PLEASE STATE NATURE OF CASE AND FILL OUT ACCORDINGLY:
Name: (first middle last)
Your E-Mail Address:
Do you wish to receive e-mails from this office on your case status:
Present Residence Address:
Residence Phone Number:
Work Phone Number:
Cell Phone Number:
Date of Birth:
SSN:
Spouse's/Partner's Name:
Spouse's/Partner's Present Address:
Spouse's/Partner's Date of Birth: SSN:
Date of Marriage:
Place of Marriage:
Date of seperation, if you are seperated at this time:
Name and DOB of each of your children:
Set forth the places where each child has lived since 1999 and the names and present address of the persons with whom each child has lived during that period. Start with the children's current address and work backwards until 1999.
From to present time. The children lived at the following address with the following persons:
From to . The children lived at the following address with the following persons:
Spouse's/Partner's place of employment:
What is your rent or mortgage payments each month?
Describe the automobile you drive:
Describe the automobile your spouse/partner drives:
If you have participated as a party, witness, or in any other capacity in any litigation concerning the custody of the children, describe that litigation in full:
City and State of Litigation: Case/File Number: Name of Court: Date Litigation Start: Date and description of any orders entered:
Do you desire to change your name? If so, to what name?
Who referred you to this office?
What is your gross monthly pay? Number of dependents claimed? What other sources of income do you have? (list)
What is your spouse's/partner's gross monthly pay? Number of dependents claimed? What other sources of income does your spouse/partner have? (list)
Please list all assets jointly owned by you and your spouse/partner and value of each asset:
Please list all debts jointly incurred by you and your spouse and the balance on the debt:
