E-mail address:

City: State: Country:

Occupation:

Home Phone Number:
Work Phone Number:

Best time of day to contact:

Marital Status: Single Married Widowed Seperated Divorced

Your Age Group: 18-25 26-35 36-45 46-55 56-Over

Do you have an attorney? Yes No

If so, who?

Does the other party have an attorney? Yes No

If so, who?

What is the temperament of your matter? N/A Friendly Tolerable Not so good Volcanic Atomic

Have any papers been filed with the court? Yes No

If yes, when?

Have you been served with any papers? Yes No

If yes, when?

Case #

Last Court Appearance

Judge's Name Department

Court House Location

Length of Marriage

Children Yes No If so, ages?

Do you have custody? Yes No

Your annual income
Your spouse's annual income

Your spouse's occupation

Any spousal support? Yes No If so, how much?

Any child support? Yes No If so, how much

Is your case a move-away case? (other spouse removed the children) Yes No

Legal problem(s) (check all that apply):

• Divorce
  
• Child Custody
  
• Visitation
  
• Paternity
  
• Child Support
  
• Spousal Support
  
• D.A. Support
  
• Property Division
  
• Modification of Prior Order
  
• Other:

  BRIEF (50 words or less) description of your situation: