Stallard & Bellof Client Intake Form

The opposing party and I have a child/children togetherNo children with opposing party

Children of the Relationship
Name of Child 1:
Date of Birth

MonthDayYear
Name of Child 2:
Date of Birth

MonthDayYear
Name of Child 3:
Date of Birth

MonthDayYear
Name of Child 4:
Date of Birth

MonthDayYear
Name of Child 5:
Date of Birth

MonthDayYear
State the current custodial arrangements and any preferences or agreements regarding custody of the children.

The opposing party and I have never resided togetherThe opposing party and I currently reside togetherThe opposing party and I formerly resided together but no longer do
The opposing party and I have never been marriedThe opposing party and I have never been married, but we own property togetherThe opposing party and I are currently marriedThe opposing party and I were married at one time, but are now divorced
Date of Marriage

MonthDayYear
Place of Marriage

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date You Began Living in Different Residences ("Date of Separation")

MonthDayYear
YesNo
Full Name To Reassume

First NameMiddle NameLast Name
Date of Divorce

MonthDayYear

Student Loans:
Please list ALL held by EITHER party,

regardless of whose name is on it
Student Loan 1 Company
MeSpouse
Balance as of Date of Separation (current if not separated)
Student Loan 2 Company
MeSpouse
Balance as of Date of Separation (current if not separated)
Student Loan 3 Company
MeSpouse
Balance as of Date of Separation (current if not separated)
Student Loan 4 Company
MeSpouse
Balance as of Date of Separation (current if not separated)

Outstanding Tax Debt:
Tax Year
Remaining Tax Owed
Tax Year
Remaining Tax Owed
Tax Year
Remaining Tax Owed

Business Property
Does either party own a business?
Business Name:
MeOpposing PartyBoth
Type of Business:
Owner's Title:
Date of Business Acquired:

MonthDayYear
Percent Ownership Interest:
Current Fair Market Value of the Business:
Business Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Real Property
Please list ALL owned by EITHER party,

regardless of whose name is on it
Real Property Address 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Names on Deed
Purchase Price
Fair Market Value as of Date of Separation (current if not separated)
Date of Purchase

MonthDayYear
Names on Mortgage
Mortgage Balance as of Date of Separation (current if not separated)
Monthly Payment
Annual Property Taxes
Real Property Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Names on Deed
Purchase Price
Fair Market Value as of Date of Separation (current if not separated)
Date of Purchase

MonthDayYear
Names on Mortgage
Mortgage Balance as of Date of Separation (current if not separated)
Monthly Payment
Annual Property Taxes
Real Property Address 3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Names on Deed
Purchase Price
Fair Market Value as of Date of Separation (current if not separated)
Date of Purchase

MonthDayYear
Names on Mortgage
Mortgage Balance as of Date of Separation (current if not separated)
Monthly Payment
Annual Property Taxes
Real Property Address 4

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Names on Deed
Purchase Price
Fair Market Value as of Date of Separation (current if not separated)
Date of Purchase

MonthDayYear
Names on Mortgage
Mortgage Balance as of Date of Separation (current if not separated)
Monthly Payment
Annual Property Taxes

Bank and Investment Accounts
Please list ALL owned by EITHER party,

regardless of whose name is on it
Bank/Investment Financial Institution 1
Name(s) on the account
Type of Account
Balance as of Date of Separation (current if not separated)
Bank/Investment Financial Institution 2
Name(s) on the account
Type of Account
Balance as of Date of Separation (current if not separated)
Bank/Investment Financial Institution 3
Name(s) on the account
Type of Account
Balance as of Date of Separation (current if not separated)
Bank/Investment Financial Institution 4
Name(s) on the account
Type of Account
Balance as of Date of Separation (current if not separated)
Bank/Investment Financial Institution 5
Name(s) on the account
Type of Account
Balance as of Date of Separation (current if not separated)
Bank/Investment Financial Institution 6
Name(s) on the account
Type of Account
Balance as of Date of Separation (current if not separated)

Automobiles, Motorcycles, RV's, Trailers, Watercraft, Airplanes
Please list ALL owned by EITHER party,

regardless of whose name is on it

Rows	Year,Make,Model	Names on Titles	Date Acquired	Date of Separation Fair Market Value	Date of Separation Loan Balance of Loan	Who drives?
Vehicle1
Vehicle2
Vehicle3
Vehicle4
Vehicle5
Vehicle6
Vehicle7
Vehicle8

Credit Cards:
Please list ALL held by EITHER party,

regardless of whose name is on it
Credit Card 1
Name on the account
Balance as of Date of Separation (current if not separated)
Credit Card 2
Name on the account
Balance as of Date of Separation (current if not separated)
Credit Card 3
Name on the account
Balance as of Date of Separation (current if not separated)
Credit Card 4
Name on the account
Balance as of Date of Separation (current if not separated)
Credit Card 5
Name on the account
Balance as of Date of Separation (current if not separated)
Credit Card 6
Name on the account
Balance as of Date of Separation (current if not separated)

Other Loans:
Please list ALL held by EITHER party,

regardless of whose name is on it
Loan Name
Name on the account 1
Balance as of Date of Separation (current if not separated)
Loan2 Name
Name on the account 1
Balance as of Date of Separation (current if not separated)
Loan3 Name
Name on the account 1
Balance as of Date of Separation (current if not separated)
Loan4 Name
Name on the account 1
Balance as of Date of Separation (current if not separated)

Any other asset or debt you want to mention that wasn't requested previously

What outcome are you seeking? (i.e., house, children, restraining orders, share of retirement)
List any questions you would like to discuss.
I have been scheduled for an initial consultation with Stallard & Bellof, PLLC, Attorneys at Law. I understand that no further obligation is incurred by either party as a result of the consultation and that Stallard & Bellof, PLLC has not yet been retained to represent me. If and when Stallard & Bellof, PLLC is retained in this matter, a formal agreement for legal services will be executed between the parties.
Should be Empty:

Client Information

Opposing Party Information

Children of the Relationship

Separate Property - property currently owned by either spouse but acquired before marriage

Inheritance Received During the Marriage

Gifts Received During the Marriage

Retirement Accounts

Student Loans:

Outstanding Tax Debt:

Business Property

Real Property

Bank and Investment Accounts

Automobiles, Motorcycles, RV's, Trailers, Watercraft, Airplanes

Please list any of the following: Precious Metals, Jewelry, Collectibles, Antiques, Other Assets.

Credit Cards:

Other Loans: