Divorce : No Children : Under 50K : Client Questionnaire

Client Questionnaire

Name

Soc. Sec. No.

Address

City

State

Zip

County

DOB

State of Birth

Home Phone

Work Phone

Facsimile Number

Email address

Drivers License Number

Dates of residency at current address?

List any previous residences in the past five (5) years, and date resided in each.

Client Questionnaire

Client Questionnaire: Spouse's Information

Name

Soc. Sec. No.

Address

City

State

Zip Code

County

DOB

State of Birth

Home Phone

Work Phone

Fax Number

Email address

Driver's License Number

Is spouse represented by cousel in this matter?

Yes

No

Spouses's Attorney

Street Address

City

State

Zip Code

Phone Number

Facsimile Number

Employer's Name (if any)

Employer's Address

City

State

Zip

Job Title

Nature of Job

Date of Employment

Occupation

Salary

Choose one

Weekly

Biweekly

Monthly

Annualy

List any other jobs held during the course of this marrage (indicate employer and annual salary)

If not currently employed, list date of last employment and last employer and reason currently unemployed.

Client Questionnaire: General Marital History

Date of Marriage

Place of Marriage

Are you and your Spouse currently living together

Yes

No

If not, then Date of Separation

Do you have interest in reconciliation

Yes

No

To the best of your knowledge, does your spouse want reconciliation

Yes

No

Describe the circumstances that caused your separation

If a suit for divorce has been previously filed by either you or your spouse as to this marriage, please provide the date such was filed, the name of the primary attorney involved, the name or location of the court, and the reason the divorce was not finalized.

Client Questionnaire: Children's Information from this Marrage

You can skip this information if you you don't have a child.

NAME

SS NUMBER

PLACE OF BIRTH

DATE OF BIRTH

LIVING WITH

SEX

Is the wife currently pregnant

Yes

No

If yes, date child is due

UCCJEA Information:

Where the child live during the last five (5) years, please complete the following information.

DATES RESIDED WITH Dates (From/To)

NAME OF CUSTODIAN

ADDRESS

Have you participated as a party, witness or any other capacity in other litigation or custody proceedings, including divorce, separate maintenance, child neglect, dependency or guardianship, concerning custody visitations of any child subject to this proceeding?

Yes

No

If yes, please describe

Do you have any information of any custody or visitation proceedings currently pending in a court of this or any other state concerning any child subject to this proceeding

Yes

No

If yes, please describe

I understand and acknowledge that by checking this box, I am legally agreeing to all of the statements in this document.