Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Plaintiff: _____________________________________
Defendant: ___________________________________
Date ______________________________
1.
CLIENT INFORMATION
Race: _________________
____________________________________________________________________
Hours Worked: __________________________________
2.
SPOUSES INFORMATION:
Full Name: ____________________________________________________________________
First
Middle
Maiden
Last
Address: _____________________________________________________________________
City
State
Zip
County
How Long?
SSN: ________________________________ Drivers License #: ____________________
Home Phone: ________________ Work: __________________ Other: ___________________
Date of Birth: ______________________ State of Birth: ________________________
Number of this marriage for you: ____________________________ Race: ________________
Education: _______________________________ Employed? Yes _______ No ___________
Occupation: ________________________________________ Salary: __________________
Employer: ____________________________________________________________________
_____________________________________________________________________________
Hours Worked: _______________________
Height: __________ Weight:_________ Eye Color: _____________ Hair Color: ____________
Scars/Tattoos: __________________________________________________________________
Auto Make/Model/Color: _________________________________________________________
Type Home: ______________________ Living With: ________________________________
3.
MARRIAGE INFORMATION:
DIVORCE INFORMATION:
Does your spouse have a sexually transmitted disease? Yes _____ No ______
Describe any incidents, locations, and dates of your spouses adultery: ___________________
____________________________________________________________________________
Witnesses: ___________________________________________________________________
______________________________________________________________________________
5.
Name
Date/Place of
Birth
Current Address
Past 5 years
lived
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please list below any children living with you who are not your spouses children:
Check here if none _________
Name
Date of Birth
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please list below any children living with your spouse who are not your children:
Check here if none: __________
Name
Date of Birth
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
6.
CHILD CUSTODY
_____________________________________________________________________________
_____________________________________________________________________________
Do you know of any custody cases concerning your children now pending in this state or any
other state? Yes ____ No ______ If yes, give details: _________________________________
______________________________________________________________________________
______________________________________________________________________________
Do you know of any person who has physical custody of the children or claims to have custody
or visitation rights with the children? Yes _____ No _____ If yes, who? ___________________
Do you want custody? Yes ____ No _______
Have you or another party been reported to DSS? Yes _______ No ______
If yes, who? ____________________________ When? _______________________________
Briefly describe what happened: ___________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
7.
VISITATION
If you do not have custody, what visitation would you like? ______________________________
______________________________________________________________________________
If you do have custody, what visitation are you willing to agree to? ________________________
______________________________________________________________________________
8.
SUPPORT
Is there an Order for support Yes _______ No _______ If yes, date: _______________________
Amount per month: $_______________
How is it paid: Directly to you ____ Through the Court ______ Wage Withholding ________
Do you want this support order to remain as it is? Yes _____ No ________
Are the payments current? Yes _____ No ________
If there is no support order, do you want child support? Yes _____ No _______
Are you or opposing party receiving TANF ( formerly AFDC) Yes _____ No _______
Do you or your spouse have health insurance for the children? Yes ____ No _______
Who pays for the insurance? Wife _____ Husband ______
How much is paid for the childrens part of the insurance alone? _________________________
Do you pay child support for any other children? Yes _____ No _______
If yes, how much? ___________ Is it court ordered? Yes ______ No _________
Does your spouse pay child support for any other children? Yes ____ No _______
If yes, how much? _____________ Is it court ordered? Yes ______ No _______
9.
MARITAL HOME
ALIMONY
ADULTERY
CHILD CARE
PROTECTIVE ORDER
MAIDEN NAME
If you are the wife, do you wish to resume use of your maiden name? Yes _____ No ________
OR- do you prefer to resume use of your prior married name: Yes _______ No _______
If yes, what is your prior married name? ___________________________________________
15.
Name on Title
Debt
owed
Balance
Payment
Make and Model
when bought
to whom
Due
Amount
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Boats You Own
Name on
Title
Debt
Owed
Balance
Payment
When
Bought
to
Whom
Due
Amount
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Name on Title
Debt Owed
Balance
When Bought
To Whom
Due
Payment
Due
______________________________________________________________________________
______________________________________________________________________________
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______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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