Name:
DOB:
- -
Spouse:
Address:
City:
State:
Zip:
Home Ph.:
Cell Ph.:
Email:
If you retain, may we email you regarding your case?
Yes No
Preferred Method/Telephone Number to contact you:
Year Married:
Husband Age:
Wife Age:
State Married AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR NY PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY
Seperation Date:
Ages of children born of marriage:
Are both parties seeking seperation/divorce?
What issues are parties in agreement? (list below)
Has there been marriage counseling?
What is the cause of seperation/divorce? (explain below)
GROSS Annual Income
Husband:
Wife:
Other:
EQUITY
Total Checking, Savings, Investments, etc.:
Home/Real estate Equity:
Personal Propert - Vehicles, Boats, etc :
Retirement Income :
Investment/Savings - 401K, IRA, etc.:
TOTAL DEBT
Total Credit Card Debit:
Personal Loans:
Automobile Loans:
Mortgage Loans (Second Mortgage if applicable):
Other Debt:
What do you want your attorney to do for you?
What court orders or written agreements are in effect now?
Is there a pending court date? If so what type?
List any questions you have for us below:
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