Family Law Intake
Information:
You:
Spouse:
Your Name:*
First Name Middle Name Last Name
Spouses Name:*
First Name Middle Name Last Name
Address*
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Spouses Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Phone Number*
Spouses Phone Number*
E-mail*
Spouses E-mail
Age
Spouses Age
Education
Education
Date of Marriage
Month Day Year
Date of Separation
Month Day Year
Reason for Separation:

CHILD1:
AGE:
CHILD2:
AGE:
CHILD3:
AGE:
State the current custodial arrangements and any preferences or agreements regarding custody of the children.
What is important to you in this divorce? (i.e., house, children, restraining orders, separate property)
List any questions you would like to discuss.
Do you or spouse have problems with any of the following?
Physical Violence Gambling Alcohol Abuse Drug Abuse Financial/Debt Physical Disability Mental Illness Boyfriend or Girlfriend

Income:
You:
Spouse:
Current Employer:
Spouses Employer:
Employer Address:
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Spouses Employer Address:
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Job Type:
Spouses Job Type:
Work Schedule/Hrs:
Spouses Work Schedule/Hrs:
Pay Rate
Spouses Pay Rate
Gross Income:
Spouses Gross Income:
Second job:
Spouses Second job:
Rental Income
Spouses Rental Income
Other Income(dividens,trust,disability?)
Spouses Other Income(dividens,trust,disability?)

Avg Monthly Expenses
Home:
Rent Mortage
If Mortgage:
Average Principal: $
Average Interest: $
Double-click to edit this text..yo.
Homeowner's or renter's insurance(if not included above):$
Real Property Taxes: $
Maintenance and repair: $
Health-care costs not paid by insurance: $
Child Care: $
Groceries and household supplies: $
Eating Out: $
Utilities(gas, electric, water, trash): $
Telephone, Cellphone, and e-mail: $
Laundry and cleaning: $
Clothes: $
Education: $
Entertainment, gifts, and vacation: $
Auto Expenses and transportation(Insurance, gas, repairs,bus, etc.): $
Insurance(life,accident, etc.;do not include auto, home, or health insurance): $
Savings and investments: $
Charitable contributions: $
Other: $
Amount of expenses paid by others: $
Please list installment payments and debts not listed above.(Please use this format:Paid to, For, Amount, Balance, last payment):
Monthly payments listed in installments(itemize above in box and insert total here): $
Business
Is there a Business Involved?
Business Name:
Type of Business:
Your Title:
Date of Business Acquired:
Month Day Year
Percent Interest:
Current FMV:
Business Address:
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country

Real Property
Property Address 1
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Property Address 2
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Names on Title
Names on Title 2
Date of Purchase
Date of Purchase 2
Purchase Price
Purchase Price 2
FMV
FMV 2
Monthly Payment
Monthly Payment 2
Annual Property Taxes
Annual Property Taxes 2
Dates of refinance
Dates of Refinance 2

Accounts
Checking Accounts
Current Balance
Checking Account 2
Current Balance 2
Checking Account 3
Current Balance 3
Savings Account
Savings Balance
Savings Accounts 2
Savings Balance 2
Brokerage Accounts
Brokerage Balance
Retirement Accounts & Balance
Vehicles
Auto
Year,Make,Model Names,on,Titles Date-Acquired Fair-Market-Value Amount,of,Loan Who,drives? Mileage?
Vehicle1
Vehicle2
Vehicle3
Vehicle4

Other Personal Property
Type
Value
Other
Please list any of the following: Motorcycles, RV's, Trailers, Watercrafts, Airplanes, Precious Metals, Investment Jewerly, Collectibles/Hobbies, Other Assests.
ITEM
Balance and FMV(Fair Market Value)
ITEM
Balance and FMV
ITEM
Balance and FMV
ITEM
Balance and FMV
ITEM
Balance and FMV
ITEM
Balance and FMV
Other

Debts
Credit Cards:
Credit Card Name
Owed?
Credit Card Name
Owed?
Credit Card Name
Owed?
Credit Card Name
Owed?
Credit Card Name
Owed?
Other
Student Loans:
Student Loan Company
Owed?
Student Loan Company
Owed?
Student Loan Company
Owed?

Other Loans:
Loan Name
Owed?
Loan2 Name
Owed?
Loan3 Name
Owed?
Loan4 Name
Owed?
Income Tax Due:
Tax Year
Owed?
Tax Year
Owed?
Tax Year
Owed?
Separate Property
Property owed before marriage?
Item:
Value
Item:
Value
Item:
Value
Item:
Value
Item:
Value
Other

Inheritance received?
Item:
Value
Item:
Value
Item:
Value
Item:
Value
Gifts received?
Item:
Value
Item:
Value
Item:
Value
Item:
Value

Information:

Income:

Avg Monthly Expenses

Business

Real Property

Accounts

Vehicles

Other Personal Property

Please list any of the following: Motorcycles, RV's, Trailers, Watercrafts, Airplanes, Precious Metals, Investment Jewerly, Collectibles/Hobbies, Other Assests.

Debts

Credit Cards:

Student Loans:

Other Loans:

Income Tax Due:

Separate Property

Property owed before marriage?

Inheritance received?

Gifts received?

Necessary Documents:

Reminders

	Year,Make,Model	Names,on,Titles	Date-Acquired	Fair-Market-Value	Amount,of,Loan	Who,drives?	Mileage?
Vehicle1
Vehicle2
Vehicle3
Vehicle4

Information:

Income:

Avg Monthly Expenses

Business

Real Property

Accounts

Vehicles

Other Personal Property

Please list any of the following: Motorcycles, RV's, Trailers, Watercrafts, Airplanes, Precious Metals, Investment Jewerly, Collectibles/Hobbies, Other Assests.

Debts

Credit Cards:

Student Loans:

Other Loans:

Income Tax Due:

Separate Property

Property owed before marriage?

Inheritance received?

Gifts received?

Necessary Documents:

***Reminders***

Reminders