Please fill out the following information worksheet prior to our first appointment. Please note that items in bold are required.

Attorney
County
Court
Court is located in...
Spouse 1 Name
Spouse 1 Maiden Name
Spouse 1 Email
Spouse 1 Address
City, State, ZIP
Spouse 1 Mailing Address (if different)
Spouse 1 Home Phone
Spouse 1 Work Phone
Spouse 1's Employer
Spouse 1's Occupation
Gross Income
County of Residence
Spouse 1 Birth Date
Spouse 1 Insurance Plan
Address
Insurance ID Number
Plan Administrator
Type of Coverage
Member of the Armed Forces?
Receiving Public Assistance?
Number of this Marriage?
Education Level?
Spouse 2 Name
Spouse 2 Maiden Name
Spouse 2 Street Address
City, State, ZIP
Mailing Address (if different)
Spouse 2 Home Phone
Spouse 2 Work Phone
Spouse 2's Employer
Occupation
Spouse 2's Gross Income
Spouse 2 County of Residence
Spouse 2's Date of Birth
Spouse 2 Insurance Plan
Address
Insurance ID Number
Plan Administrator
Type of Coverage
Member of the Armed Forces?
Receiving Public Assistance?
Number of this Marriage?
Education Level?
Date of Marriage
Town/City/Village of Marriage
County of Marriage
State of Marriage
Type of Ceremony?
Do you have a separation agreement?
If so, what date?
Number of Children
Child 1 Name
Birth Date
Age
Child 2 Name
Birth Date
Age
Child 3 Name
Birth Date
Age
Child 4 Name
Birth Date
Age
Child 5 Name
Birth Date
Age
Relief Sought
Grounds