Family Law Intake Form

Family Law Intake
Information:
You:
Spouse:
Your Name:*

First NameMiddle NameLast Name
Spouses Name:*

First NameMiddle NameLast Name
Your Phone Number*
Format: (000) 000-0000.
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Spouses Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Spouses Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Spouses E-mail
example@example.com
Your Age
Spouses Age
Date of Marriage

MonthDayYear
Date of Separation

MonthDayYear
Reason for Separation:

CHILD1:
AGE:
CHILD2:
AGE:
CHILD3:
AGE:
State the current custodial arrangements and any preferences or agreements regarding custody of the children.
What is important to you in this divorce? (i.e., house, children, restraining orders, separate property)
List any questions you would like to discuss.
Physical ViolenceGamblingAlcohol AbuseDrug AbuseFinancial/DebtPhysical DisabilityMental IllnessBoyfriend or Girlfriend

Income:
You:
Spouse:
Current Employer:
Spouses Employer:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Spouses Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Job Type:
Spouses Job Type:
Work Schedule/Hrs:
Spouses Work Schedule/Hrs:
Pay Rate
Spouses Pay Rate
Gross Income:
Spouses Gross Income:
Second job:
Spouses Second job:
Rental Income
Spouses Rental Income
Other Income(dividens,trust,disability?)
Spouses Other Income(dividens,trust,disability?)
RentMortage
Monthly Rent/Mortgage Payment
Double-click to edit this text..yo.
Business
Is there a Business Involved?
Business Name:
Type of Business:
Your Title:
Date of Business Acquired:

MonthDayYear
Percent Interest:
Current FMV:
Business Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Real Property
Property Address 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Property Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Names on Title
Names on Title 2
Date of Purchase
Date of Purchase 2
Purchase Price
Purchase Price 2
FMV
FMV 2
Monthly Payment
Monthly Payment 2
Annual Property Taxes
Annual Property Taxes 2
Dates of refinance
Dates of Refinance 2
Vehicles

Auto

Rows	Year,Make,Model	Names,on,Titles	Date-Acquired	Fair-Market-Value	Amount,of,Loan	Who,drives?	Mileage?
Vehicle1
Vehicle2
Vehicle3
Vehicle4