Family Law

Family Law Intake

*TYPE *

Premarital Agreement Divorce Child Custody Guardianship

DATE: *

Month Day Year

Lead Source *

Other

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 Country

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

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

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?

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?

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:

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:

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:

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):

Salary (gross monthly):

Salary (net monthly):

Deductions (monthly)

Overtime and bonus:

Additional Income from rental, trusts, interest, etc.? If so, please explain:

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):

Salary (gross monthly):

Salary (net monthly):

Deductions (monthly)

Overtime and bonus:

Additional Income from rental, trusts, interest, etc. If so, please explain:

Do you have an interest in reconciliation?

Does your spouse (if known)?

Have you tried marriage counseling? If so, when and with whom?

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 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):

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: 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:

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: