Client Profile Intake Form

As to each minor child of both parties:

*Your Full Name:

Address:

Phone:

*Email Address:

Employeer Name:

Employeer Address:

Employeer Phone:

Other Party's Information:

Full Name of Other Party:

Other Party's DOB:

Other Party's Address:

Other Party's Employeer Name:

Other Party's Employeer Address:

Other Party's Employeer Phone:

Other Information:

Date of Marriage:

City of Marriage:

County of Marriage:

State of Marriage:
Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

As to each minor child of both parties:

Name:

Date of Birth:

Who has custody?

Are you trying to change custody?

As to children of either party (not both parties):

Name:

Date of Birth:

Who has custody?

Does either party pay child support and if so how much.

State All Grounds for Divorce
(e.g. irreconcilable differences, adultery, desertion, domestic violence):

If alimony, child support, or a division of property is in issue, list:

Your property and monthly earnings:

Other Partys property and monthly earnings:

Notes and Comments: