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Family Law Intake Form
Today's Date
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Please provide as much of the information below as you are able. The more we know about you and your family situation, the better we can help you.
All information will be kept confidential.
The firm does not use the information provided in any solicitation and will not send you any mailings or make calls to you unless or until you have retained the firm or authorize the firm to do so.
1. Your information
Name
*
Please provide your full name
Address
*
Please provide address
City
*
Please provide city
State
*
Please provide state
Zip Code
*
Please provide zip code
Home Phone
*
Please provide home phone number
Work Phone
*
Please provide work phone number
Cell Phone
*
Please provide cell phone number
Email Address
*
Please provide valid email address
Note – all clients are required to obtain and maintain an email address for regular communications with this firm.
Date of Birth
*
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Would you like mail sent to a different address?
Yes
No
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Address
Please provide address
City
Please provide city
State
Please provide state
Zip Code
Please provide zip code
Employer
Please provide address
Employer Address
Please provide address
City
Please provide city
State
Please provide state
Zip Code
Please provide zip code
If you are currently represented by another attorney,
please provide the name:
Please provide address
2. Opposing Party
Name
Please provide your full name
Address
Please provide address
City
Please provide city
State
Please provide state
Zip Code
Please provide zip code
Home Phone
Please provide home phone number
Work Phone
Please provide work phone number
Cell Phone
Please provide cell phone number
Email Address
Please provide valid email address
Date of Birth
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Employer
Please provide address
Employer Address
Please provide address
City
Please provide city
State
Please provide state
Zip Code
Please provide zip code
If this person is represented by an attorney,
please provide the name:
Please provide address
Height
Please provide address
Eye Color
Please provide address
Weight
Please provide address
Hair Color
Please provide address
The above items are needed for service arrangements.
3. Marriage
Date of Marriage
Please provide address
Location of Marriage
Please provide your full name
Date of Divorce
Please provide address
Location of Divorce
Please provide your full name
4. Children in Common
Child 1 Name
Please provide your full name
Date of Birth
Please provide address
Does this child reside with you primarily?
Yes
No
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If Not, Address
Please provide address
City
Please provide city
State
Please provide state
Zip Code
Please provide zip code
Child 2 Name
Please provide your full name
Date of Birth
Please provide address
Does this child reside with you primarily?
Yes
No
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If Not, Address
Please provide address
City
Please provide city
State
Please provide state
Zip Code
Please provide zip code
Child 3 Name
Please provide your full name
Date of Birth
Please provide address
Does this child reside with you primarily?
Yes
No
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If Not, Address
Please provide address
City
Please provide city
State
Please provide state
Zip Code
Please provide zip code
Child 4 Name
Please provide your full name
Date of Birth
Please provide address
Does this child reside with you primarily?
Yes
No
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If Not, Address
Please provide address
City
Please provide city
State
Please provide state
Zip Code
Please provide zip code
With whom do your children
live most of the time?
Mother
Father
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With whom do your children
live now?
Mother
Father
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About how many days each week does
the other parent see the child(ren)?
1
2
3
4
5
6
7
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About how much time each day?
Please provide address
Please provide address(es) for where the child(ren)
have lived for the past five (5) years:
Address
Please provide address
City
Please provide city
State
Please provide state
Zip Code
Please provide zip code
Time Period
Please provide address
Address
Please provide address
City
Please provide city
State
Please provide state
Zip Code
Please provide zip code
Time Period
Please provide address
Address
Please provide address
City
Please provide city
State
Please provide state
Zip Code
Please provide zip code
Time Period
Please provide address
Who provides medical insurance?
Mother
Father
Other
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How much does that parent pay each month
for the child(ren)’s medical insurance?
Please provide address
Do/does the child(ren) require daycare?
Yes
No
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Who pays for daycare?
Mother
Father
Other
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How much does daycare cost each month
on average over the entire year?
Please provide address
Does Mother pay court-ordered spousal maintenance (alimony)?
Yes
No
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How much?
Please provide address
Does Father pay court-ordered spousal maintenance (alimony)?
Yes
No
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How much?
Please provide address
Does Mother pay court-ordered child support for other child(ren)?
Yes
No
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How much?
Please provide address
Does Father pay court-ordered child support for other child(ren)?
Yes
No
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How much?
Please provide address
Does Mother support any other natural or adopted child(ren) who also live with Mother?
Yes
No
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How many?
Please provide address
Names and Ages
Please provide address
Does Father support any other natural or adopted child(ren) who also live with Mother?
Yes
No
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How many?
Please provide address
Names and Ages
Please provide address
Are there any other child support orders in
effect for any of the children identified above?
Yes
No
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What is Mother’s gross (total) income before deductions
and taxes?
Please provide address
What is Mother’s completed education level or degree(s) received?
Please provide address
What is Father's gross (total) income before deductions
and taxes?
Please provide address
What is Father’s completed education level or degree(s) received?
Please provide address
Has paternity for the child(ren) been established?
Yes
No
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Is Father listed on the child(ren)’s birth certificate?
Yes
No
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Did Father sign a voluntary acknowledgement of paternity at the child(ren)’s birth(s)?
Yes
No
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5. Property
Do you and opposing party jointly own a residence?
Yes
No
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How is this residence titled?
Please provide address
Has this property been refinanced?
Please provide address
Did either party sign a disclaimer deed for this property?
Please provide address
Do you own any property that you feel is your sole and separate property?
Yes
No
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Describe Property 1
Please provide address
How/when was it acquired?
Gift
Inherited
Purchased prior to marriage
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Describe Property 2
Please provide address
How/when was it acquired?
Gift
Inherited
Purchased prior to marriage
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Describe Property 3
Please provide address
How/when was it acquired?
Gift
Inherited
Purchased prior to marriage
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How were you referred to this firm?
Please provide address
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