Family Law Intake

Page 1

Instructions

Your name

Nombre

Apellido

Spouse's name

Nombre

Apellido

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Spouse's address

Dirección

Ciudad

Estado / Provincia

Código postal

Phone number

Spouse's phone number

Email

Spouse's email

Age

Spouse's age

Education

Date of marriage

Date of separation

Reason for separation

Page 2

Child 1

Age

Child 2

Age

Child 3

Age

Describe the current custody arrangements and any preferences or agreements regarding the children

What matters most to you in this divorce? (house, children, restraining orders, separate property)

List any questions you would like to discuss

Do you or your spouse have problems with any of the following?

Page 3

Instructions

Current employer

Spouse's employer

Employer address

Dirección

Ciudad

Estado / Provincia

Código postal

Spouse's employer address

Dirección

Ciudad

Estado / Provincia

Código postal

Job type

Spouse's job type

Work schedule/hours

Spouse's work schedule/hours

Pay rate

Spouse's pay rate

Gross income

Spouse's gross income

Second job

Spouse's second job

Rental income

Spouse's rental income

Other income (dividends, trusts, disability)

Spouse's other income (dividends, trusts, disability)

Page 4

Home

Instructions

Average principal ($)

Average interest ($)

Instructions

Homeowner's or renter's insurance, if not included above ($)

Real property taxes ($)

Maintenance and repair ($)

Health-care costs not covered by insurance ($)

Child care ($)

Groceries and household supplies ($)

Eating out ($)

Utilities (gas, electric, water, trash) ($)

Telephone, cellphone and internet ($)

Laundry and cleaning ($)

Clothes ($)

Education ($)

Entertainment, gifts and vacation ($)

Auto and transportation expenses (insurance, gas, repairs, bus) ($)

Insurance (life, accident; do not include auto, home or health) ($)

Savings and investments ($)

Charitable contributions ($)

Other ($)

Expenses paid by others ($)

List installment payments and debts not shown above (format: paid to, for, amount, balance, last payment)

Monthly total of the installment payments itemized above ($)

Is there a business involved?

Business name

Type of business

Your title

Date business acquired

Percent interest

Current fair market value

Business address

Dirección

Ciudad

Estado / Provincia

Código postal

Page 5

Property address 1

Dirección

Ciudad

Estado / Provincia

Código postal

Property address 2

Dirección

Ciudad

Estado / Provincia

Código postal

Names on title

Names on title 2

Date of purchase

Date of purchase 2

Purchase price

Purchase price 2

Fair market value

Fair market value 2

Monthly payment

Monthly payment 2

Annual property taxes

Annual property taxes 2

Dates of refinance

Dates of refinance 2

Page 6

Checking accounts

Current balance

Checking account 2

Current balance 2

Checking account 3

Current balance 3

Savings account

Savings balance

Savings account 2

Savings balance 2

Brokerage accounts

Brokerage balance

Retirement accounts and balances

Page 7

Instructions

Additional question

Other

Item

Balance and fair market value

Item

Balance and FMV

Item

Balance and FMV

Item

Balance and FMV

Item

Balance and FMV

Item

Balance and FMV

Other

Page 8

Credit card name

Amount owed

Credit card name

Amount owed

Credit card name

Amount owed

Credit card name

Amount owed

Credit card name

Amount owed

Other

Student loan company

Amount owed

Student loan company

Amount owed

Student loan company

Amount owed

Page 9

Loan name

Amount owed

Loan 2 name

Amount owed

Loan 3 name

Amount owed

Loan 4 name

Amount owed

Tax year

Amount owed

Tax year

Amount owed

Tax year

Amount owed

Item

Value

Item

Value

Item

Value

Item

Value

Item

Value

Other

Page 10

Item

Value

Item

Value

Item

Value

Item

Value

Item

Value

Item

Value

Item

Value

Item

Value

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