Husband's Full Name
First Name
Last Name
Husband's Phone Number
Please enter a valid phone number.
Husband's Email
example@example.com
Wife's Full Name
Wife's Phone Number
Please enter a valid phone number.
Wife's Email
example@example.com
Adress of Marital Residence
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Marriage
/
Month
/
Day
Year
Date
Information about children (under the age of 18)
Information about children
We share biological children under the age of 18
Wife has given birth to a child/ren that is/are not Husband's biological children which was/were born during the marriage or after we separated
We have one or more children that are adopted (including step-parent adoption)
Child #1 Full Name
Child #1 Gender
Male
Female
Child #1 Date of Birth
Child #1 currently lives with
Father
Mother
Both Parents
Other
Child #2 Full Name
Child #2 Gender
Male
Female
Child #2 Date of Birth
Child #2 currently lives with
Father
Mother
Both Parents
Other
Child #3 Full Name
Child #3 Gender
Male
Female
Child #3 Date of Birth
Child #3 currently lives with
Father
Mother
Both Parents
Other
Child #4 Full Name
Child #4 Gender
Male
Female
Child #4 Date of Birth
Child #4 currently lives with
Father
Mother
Both Parents
Other
Please type the names, year of birth, and gender for additional children:
Please list the children who were not legally adopted by the husband or are not the husband's biological children (include children born after you already separated):
What type of custody and visitation do you want?
If there is someone other than the parents who has custody or guardianship over any of your children, please list the custodian/guardian's name, address and phone number:
Submit
Should be Empty: