Probate Intake Form

Divorce Intake Form
Name

First NameLast Name
Email
Address
Spouse's Name
Telephone
Minor Children
Child's name

First NameLast Name
Date of Birth

MonthDayYear
Date
Place of Birth
Dates and Addresses of All Residences for Past 5 Years
START Date

MonthDayYear
Date
END Date

MonthDayYear
Date
Address
Descendant

Descendant was [ ] was not survived by a stepchild or foster child or children who have been adopted by decedent but for a legal barrier:
Heading

Name relationships to decedent, ages, and addresses, so far as known to or reasonably known of all persons mentioned in decedent's will or any codicil, whether living or deceased: all persons named or checked in items 2, 5, 6, and 7; and all beneficiaries of a trust named in decedent's will or any codicil in which the trustee and personal representative are the same person.
Number of Your Children

12345678910Greater than 10
If the other children from this marriage have the same residential history skip residential section,check this box
Child's Name
Place of BirthDate of Birth
Dates and Addresses of All Residences for Past 5 Years:

Start Date End Date Address
Minor Child (2):

Child's Name Date of Birth Place of Birth
Dates and Addresses of All Residences for Past 5 Years:

Start Date End Date Address
Minor Child (3):

Child's Name Date of Birth Place of Birth
Dates and Addresses of All Residences for Past 5 Years:

Start Date End Date Address
Minor Child (4):

Child's Name Date of Birth Place of Birth
Dates and Addresses of All Residences for Past 5 Years:

Start Date End Date Address
Minor Child (5):

Child's Name Date of Birth Place of Birth
Dates and Addresses of All Residences for Past 5 Years:

Start Date End Date Address
Minor Child (6):

Child's Name Date of Birth Place of Birth
Dates and Addresses of All Residences for Past 5 Years:

Start Date End Date Address
Minor Child (7):

Child's Name Date of Birth Place of Birth
Dates and Addresses of All Residences for Past 5 Years:

Start Date End Date Address
Minor Child (8):

Child's Name Date of Birth Place of Birth
Dates and Addresses of All Residences for Past 5 Years:

Start Date End Date Address
Minor Child (9):

Child's Name Date of Birth Place of Birth
Dates and Addresses of All Residences for Past 5 Years:

Start Date End Date Address
Minor Child (10):

Child's Name Date of Birth Place of Birth
Dates and Addresses of All Residences for Past 5 Years:

Start Date End Date Address
Additional Information
Marriage Information:
Date of Marriage

MonthDayYear
Date of Separation

MonthDayYear
Does Wife Want Maiden Name Restored?

YesNo
Will Someone Pay Spousal Support?

YesNo
Assets and Debts Acquired During the Marriage:
Car
Houses
Retirement

401(k)(b)IRAPensionUnknown Type
Timeshare / Off-road / Sea Boat, etc.
Other assets and debts acquired during the marriage
Assets and Debts from Either Before Marriage or After Separation:

Student LoansHouse PaymentsLoansCredit Card DebtsTimeshare/Off-Road/Sea Boat, etc.
Orders Related to Children
With which parent does the child or children spend most of their time
Has the decedent or other family members ever served time in prison or jail Yes
No
Have taxes been filed and does the decedent owe the IRS or the State any money Yes
No
We will need your paycheck stubs for two months (or as close to that as possible)
Provide the other parent's stubs or tax returns for the last two years (if possible)
Employment Information
Name of Employer
Address
Start Date of Job

MonthDayYear
Employer Phone
Please enter a valid phone number.
Do you have other sources of income? If so, how much and from what source?
Do you pay or receive support from another relationship? If so, how much?
Are you receiving workers comp., social security, disability, or other disability compensation? If so, how much?
How many hours a week do you work? Occupation
Your monthly income before taxes are deducted
Any other source of income other than from employment (i.e., do you receive rent, support, or other forms of income)? If so, how much
Age and Education
My age is
Number of years of college
Professional or occupational license

YesNo
Vocational training consisting of:
Did you obtain a college degree? If so, what?
Tax Information
Did you file taxes last year? If not, what was the last year you filed:
My filing status is:

SingleHead of HouseholdMarried Filing SeparatelyMarried Filing Jointly with ___
Marriage Filling Jointly with:
How many exemptions do you have?
OTHER PARENT/PARTY:
Age of the other parent
Other parent's income before taxes are deducted:
Any other source of income other than from employment (i.e., does the other parent receive rent, support, or other forms of income)? If so, how much:
Source of other income:
DO EITHER YOU OR THE CHILDREN RECEIVE MEDI-CAL, FOOD STAMPS, OR CASH ASSISTANCE, CALWORKS, NEEDY FAMILY RELIEF

YesNo
Monthly Expenses
Rent
Mortgage
Property taxes paid
Property insurance for house
Interest paid on the house note
Groceries
Going out to eat
Dry cleaning amount
Household supplies
Gardener/pool/cleaning assistance
Household repairs
Utilities
Gas for your car:
Auto Insurance:
Cell Phone:
Life Insurance
Life Insurance
Life Insurance
Health Insurance
Child Support
Spousal Support
Required Retirement Contributions
Union Dues
DIVIDING THE PROPERTY AND DEBT:

From the property acquired during the marriage that you still have, please make a list to show what you would like to keep and what you want your spouse/partner to keep (i.e., autos, furniture, retirement, 401k, credit cards, houses, anything)
TO BE YOURS:
TO BE OTHER PARTY:
Do you want each person to receive the debts in their name alone?

YesNo
How would you like the debts to be divided?
Financial Disclosures:

You will be required to serve the other party with your financial disclosures. You will need to provide the name of each institution in which you deposit funds, as well as all investment accounts, including the balances.
Checking
Institution Name
Last Four Digits of Account Number
Savings
Institution Name
Last Four Digits of Account Number
Retirement/Pension
Institution Name
Last Four Digits of Account Number
Mutual Funds:
Institution Name
Last Four Digits of Account Number
Notary fees are charged at $15 per notarization when applicable.
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Divorce Intake Form

Minor Children

Dates and Addresses of All Residences for Past 5 Years

Heading

Dates and Addresses of All Residences for Past 5 Years:

Minor Child (2):

Dates and Addresses of All Residences for Past 5 Years:

Minor Child (3):

Dates and Addresses of All Residences for Past 5 Years:

Minor Child (4):

Dates and Addresses of All Residences for Past 5 Years:

Minor Child (5):

Dates and Addresses of All Residences for Past 5 Years:

Minor Child (6):

Dates and Addresses of All Residences for Past 5 Years:

Minor Child (7):

Dates and Addresses of All Residences for Past 5 Years:

Minor Child (8):

Dates and Addresses of All Residences for Past 5 Years:

Minor Child (9):

Dates and Addresses of All Residences for Past 5 Years:

Minor Child (10):

Dates and Addresses of All Residences for Past 5 Years:

Marriage Information:

Assets and Debts Acquired During the Marriage:

Orders Related to Children

Employment Information

Age and Education

Tax Information

OTHER PARENT/PARTY:

Monthly Expenses

DIVIDING THE PROPERTY AND DEBT:

Financial Disclosures:

Checking

Savings

Retirement/Pension

Mutual Funds: