payments be collected?

Wage assignment — taken from the paycheck Direct payment between the parties Not sure

💡 An Earnings Assignment Order goes with most support orders. Parties who prefer to pay each other directly usually ask the court to stay it. JoHanna will go over both options with you.

Who provides health insurance for the children?

Monthly cost of children's health insurance

Childcare costs related to employment or education

How are childcare costs shared?

How are uninsured medical, dental, and vision costs shared?

Tax exemptions — who claims which child?

School(s) children currently attend

Are there any special needs, medical conditions, or ongoing treatments for any child?

Yes No

Parenting Plan

How would you like your parenting plan written? *

General statement Detailed parenting plan

💡 A general statement uses broad language (for example, that you will share time and decisions). A detailed plan spells out the weekly schedule, holidays, and specific provisions. The questions above are included in both.

General custody / parenting statement

Regular Parenting Schedule

Weekday schedule — school year

Exchange location

Exchange time

Who handles transportation?

Holiday Schedule

For each holiday, choose the arrangement you and the other parent have agreed on. "Alternate" means it rotates each year.

New Year's Day

New Year's Eve

Martin Luther King Day

Presidents' Day

Spring Break

Easter

Mother's Day

Father's Day

Memorial Day

4th of July

Labor Day

Halloween

Thanksgiving

Christmas Eve

Christmas Day

Winter Break

Child's Birthday

Petitioner's Birthday

Respondent's Birthday

School's Out / Teacher Days

Holiday schedule notes or special arrangements (optional)

Summer & Vacation

Summer break schedule

Extended vacation — Petitioner notice

Extended vacation — Respondent notice

International travel — advance written consent from the other parent?

School, Healthcare & Communication

Who enrolls children in school?

How will the parents communicate about the children?

Routine medical decisions — who decides?

Emergency medical decisions

Relocation & Move-Away

Written notice before a parent moves outside the current area?

Relocation notes or special arrangements (optional)

Parenting Plan Provisions

Select all provisions you and the other parent agree to include. Review each one and check what applies to your situation.

The children will spend alternate weekends with each parent.

Parents will alternate major holidays each year — Thanksgiving, Christmas, New Year's, Easter, and other significant holidays — ensuring each parent spends time with children on special days.

Each party shall have the right of first refusal to care for the children if the other party needs an alternate caregiver for more than 4 hours.

Children shall have unrestricted and unmonitored phone access to both parents during reasonable hours.

Neither parent shall be under the influence of illegal drugs or allow illegal drug use while children are in their care.

Neither parent shall drink to intoxication while children are in their care.

If children are to be transported out of California for more than 24 hours, the traveling parent must provide the other with prior notice including dates, location, and contact numbers.

Each parent agrees to provide 45 days prior written notice if they intend to move outside a 25-mile radius of their current residence.

Each parent is responsible for picking up the children at the start of their parenting time unless exchanging at an agreed location such as school or daycare.

If either parent will be more than 15 minutes late for a pickup or dropoff, they must notify the other parent and make a good faith effort to communicate.

Each parent agrees to consult the other when designating authorized adults to pick up children when a parent cannot be present.

Children shall only be transported by a properly licensed and insured driver in an insured vehicle with an appropriate federally approved child restraint system.

Neither parent shall make disparaging remarks about the other in the presence of the children. Each parent shall foster a positive relationship between the children and the other parent.

Neither parent shall change the children's school without mutual agreement or a further court order.

Each parent shall provide the other with notice of any sporting or extracurricular activities including practice and game schedules.

Each parent shall provide the other with copies of school notices, report cards, parent-teacher conferences, and school activities.

Each parent shall provide the other with a current address and phone number at all times.

Additional parenting plan provisions (optional)

Anything else important about custody or parenting to address? (optional)

Property Going to Petitioner

List all assets the Petitioner will keep. Include community property only — separate property (owned before marriage or received by gift/inheritance) is addressed separately below.

Bank & Financial Accounts

Bank accounts (institution, account type, approximate balance)

Vehicles

Vehicle 1

Year, make and model

Estimated value

Loan balance

Lender name

Vehicle 2 (if applicable)

Year, make and model

Estimated value

Loan balance

Lender name

Other Assets

Other assets going to Petitioner (business interests, stocks, boats, trailers, valuables, etc.)

Debts Petitioner is Responsible For

Credit cards and loans (creditor, balance, Petitioner responsible)

Property Going to Respondent

List all assets the Respondent will keep.

Bank & Financial Accounts

Bank accounts (institution, account type, approximate balance)

Vehicles

Vehicle 1

Year, make and model

Estimated value

Loan balance

Lender name

Vehicle 2 (if applicable)

Year, make and model

Estimated value

Loan balance

Lender name

Other Assets

Other assets going to Respondent (business interests, stocks, boats, trailers, valuables, etc.)

Debts Respondent is Responsible For

Credit cards and loans (creditor, balance, Respondent responsible)

Equalization Payment

An equalization payment is a lump sum one party pays the other to balance the overall division of assets.

Is an equalization payment part of your agreement?

Yes No To be determined

Amount

Paid by

Terms of payment

Real Property

Do you own real property? (house, condo, land, rental, commercial, mobile home, timeshare)

Yes No

⚠️ Preparing and recording the deed that transfers title is handled separately and is not part of JoHanna's services at this time. The disposition you choose here will be reflected in your MSA. For property located outside California, title transfers follow that state's process.

💡 For Sacramento County cases, please upload a copy of the deed using the upload field at the end of this form.

Property 1

Property type

Date acquired

Property address (vacant land may have none — use the APN)

APN (Assessor's Parcel Number)

County

State property is located in

Community or separate property?

How is title currently held (vesting)?

Estimated current value

Mortgage lender

Mortgage balance

HELOC or second mortgage?

Other liens (tax lien, judgment, etc.)

Monthly payment

Who has been paying it?

Agreed disposition *

Disposition terms (buyout amount, refinance deadline, sale timeline, who pays sale costs, how proceeds split)

Type-specific details (rental, mobile home, timeshare, vacant land)

Property 2 (if applicable)

Property type

Date acquired

Property address (vacant land may have none — use the APN)

APN (Assessor's Parcel Number)

County

State property is located in

Community or separate property?

How is title currently held (vesting)?

Estimated current value

Mortgage lender

Mortgage balance

HELOC or second mortgage?

Other liens (tax lien, judgment, etc.)

Monthly payment

Who has been paying it?

Agreed disposition

Disposition terms (buyout amount, refinance deadline, sale timeline, who pays sale costs, how proceeds split)

Type-specific details (rental, mobile home, timeshare, vacant land)

Property 3 (if applicable)

Property type

Date acquired

Property address (vacant land may have none — use the APN)

APN (Assessor's Parcel Number)

County

State property is located in

Community or separate property?

How is title currently held (vesting)?

Estimated current value

Mortgage lender

Mortgage balance

HELOC or second mortgage?

Other liens (tax lien, judgment, etc.)

Monthly payment

Who has been paying it?

Agreed disposition

Disposition terms (buyout amount, refinance deadline, sale timeline, who pays sale costs, how proceeds split)

Type-specific details (rental, mobile home, timeshare, vacant land)

Property 4 (if applicable)

Property type

Date acquired

Property address (vacant land may have none — use the APN)

APN (Assessor's Parcel Number)

County

State property is located in

Community or separate property?

How is title currently held (vesting)?

Estimated current value

Mortgage lender

Mortgage balance

HELOC or second mortgage?

Other liens (tax lien, judgment, etc.)

Monthly payment

Who has been paying it?

Agreed disposition

Disposition terms (buyout amount, refinance deadline, sale timeline, who pays sale costs, how proceeds split)

Type-specific details (rental, mobile home, timeshare, vacant land)

Property 5 (if applicable)

Property type

Date acquired

Property address (vacant land may have none — use the APN)

APN (Assessor's Parcel Number)

County

State property is located in

Community or separate property?

How is title currently held (vesting)?

Estimated current value

Mortgage lender

Mortgage balance

HELOC or second mortgage?

Other liens (tax lien, judgment, etc.)

Monthly payment

Who has been paying it?

Agreed disposition

Disposition terms (buyout amount, refinance deadline, sale timeline, who pays sale costs, how proceeds split)

Type-specific details (rental, mobile home, timeshare, vacant land)

Retirement Accounts

Does either party have retirement accounts? (401k, IRA, pension, Roth, CalPERS, CalSTRS)

Yes No

⚠️ Dividing a retirement account often takes a Qualified Domestic Relations Order (QDRO), a separate court order sent to the plan administrator. QDRO preparation is handled separately and is not part of JoHanna's services at this time. JoHanna will note this in the MSA and reserve jurisdiction for the QDRO.

Petitioner's Retirement

Spouse waives all rights to Petitioner's retirement?

Yes — Respondent waives all rights No — to be divided (QDRO needed)

Petitioner Retirement Account 1

Employer

Retirement type

Approximate value

Date accrued / years of service

Legal description of retirement benefit (if known)

Petitioner Retirement Account 2 (if applicable)

Employer

Retirement type

Approximate value

Date accrued / years of service

Legal description of retirement benefit (if known)

Petitioner Retirement Account 3 (if applicable)

Employer

Retirement type

Approximate value

Date accrued / years of service

Legal description of retirement benefit (if known)

Respondent's Retirement

Petitioner waives all rights to Respondent's retirement?

Yes — Petitioner waives all rights No — to be divided (QDRO needed)

Respondent Retirement Account 1

Employer

Retirement type

Approximate value

Date accrued / years of service

Legal description of retirement benefit (if known)

Respondent Retirement Account 2 (if applicable)

Employer

Retirement type

Approximate value

Date accrued / years of service

Legal description of retirement benefit (if known)

Respondent Retirement Account 3 (if applicable)

Employer

Retirement type

Approximate value

Date accrued / years of service

Legal description of retirement benefit (if known)

Separate Property Claims

Separate property is property one spouse owned before marriage, or received by gift or inheritance during the marriage. If you would like it confirmed in the MSA, describe it below.

Does either party have separate property claims?

Yes No

Describe all separate property claims

💡 You can list each party's separate property here so it is identified in the MSA.

Remaining Items

Are there any joint accounts that need to be closed or separated?

Yes No

Are there any life insurance policies with beneficiary designations to update?

Yes No

Are there any pending lawsuits, settlements, or legal claims involving either party?

Yes No

Any other assets, debts, or items not covered above?

Additional comments or special provisions

Upload Documents & Submit

Upload supporting documents (optional but helpful)

💡 Please upload any of the following if you have them: property deed (for Sacramento County), retirement account statements, vehicle titles, existing court orders, respondent's filed response. Multiple files accepted.

Phase 2 Payment Due
Your remaining balance is due upon submission of this questionnaire. Once payment is received, JoHanna will begin drafting your Marital Settlement Agreement and email you a draft for review.

Accepted payment methods: Credit/Debit Card (Square) · Cash · Check (payable to JoHanna Cody) · Zelle · Venmo (1.9% fee)

Contact JoHanna to arrange payment: (916) 751-6498 or newleafoffice.us@gmail.com

⚠️ If it has been more than six months since your file was opened, your file may have been archived. A file reopening fee will apply. Please contact JoHanna before submitting if this applies to your situation.

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🌿 Questionnaire Received — Thank You!

JoHanna will review your information and begin preparing your Marital Settlement Agreement. You will receive a draft by email for your review before anything is finalized.

Questions in the meantime:

(916) 751-6498 — Call or text
newleafoffice.us@gmail.com

NewLeaf Document Services · LDA #23-003 · Not a Law Firm · Not an Attorney

NewLeaf Document Services · JoHanna C. Cody, LDA #23-003 · Placer County · Registered & Bonded
(916) 751-6498 · newleafoffice.us@gmail.com · NewleafDocumentServices.com
This questionnaire is confidential. Not a Law Firm. Not an Attorney.

Divorce & Legal Separation Settlement Questionnaire

Child 1

Child 2 (if applicable)

Child 3 (if applicable)

Child 4 (if applicable)

Child 5 (if applicable)

Child 6 (if applicable)

Vehicle 1

Vehicle 2 (if applicable)

Vehicle 1

Vehicle 2 (if applicable)

Property 1

Property 2 (if applicable)

Property 3 (if applicable)

Property 4 (if applicable)

Property 5 (if applicable)

Petitioner Retirement Account 1

Petitioner Retirement Account 2 (if applicable)

Petitioner Retirement Account 3 (if applicable)

Respondent Retirement Account 1

Respondent Retirement Account 2 (if applicable)

Respondent Retirement Account 3 (if applicable)

🌿 Questionnaire Received — Thank You!

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