Client Data Sheet: Divorce

Law Office of Melissa D. Rowcliffe, P.C.

CLIENT DATA SHEET

DIVORCE INFO
Date:

MonthDayYear
Date
Mobile Phone:
Format: (000) 000-0000.
Home Phone:
Format: (000) 000-0000.
Email Address:
example@example.com
CLIENT >>
1. Full Name:

First NameLast Name
Age:
2. Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. How Long Have You Lived at this Address?
4. What COUNTY Do You Currently Reside in?
Race:
5. Date of Birth:

MonthDayYear
Date
Place of Birth (city/state):
6. Please Provide the Following Information Concerning Your Employment:
Employer:
Job Title:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone:
Format: (000) 000-0000.
May We Call You at Work?
Work Email:
example@example.com
May We Email You at Work?
Monthly Gross Salary $:
Annual Gross Salary $:
Length of Employment:
Please List Any/All Education/Training:
If Military, Which Branch?
Rank:
Months in Service:
Military Status:
7. Social Security #:
Driver's License (inc state):
8. Additional Address Where You Can Be Reached?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Phone:
Format: (000) 000-0000.
If You Need to List Additional Phone and/or Addresses, Please Use Comments Section at the end of the Form.
9. Level of Schooling Completed:
10. Number of Marriages (including present):
11. If Previously Married, How Many Marriages Ended By Death:
Death
Divorce:
Annulment:
SPOUSE >>
1. Full Spouse Name:

First NameLast Name
Age:
2. Spouse Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. How Long Has Other Parent Lived at this Address?
What COUNTY Does Spouse Currently Reside in?
Race:
4. Home/Mobile Phone:
Format: (000) 000-0000.
Email:
example@example.com
5. Date of Birth:

MonthDayYear
Date
Place of Birth (city/state):
6. Please Provide the Following Information Concerning Spouse Employment:
Spouse Employer:
Job Title:
Spouse Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Monthly Gross Salary $:
Yearly Gross Salary $:
Main Work Phone:
Format: (000) 000-0000.
Length of Employment:
Please List Any/All Education/Training:
If Military, Which Branch?
Rank:
Months in Service:
Military Status:
7. Social Security #:
Drivers License (inc state):
8. Additional Address and/or Phone Number Where Spouse Can Be Reached:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Phone:
Format: (000) 000-0000.
If You Need to List Additional Phone and/or Addresses, Please Use Comments Section at the end of the Form.
9. Level of Schooling Completed by Spouse:
10. Number of Marriages (including present):
11. If Previously Married, How Many Marriages Ended By: Death:
Divorce:
Annulment:
MARRIAGE >>
1. Date of Marriage:

MonthDayYear
Date
Total Years of Marriage:
2. Marriage Location (city, state & county):
3. Your/Wife's Maiden Name:
4. Do You Wish to Change Your Name?
5. Date of Separation:

MonthDayYear
Date
Is This Marriage Common Law?
6. Are You/Wife Currently Pregnant?
Have You Seen a Marriage Counselor?
If Yes, Please Provide Counselor Info:

Name

Street Address Line 2

City & CountyState / Province

Postal / Zip Code
Counselor Phone:
Format: (000) 000-0000.
Have You and Your Spouse Attempted Reconciliation?
If No, Would You Like to Attempt Reconciliation?
Designate As Appropriate if Your Marital Difficulties Involve Any of the Following:

Other
Have You or Your Spouse Ever Used/Currently Using Any Illicit Drugs including Marijuana, THC or Delta 8?
If Yes, Explain:
Are You or Your Spouse Taking Any Medications that are Not Prescribed By a Doctor?
If Yes, Explain:
Are You or Your Spouse Taking Any Medications for a Mental Health Condition?
If Yes, Explain:
LIVING CHILD(REN) OF THIS MARRIAGE >>
CHILD #1
Full Name:
SS #:
Gender:
Place of Birth (city, state & county):
Date of Birth:

MonthDayYear
Date
Currently Resides with:
CHILD #2
Full Name:
SS #:
Gender:
Place of Birth (city, state & county):
Date of Birth:

MonthDayYear
Date
Currently Resides with:
CHILD #3
Full Name:
SS #:
Gender:
Place of Birth (city, state & county):
Date of Birth:

MonthDayYear
Date
Currently Resides with:
CHILD #4
Full Name:
SS #:
Gender:
Place of Birth (city, state & county):
Date of Birth:

MonthDayYear
Date
Currently Resides with:
Are the Child(ren) Covered by Health Insurance?
If Yes, Provide Info (carrier & which parent provides coverage):
Are the Child(ren) Covered by Dental Insurance?
If Yes, Provide Info (carrier & which parent provides coverage):

Where Has the Child(ren) Been Living For the Past 5 Years?

Rows	Where:	From-To:	With Whom:
Child #1
Child #2
Child #3

Has There Ever Been a Custody Fight Regarding the Child(ren)?
Has There Ever Been a Protective Order Issued/Applied For the Child(ren)?
COMMUNITY PROPERTY >>
List All Real Property Owned/Purchased DURING the Marriage (including County where property is located):
Property Location 1:
Property Location 2:
List All Vehicles Owned/Purchased DURING the Marriage (including year, make & model):
Vehicle 1:
Year, Make & Model
Loan/Lease?
Vehicle 2:
Year, Make & Model
Loan/Lease?
Vehicle 3:
Year, Make & Model
Loan/Lease?
Vehicle 4:
Year, Make & Model
Loan/Lease?
List All Retirement Accounts Acquired DURING the Marriage:
Account 1:
Bank Name & Account Type
Approximate Balance $:
Account 2:
Bank Name & Account Type
Approximate Balance $:
Account 3:
Bank Name & Account Type
Approximate Balance $:
Account 4:
Bank Name & Account Type
Approximate Balance $:
SEPARATE PROPERTY >>
List All Real Property Owned/Purchased PRIOR to the Marriage (including County where property is located):
Property Location 1:
Property Location 2:
List All Vehicles Owned/Purchased PRIOR to the Marriage (including year, make & model):
Vehicle 1:
Year, Make & Model
Loan/Lease?
Vehicle 2:
Year, Make & Model
Loan/Lease?
Vehicle 3:
Year, Make & Model
Loan/Lease?
List All Retirement Accounts Acquired PRIOR to the Marriage:
Account 1:
Bank Name & Account Type
Approximate Balance $:
Account 2:
Bank Name & Account Type
Approximate Balance $:
Have You Ever Visited an Attorney Prior to Today?
Have You Ever Discussed this Case with Another Attorney?
If Yes, Please Provide Attorney Name:
Attorney Phone:
Format: (000) 000-0000.
Attorney Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Has Your Spouse Ever Discussed ANY Case with the Law Office of Melissa D. Rowcliffe?
Who Did You Hear About the Law Office of Melissa D. Rowcliffe?
If Client Referral, Who Provided Referral?
I certify that all information contained in this form is correct and true.
Client Signature:
RETAINER QUOTES FOR DIVORCE CASES ARE VALID FOR 90 DAYS
Should be Empty:

CLIENT >>

SPOUSE >>

MARRIAGE >>

LIVING CHILD(REN) OF THIS MARRIAGE >>

COMMUNITY PROPERTY >>

SEPARATE PROPERTY >>

RETAINER QUOTES FOR DIVORCE CASES ARE VALID FOR 90 DAYS