Divorce/Child Custordy Intake FormPlease answer all questions fully and honestly. The answers may affect your case. YOUR ANSWERS TO THE QUESTIONS ARE COMPLETELY CONFIDENTIAL AND WILL NOT BE RELEASED TO ANYONE WITHOUT YOUR PERMISSIONPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Client Name *FirstMiddleLastReferred By * you social license Phone Number *Email *Address *Date of Birth *Place of Birth *Nationality *Driver's License Number (Client) *Social Secuity Number (Client) *Are you currently married? *YesNoDate of current marriage? *Place of marraige *Are you currently separated (living apart)?YesNoIf Yes, what is the date of separation?Have you been previously married? *YesNoIf Yes, List all previous spouse and marriage information, in or outside the United State *(N/A if not applicable)Are you currently employed? *YesNoWhat is the name of current employer? *When was your employment starte date? *What is your employment type? *What is your job title or position? *What is you annual salary? *Have you been previously employeed? *YesNoIf Yes, List all previous employment *Spouse Name *FirstMiddleLastWhat is your spouse data of birth? *What is your spouse place of birth? *What is your spouse nationality and race? *What is your spouse physical/mailing current address? *What is your spouse email address? *What is your spouse phone number? *What is your spouse driver's license #?What is your spouse social security #? Is your spouse currently employed? *YesNoWhat is name of your spouse employer?Please provide the address and phone number of your spouse employer.What is spouse job title and employment type?What is spouse current salary?Do you have children with your spouse? *YesNoPlease provide names, date of birth, place of birth, and current primary resident of all the childern *(N/A if not applicable)Please list all properties and asserts acquired in or outside your marriage (if it’s a vehicle, list make and model). *(N/A if not applicable)Have you ever been a victim of domestic abuse by a spouse or children? *YesNoHave your spouse been a victim of domestic abuse by you or children? *YesNoHave your children or child been victim(s) of domestic abuse by your or your spouse? *Yes - US CitizenYes - Permanent ResidentNoIf you answered Yes to any of the above question, was there a police report filed? *YesNoHave you been arrested for family violence or domestic abuse? *YesNoHave your spouse been arrested for family violence or domestic abuse? *YesNoProvide details of any family violence or domestic abuse *Provide details of any police report and arrest. *Submit
