Family Law Intake Form

Family Law Intake
Information:
You:
Spouse:
Your Name:*
First NameMiddle NameLast Name
Spouses Name:*
First NameMiddle NameLast Name
Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Spouses Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Phone Number*
Spouses Phone Number*
E-mail*
Spouses E-mail
Age
Spouses Age
Education
Education
Date of Marriage
MonthDayYear
Date of Separation
MonthDayYear
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 ViolenceGamblingAlcohol AbuseDrug AbuseFinancial/DebtPhysical DisabilityMental IllnessBoyfriend or Girlfriend

Income:
You:
Spouse:
Current Employer:
Spouses Employer:
Employer Address:
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Spouses Employer Address:
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
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:
RentMortage
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:
MonthDayYear
Percent Interest:
Current FMV:
Business Address:
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry

Real Property
Property Address 1
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Property Address 2
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
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

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

Information: