Secure Web Information Form Transfer
(SWIFT)
Welcome Desk


Directions:

  1) This is a single session data entry form. Complete and review all your entries before clicking "Submit Now."
  2) After reviewing your entries, click the "Submit Now" button at the bottom of the form to send your data.
  3) Contact and inform your attorney that you submitted the requested information.



IDENTIFICATION
Your Email (required)
Attorney Email (required)
 
Extra Password
Either leave blank, or give this password to your attorney. In either case, your information is always encrypted for privacy. Complete this password field if you plan on entering sensitive information.
Automatic Encryption: (High Security)


MAIN MENU
CIBug Enter Confidential-Master Information Form
HBBug Enter Monthly Household Budget Data
PCBug Enter PropertyCalc Data



 General   Wife/Mother   Husband/Father   Children 


Confidential-Master Information Form
To Return to Main Menu, Click Here
SINGLE SESSION -- ENTER ALL DATA ON ALL FORMS AT ONE TIME
After entering ALL data, you must click the "Submit Now" button
on the bottom of this form to send your data!


Image GENERAL INFORMATION *Press Tab Key to Move From Field to Field
County Name
Date of Marriage
Where Married
Date of Physical Separation
Marital Residence Occupied By
Number of Children Ever Born Alive of This Marriage
Number of Minor Children
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WIFE/MOTHER'S INFORMATION
(*If parties are not married, female's information)
*Press Tab Key to Move From Field to Field
Image NAME
Title of Wife (i.e., Ms. Mrs., Dr.)
Wife's First Name
Wife's Middle Name
Wife's Last Name
Image TELEPHONE
Wife's Day Phone
Wife's Evening Phone
Wife's Msg./Pager Phone
Wife's Fax Phone
Image RESIDENTIAL ADDRESS
Wife's Address
Wife's City
Wife's State
Wife's Zip code
Image MAILING ADDRESS
Leave blank if you wish to use your residential address as your mailing address.
Wife's Mailing Address
Wife's Mailing City
Wife's Mailing State
Wife's Mailing Zip
Image EMPLOYMENT
Wife's Employer Name
Wife's Employer Phone
Wife's Employer Address
Wife's Employer City
Wife's Employer State
Wife's Employer Zip
Image VITAL STATISTICS/CONFIDENTIAL IDENTIFICATION INFORMATION
You may wish to password protect this form if you complete this field.
Wife's Soc. Sec. Number
Wife's Birth date:
Wife's Birthplace:
Wife's Maiden Name:
Wife's Highest Education Achieved:
Wife's Number of This Marriage:
If Previously Married, Number Ended in Death:
Number Divorced or Annulled:
Image HEALTH INSURANCE INFORMATION
GROUP HEALTH PLAN #1
Group Health Plan:
Address ln 1:
Address ln 2:
Address ln 3:
Address ln 4:
Identification Number:
Plan Administrator:
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GROUP HEALTH PLAN #2
Group Health Plan:
Address Line 1:
Address Line 2:
Address Line 3:
Address Line 4:
Identification Number:
Plan Administrator:
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HUSBAND/FATHER'S INFORMATION
(*If parties are not married, male's information)
*Press Tab Key to Move From Field to Field
Image NAME
Title of Husband (i.e., Mr., Dr..)
Husband's First Name
Husband's Middle Name
Husband's Last Name
Image TELEPHONE
Husband's Day Phone
Husband's Evening Phone
Husband's Msg./Pager Phone
Husband's Fax Phone
Image RESIDENTIAL ADDRESS
Husband's Address
Husband's City
Husband's State
Husband's Zip
Image MAILING ADDRESS
Leave blank if you wish to use your residential address as your mailing address.
Husband's Mailing Address
Husband's Mailing City
Husband's Mailing State
Husband's Mailing Zip
Image EMPLOYMENT
Husband's Employer Name
Husband's Employer Phone
Husband's Employer Address
Husband's Employer City
Husband's Employer State
Husband's Employer Zip
Image VITAL STATISTICS/CONFIDENTIAL IDENTIFICATION INFORMATION
You may wish to password protect this form if you complete this field.
Husband's Soc. Sec. Number
Husband's Birth date:
Husband's Birthplace:
Husband's Maiden Name:
Husband's Highest Education Achieved:
Husband's Number of This Marriage:
If Previously Married, Number Ended in Death:
Number Divorced or Annulled:
Image HEALTH INSURANCE INFORMATION
GROUP HEALTH PLAN #1
Group Health Plan:
Address Line 1:
Address Line 2:
Address Line 3:
Address Line 4:
Identification Number:
Plan Administrator:
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GROUP HEALTH PLAN #2
Group Health Plan:
Address Line 1:
Address Line 2:
Address Line 3:
Address Line 4:
Identification Number:
Plan Administrator:
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CHILDREN INFORMATION
OLDEST CHILD
Oldest Child's First and Middle Name:
Oldest Child's Last Name:
Oldest Child's Age:
Oldest Child's Birth date
You may wish to password protect this form if you complete this field.
Oldest Child's SSN
Oldest Child Resides with
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2ND CHILD
Second Child's First and Middle Name:
Second Child's Last Name:
Second Child's Age:
Second Child's Birth date
You may wish to password protect this form if you complete this field.
Second Child's SSN
Second Child Resides with
3RD CHILD
Third Child's First and Middle Name:
Third Child's Last Name:
Third Child's Age:
Third Child's Birth date
You may wish to password protect this form if you complete this field.
Third Child's SSN
Third Child Resides with
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4TH CHILD
Fourth Child's First and Middle Name:
Fourth Child's Last Name:
Fourth Child's Age:
Fourth Child's Birth date
You may wish to password protect this form if you complete this field.
Fourth Child's SSN
Fourth Child Resides with
5TH CHILD
Fifth Child's First and Middle Name:
Fifth Child's Last Name:
Fifth Child's Age:
Fifth Child's Birth date
You may wish to password protect this form if you complete this field.
Fifth Child's SSN
Fifth Child Resides with
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NOTE: You MUST click the "Submit Now" button on the bottom of this form to send your data! Be sure to complete all the sections of this form as requested by your attorney before submitting your data.
Next >> Household Budget




Expenses Income


Image Monthly Household Budget

To Return to Main Menu, Click Here
SINGLE SESSION -- ENTER ALL DATA ON ALL FORMS AT ONE TIME
After entering ALL data, you must click the "Submit Now" button
on the bottom of this form to send your data!


If you consider this information sensitive you may wish to password protect this file.

Image EXPENSES *Press Tab Key to Move From Field to Field
(a) Housing(Enter Monthly Amount)
1. Mortgage/Co-Op Loan
2. Home Equity Line of Credit/Second Mortgage
3. Real estate taxes
4. Homeowners/Renter's Insurance
5. Cooperative Apartment Maintenance charges/Condominium charges
6. Rent
7. Other
 
(b) Utilities(Enter Monthly Amount)
1. Fuel oil
    Gas
2. Electricity
3. Telephone (land line)
4. Mobile Phone
5. Cable/Satellite TV
6. Internet
7. Alarm
8. Water
9. Other
 
(c) Food(Enter Monthly Amount)
1. Groceries
    Lunches at work
2. Dining out
    Liquor/alcohol
    Home entertainment
3. Other
 
(d) Clothing(Enter Monthly Amount)
1.
    
2. Children
    Other
    Laundry at home
3. Dry cleaning
4. Other
 
(e) Insurance(Enter Monthly Amount)
1. Life
    Homeowner's/tenant's
2. Fire, theft, and liability and personal articles policy
3. Automotive
4. Umbrella policy
5. Medical plane of insured)
5A. Medical Plan for yourself (including name of carrier and name of insured
5B. Medical Plan for children (including name of carrier and name of insured
6. Dental plan
7. Optical plan
8. Disability
9. Worker's Comp.
10. Long Term Care Insurance
11. Other
 
(f) Unreimbursed medical(Enter Monthly Amount)
1. Medical
2. Dental
3. Optical
4. Pharmaceutical
5. Surgical, nursing, hospital
6. Psychotherapy
7. Other
 
(g) Household maintenance(Enter Monthly Amount)
1. Repairs
    Furniture, furnishings, housewares
    Cleaning Supplies
    Appliances including maintenance
    Painting
2. Gardening/landscape
3. Sanitation/carting
4. Snow removal
5. Extermination
6. Other
 
(h) Household Help(Enter Monthly Amount)
1. Domestic (housekeeper, etc.)
2. Nanny/Au Pair/Child Care
3. Babysitter
    Nurse
4. Other:
 
(i) Automotive
1. Year:    Make:
Model: Personal (Y/N): 
Business (Y/N):
2. Year:    Make:
Model: Personal (Y/N): 
Business (Y/N):
3. Year:    Make:
Model: Personal (Y/N): 
Business (Y/N):
4. Year:    Make:
Model: Personal (Y/N): 
Business (Y/N):
5. Year:    Make:
Model: Personal (Y/N): 
Business (Y/N):
(Enter Monthly Amount)
1. Lease or Loan Payments (indicate lease term)
    
2. Gas and oil
3. Repairs
4. Car wash
    Registration/license
5. Parking and Tolls
6. Other
 
(j) Educational(Enter Monthly Amount)
1. Nursery and pre-school
2. Primary and secondary
3. College
4. Post-graduate
5. Religious Instruction
6. School Transportation
7. School Supplies/Books
8. School Lunches
9. Tutoring
10. School events
11. Child(ren)'s extra-curricular and educational enrichment activities
12. Other
 
(k) Recreational(Enter Monthly Amount)
1. Vacations
2. Movies
    Video rentals
3. Music (Digital or Physical Media)
4. Recreation Clubs and Memberships (County Club, etc.)
5. Activities for yourself
    Hobbies
    Theatre, ballet, etc.
6. Health club
7. Summer camp
    Team Sports
    Sporting goods
    Sports lessons
    Music/dance lessons
8. Birthday party costs for your child(ren)
9. Other
 
(l) Income Taxes(Enter Monthly Amount)
1. Federal
2. State
3. City
4. Social Security and Medicare
5. Number of dependents claimed in prior tax year
6. List any refund received by you for prior tax year
 
(m) Miscellaneous(Enter Monthly Amount)
1. Beauty parlor/barber/Spa
2. Toiletries/Non-Prescription Drugs
    Cigarettes/tobacco
3. Books, magazines,newspapers
    Children's allowances
4. Gifts to others
5. Charitable contribution
6. Religious organization dues
7. Union and organization dues
8. Commutation and transportation
9. Veterinarian/pet exp
10. Child support payments (for Child(ren) of a prior marriage or relationship pursuant to court order or agreement)
11. Alimony and maintenance payments (prior marriage pursuant to court order or agreement)
12. Loan Payments
13. Unreimbursed business exp
14. Safe Deposit Box rental fee
 
(n) Other(Enter Monthly Amount)
1.
2.
3.
4.
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Image GROSS INCOME INFORMATION: (Monthly Amounts) *Press Tab Key to Move From Field to Field
If you consider this information sensitive you may wish to password protect this file.
(a) Gross (total) income:
(as should have been or should be reported in the most recent Federal income tax return. (State whether your income has changed during the year preceding date of this affidavit. If so, please explain.))
(Enter Monthly Amount)
    
 
(b) To the extent not already included in gross income in (a) above:    
(Enter Monthly Amount)
1. Investment income, including interest and dividend income, reduced by sums expended in connection with such investment    
2. Worker’s compensation (indicate percentage of amount due to lost wages)    
3. Disability benefits (indicate percentage of amount due to lost wages)    
4. Unemployment insurance benefits    
5. Social Security benefits    
6. Supplemental Security Income    
7. Public assistance    
8. Food stamps    
9. Veterans benefits    
10. Pensions and retirement benefits    
11. Fellowships and stipends    
12. Annuity payments    
 
(c) If any child or other member of your household is employed, set forth name and that person's annual income(Enter Monthly Amount)
       
       
(d) List any maintenance and/or child support you are receiving pursuant to court order or agreement    
(e) Other:    
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Assets and Liabilities Debts


Image PropertyCalc

To Return to Main Menu, Click Here
SINGLE SESSION -- ENTER ALL DATA ON ALL FORMS AT ONE TIME
After entering ALL data, you must click the "Submit Now" button
on the bottom of this form to send your data!



PROPERTYCALC - ASSETS AND LIABILITIES
Category Description Current
Value
Lien
Obligation
Monthly
Payment
Date Incurred
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PROPERTYCALC - DEBTS
Category Description Current Debt
Amount
Monthly
Payment
Date Incurred
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Are you ready to send your information to your attorney?

     CheckList:
      1. You have entered you and your attorney's Email address accurately at the top of this form.
      2. Your entries are complete as requested by your attorney.
      3. You have printed this form for your own records.
      4. Inform your attorney after you click submit so they may know your information is ready for downloading.

      Remember, this is a single session form. Enter all your information in one session, then click submit.
      Alternatively, You can begin a second session only AFTER your attorney downloads this information.


Click "Submit Now" To Send Your Data!

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