FAMILY LAW CLIENT INTAKE FORM

INSTRUCTIONS: Please complete this confidential questionnaire, If you spend the time to complete all items, you will give us the background information necessary to begin to understand the complexity of the personal aspects of your family law problem. All information will be held in strict confidence.

1. Please provide your full name, date of birth, place of birth, Social Security Number and Driver's License Number

• Name:
• Maiden Name:
• Date of Birth:
• Place of Birth:
• Driver's License #:
• Social Security Number:
• Do you want your maiden name restored upon Divorce?:
• If so, please indicate exactly how you would like it restored, including middle name:

2. Where are you living now?

• Address:
•  
• How long in county:
• Residence Telephone:
• Mobile Telephone:
• Email Address:

3. Please complete following concerning your employment:

• Employer:
• Job Title:
• Address:
• Annual Gross (Including bonuses and overtime):
• Length of employment:
• Education Training:
• If retired, date of retirement:
• Employer from whom retired:
• Annual income last year before retirement:

4. Please provide the other party's full name, date of birth, place of birth, Social Security Number and Driver's License Number

• Name:
• Maiden Name:
• Date of Birth:
• Telephone Number:
• Email Address:

5. Where are the "other party" living?

• Address:
•  
• How long in county:
• Residence Telephone:
• Email Address:

6. Please complete the following concerning the "other party" employment:

• Employer:
• Job Title
• Address:
• Annual Gross (Including bonuses and overtime):
• Length of employment:
• Education Training:
• If retired, date of retirement:
• Employer from whom retired:
• Annual income last year before retirement:

7. Please provide the date and place of your marriage (if this is for a divorce proceeding):

• Date:
• City, State:

10. If there are any children of this marriage, please provide all requested information:

11. If known, please list all addresses the child(ren) has lived at for the last five years, or from the date of the Last Order in this case if less than five years ago.

14. What is your ideal timesharing agreement between yourself and the other parent?

15. Are there any reason why you feel as though Shared Parental Responsibility would not be in the best interest of the child(ren)? Areas of responsibility may include decision-making as to education, health care, and other major decisions for the child(ren).

17. Name of the other party's attorney, if any: