Family Law Intake
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Premarital Agreement
Divorce
Child Custody
Guardianship
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CLIENT INFORMATION
Full Name:
*
First Name
Last Name
Maiden Name (if applicable):
Gender
M
F
M-F
F-M
Pronouns
Social Security Number:
Date of Birth:
Place of Birth:
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
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Lived at current address since:
Phone number:
*
 -
Area Code
Phone Number
E-mail:
*
example@example.com
Have you ever served in the military or naval service of the United States or its allies within the provisions of the Service Members' Civil Relief Act of 2003?
Do you have children?
Yes
No
Are they from a previous relationship?
Yes
No
PARTNER INFORMATION
Full Name:
Maiden Name (if applicable):
Gender
M
F
M-F
F-M
Pronouns
Social Security Number:
Date of Birth:
Place of Birth:
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Lived at current address since:
Phone number:
 -
Area Code
Phone Number
Email:
example@example.com
Has your spouse ever served in the military or naval service of the United States or its allies within the provisions of the Service Members' Civil Relief Act of 2003?
Does your Partner have children from another relationship?
Yes
No
DISABLED PERSON'S INFORMATION
Full Name:
Maiden Name (if applicable):
Gender
M
F
M-F
F-M
Pronouns
Social Security Number:
Date of Birth:
Age:
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Lived at current address since:
Phone number:
 -
Area Code
Phone Number
Email:
example@example.com
Names and Addresses of the Disabled Person's Spouse, Parent(s), and Presumptive Heirs
Why is a guardianship sought? Include a description of the physical, functional and mental limitations of the disabled person.
Why should the proposed guardian be appointed?
MARRIAGE INFORMATION
Date of marriage:
Place where married:
Date of separation:
Including this marriage, how many times have you been married?
Including this marriage, how many times has your spouse been married?
Are you and your spouse living together now?
Reason for separation:
Do you believe your spouse will consent to a divorce?
CHILDREN
CHILD 1:
Date of Birth:
Age:
Resides with:
CHILD 2:
Date of Birth:
Age:
Resides with:
CHILD 3:
Date of Birth:
Age:
Resides with:
Do you anticipate a dispute about custody of the children?
State current custodial arrangement for the children, and any preference or agreement regarding custody of the children:
CLIENT'S CHILDREN
CHILD 1:
Date of Birth:
Age:
Resides with:
CHILD 2:
Date of Birth:
Age:
Resides with:
CHILD 3:
Date of Birth:
Age:
Resides with:
Do you anticipate a dispute about custody of the children?
State current custodial arrangement for the children, and any preference or agreement regarding custody of the children:
PARTNER'S CHILDREN
CHILD 1:
Date of Birth:
Age:
Resides with:
CHILD 2:
Date of Birth:
Age:
Resides with:
CHILD 3:
Date of Birth:
Age:
Resides with:
Do you anticipate a dispute about custody of the children?
State current custodial arrangement for the children, and any preference or agreement regarding custody of the children:
EMPLOYMENT INFORMATION
Are you employed?
If so, state your employer:
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Job title:
Employed since:
Please state your education and vocational training (including number of years you attended high school and college, if applicable):
INCOME
Salary (gross monthly):
Salary (net monthly):
Deductions (monthly)
Overtime and bonus:
Additional Income from rental, trusts, interest, etc.? If so, please explain:
PARTNER'S EMPLOYMENT INFORMATION
Employed?
If so, state employer:
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Job title:
Employed since:
Please state education and vocational training (including number of years spouse attended high school and college, if applicable):
PARTNER'S INCOME
Salary (gross monthly):
Salary (net monthly):
Deductions (monthly)
Overtime and bonus:
Additional Income from rental, trusts, interest, etc. If so, please explain:
RECONCILIATION
Do you have an interest in reconciliation?
Does your spouse (if known)?
Have you tried marriage counseling? If so, when and with whom?
ASSETS
(of you and your partner)
Real property? If yes, specify address and owner:
Estimate the value of any bank accounts (savings & checking) and indicate the name on the account(s), where the account(s) is held, the present value of the account(s) and how much was contributed to each account by you and spouse, whether separately or jointly:
Estimate the value of any bank accounts (savings & checking) and indicate the name on the account(s), where the account(s) is held, the present value of the account(s) and how much was contributed to each account by you and spouse, whether separately or jointly:
Estimate the value of any stocks and bonds and indicate the number of shares, how much was contributed by each, the present value, and location of article:
Miscellaneous items such as property, patents, trademarks, copyrights, royalties, limited partnership interests, proprietary interest and other investments? If so, please describe:
Significant personal effects such as jewelry, art, antiques, boats, aircraft collections, furs, and tangible personal property? If so, please specify:
Employee benefits, pension, retirement, profit-sharing plans, regardless of whether presently vested or by whom contributed? If so, please specify:
Insurance Policy? Do you or your spouse have an insurance policy? If so, specify who owner of the policy, the company, value, type and beneficiary of the account:
Expected gifts or inheritance (you, your spouse and children)? If so, when, by whom, from whom and in what amount (if known):
LIABILITIES
Mortgages on real estate? If so, please specify who owns the mortgage, present amount and payment date:
Other debts, including student loans, consumer credit or alimony obligations? If so, please specify loan provider, total amount owed, and who pays existing loan:
Special medical and educational needs, whether you, your spouse, or children? If so, please describe:
MEDICAL/DENTAL/EYE INSURANCE
Medical: Specify insurer, policy number persons covered, nature and extent of coverage and whether group or individual, by whom paid and how much, and whether both spouses can remain covered after divorce is final:
Dental: Specify insurer, policy number persons covered, nature and extent of coverage and whether group or individual, by whom paid and how much, and whether both spouses can remain covered after divorce is final:
Other: Specify type of insurance, insurer, persons covered, nature and extent of coverage and whether group or individual, by whom paid and how much, and whether both spouses can remain covered after divorce is final:
MONTHLY EXPENSES
Mortgage (monthly total):
Real estate taxes( if applicable):
Rent (if applicable):
Utilities:
(Gas, electric, water)
Telephone:
Car payment (if applicable):
Food:
Transportation:
(Gas, electric, water)
Food:
Clothing:
Medical expenses:
Childcare (if applicable):
Education (if applicable):
Entertainment and recreation:
Membership dues:
Consumer debts:
Other, please specify:
ASSETS OF DISABLED PERSON
Real property? If yes, specify address and owner:
Estimate the value of any bank accounts (savings & checking) and indicate the name on the account(s), where the account(s) is held, the present value of the account(s) and how much was contributed to each account by you and spouse, whether separately or jointly:
Estimate the value of any bank accounts (savings & checking) and indicate the name on the account(s), where the account(s) is held, the present value of the account(s) and how much was contributed to each account by you and spouse, whether separately or jointly:
Estimate the value of any stocks and bonds and indicate the number of shares, how much was contributed by each, the present value, and location of article:
Miscellaneous items such as property, patents, trademarks, copyrights, royalties, limited partnership interests, proprietary interest and other investments? If so, please describe:
Significant personal effects such as jewelry, art, antiques, boats, aircraft collections, furs, and tangible personal property? If so, please specify:
Employee benefits, pension, retirement, profit-sharing plans, regardless of whether presently vested or by whom contributed? If so, please specify:
Insurance Policy? Do you or your spouse have an insurance policy? If so, specify who owner of the policy, the company, value, type and beneficiary of the account:
Expected gifts or inheritance (you, your spouse and children)? If so, when, by whom, from whom and in what amount (if known):
LIABILITIES OF DISABLED PERSON
Mortgages on real estate? If so, please specify who owns the mortgage, present amount and payment date:
Other debts, including student loans, consumer credit or alimony obligations? If so, please specify loan provider, total amount owed, and who pays existing loan:
Special medical and educational needs, whether you, your spouse, or children? If so, please describe:
MEDICAL/DENTAL/EYE INSURANCE OF DISABLED PERSON
Medical: Specify insurer, policy number persons covered, nature and extent of coverage and whether group or individual, by whom paid and how much, and whether both spouses can remain covered after divorce is final:
Dental: Specify insurer, policy number persons covered, nature and extent of coverage and whether group or individual, by whom paid and how much, and whether both spouses can remain covered after divorce is final:
Other: Specify type of insurance, insurer, persons covered, nature and extent of coverage and whether group or individual, by whom paid and how much, and whether both spouses can remain covered after divorce is final:
MONTHLY EXPENSES OF DISABLED PERSON
Mortgage (monthly total):
Real estate taxes( if applicable):
Rent (if applicable):
Utilities:
(Gas, electric, water)
Telephone:
Car payment (if applicable):
Food:
Transportation:
(Gas, electric, water)
Food:
Clothing:
Medical expenses:
Childcare (if applicable):
Education (if applicable):
Entertainment and recreation:
Membership dues:
Consumer debts:
Other, please specify:
OTHER
Do you and/or your partner have a history of mental health or substance abuse? If so, please explain:
During the marriage, was either party the victim of abuse? If so, was a Protection from Abuse Order entered? Please specify:
Were the any other problems/issues that existed during the relationship? If so, please identify:
Has your partner consulted an attorney regarding this matter? If so, please indicate his/her name and address, if known:
Do you have a will? If so, who are the beneficiaries?
Do you have an accountant or have you ever used an accountant? If so, please state his/her name and address?
Are there bank accounts, lines of credit, stock and investment accounts or other accounts to which your partner has access? If so, please clarify:
Does your partner have in his or her possession credit cards for which you are responsible? if so, please specify:
Have you ever signed anything which may affect the case, including prenuptial or post-nuptial agreement(s), or other documents presented by your spouse? If so, please describe what you signed:
What is important to you in this relationship: (i.e. house, children, restraining orders, separate property)?
Submit
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