Important, Please read!

Please fill in the form below to the best of your ability. This form contains
the basic information I will need to begin your case, I will obtain the
information pertaining to child custody, property division etc. through a
telephone or in person interview at a later time. I will generally call you
the same day I receive this information. I check this website daily. I will
need the information for both you and your spouse. If you don't
have all the information fill in what you have and I can get the rest later.
CLIENT FULL NAME
SPOUSE FULL NAME
CLIENT SEX:  MALE OR FEMALE
MAIDEN NAME OF WIFE
IF WIFE WANTS NAME
CHANGE, ADD NEW
FULL NAME HERE
CLIENT HOME PHONE
CLIENT WORK PHONE
SPOUSE HOME PHONE
CLIENT COMPLETE HOME
ADDRESS WITH ZIP CODE
SPOUSE COMPLETE HOME
ADDRESS WITH ZIP CODE
CLIENT SOC. SECURITY NUMBER
SPOUSE SOC. SECURITY NUMBER
CLIENT DATE OF BIRTH
SPOUSE DATE OF BIRTH
CLIENT COUNTY YOU LIVE IN:
EXAMPLE LAUDERDALE, COLBERT
SPOUSE COUNTY YOU LIVE IN:
EXAMPLE LAUDERDALE, COLBERT
CLIENT. HAVE YOU LIVED IN THIS COUNTY AT
LEAST 6 MONTHS? YES OR NO
HAS YOUR SPOUSE LIVED IN THIS COUNTY
AT LEAST 6 MONTHS? YES OR NO
IN CASE YOU ARE WONDERING THE NEXT GROUP OF QUESTIONS
ARE REQUIRED ON A FORM THAT IS SENT TO THE BUREAU OF VITAL
STATISTICS. THE COURT WILL REQUIRE ME TO COMPLETE THE
FORM BEFORE THEY WILL ISSUE A DIVORCE DECREE.
CLIENT RACE:WHITE,BLACK,ASIAN,OTHER
SPOUSE RACE: WHITE,BLACK,ASIAN,OTHER
CLIENT. HOW MANY TIMES
HAVE YOU BEEN MARRIED
INCLUDING THIS ONE?
HOW MANY TIMES HAS YOUR
SPOUSE BEEN MARRIED
INCLUDING THIS ONE?
HOW FAR DID YOU GO IN
SCHOOL? EXAMPLE 1-12
GRADE, 1-4 COLLEGE
HOW FAR DID YOUR SPOUSE
GO IN SCHOOL? EXAMPLE
1-12 GRADE, 1-4 COLLEGE
WHAT DATE DID YOU GET
MARRIED, IF UNSURE YOU MAY
MAKE AN ESTIMATE OF THE DATE
WHAT COUNTY AND STATE
DID YOU MARRY IN?
IS THE WIFE CURRENTLY PREGNANT?
DATE YOU SEPERATED.
COUNTY AND STATE
YOU SEPERATED IN
IF THERE WERE NO CHILDREN BORN OR ADOPTED DURING THIS
MARRIAGE WHO ARE CURRENTLY UNDER 19 YEARS OF AGE OR ARE
IN COLLEGE AND UNDER AGE 23, YOU MAY SKIP DOWN TO THE
CREDIT CARD SECTION OR IF YOU ARE GOING TO PAY LATER THE
SUBMIT BUTTON. THANK YOU FOR YOUR TIME IN FILLING IN THIS
FORM.
FILL IN THE NAME, SEX, DATE
OF BIRTH AND SOC. SECURITY
NUMBER OF EACH OF YOUR
CHILDREN IN THIS SEQUENCE:
EXAMPLE, JOHN THOMAS
SMITH, MALE, 5-6-67,
446-78-3528,   SUSAN ANN
JONES, FEMALE, 8-12-01,
478-98-9884
CLIENT NAME OF EMPLOYER AND
FULL ADDRESS OF EMPLOYER
WITH ZIP CODE. IF NONE OR SELF
EMPLOYED TYPE NONE OR SELF
CLIENT GROSS WAGE: LOOK FOR
WORDS GROSS ON PAYCHECK OR
GIVE HOURLY RATE IF PAID CASH:
EXAMPLE $450 BI- WEEKLY OR $12
PER HOUR
SPOUSE NAME OF EMPLOYER AND
FULL ADDRESS OF EMPLOYER
WITH ZIP CODE. IF NONE OR SELF
EMPLOYED TYPE NONE OR SELF
SPOUSE GROSS WAGE: LOOK FOR
WORDS GROSS ON PAYCHECK OR
GIVE HOURLY RATE IF PAID CASH:
EXAMPLE $450 BI- WEEKLY OR $12
PER HOUR
LIST THE AMOUNT PAID AND
WHO PAYS ANY HEALTH
INSURANCE OR DAYCARE :
EXAMPLE DAD 80 PER WEEK
HEALTH INS, MOM 70 WEEK
DAYCARE
LIST THE AMOUNT OF CHILD
SUPPORT PAID TO ANY CHILD
BORN PRIOR TO THIS
MARRIAGE: EXAMPLE DAD 220
PER MONTH FOR PRIOR CHILD
PLEASE ADD THE AMOUNT YOU WOULD LIKE BILLED TO YOUR
CREDIT CARD BELOW BEFORE PRESSING THE SUBMIT
BUTTON. BY FILLING IN THE INFORMATION BELOW YOU
AGREE THAT YOU HAVE AUTHORIZATION TO USE SAID CREDIT
CARD. IF YOU DO NOT HAVE A CREDIT CARD OR WISH TO PAY
AFTER DISCUSSING YOUR CASE WITH ME SIMPLY PRESS THE
SUBMIT BUTTON BELOW.
PLEASE ENTER THE TOTAL AMOUNT YOU
WOULD LIKE BILLED TO YOUR CARD AT THIS
TIME.   $350 FOR  UNCONTESTED DIVORCE.
(CONTESTED DIVORCE CALL FOR FEE) YOU
 PAY THE COURT COST WHEN YOU SIGN
THE DOCUMENTS PRIOR TO FILING.
CREDIT CARD NUMBER
CARD EXPIRATION DATE
PRESS THE SEND BUTTON TO SEND FORM
HINT, IT IS EASIER TO FILL IN
THE FORM IF YOU ADD YOUR
AND HIT (THE TAB KEY) TO
GO TO NEXT BOX.