Divorce With Protective Order Questionnaire

Name:(Required)

Social Security Number:(Required)

Home Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

County:(Required)

Date of Birth:(Required)

Home Phone:(Required)

Work Phone:(Required)

Other Number:(Required)

Email Address:(Required)

Facsimile Number:(Required)

Driver's License Number:(Required)

Driver's License Issuing State:(Required)

Dates of Residency at Current Address:(Required)

List any previous residences in the past five (5) years, and dates resided in each:(Required)

Employer's Name (if any)(Required)

Employer's Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer's Telephone Number:(Required)

Date of Employment:(Required)

Occupation:(Required)

Salary:(Required)

How Often?:(Required)

List any other jobs held during the course of this marriage (indicate employer and annual salary):(Required)

If not currently employed, list date of last employment, name of last employer, and reason currently unemployed:(Required)

Indicate any additional plans for future employment:(Required)

Highest level of education completed:(Required)

Describe any other education received such as Post-high school training/education including the name of the school or college, dates attended and degree received:(Required)

Describe plans you have to enroll in school or complete your education, if any:(Required)

What is your religious preference?:(Required)

How did you hear about our office?:(Required)

Have you retained any other attorneys on this matter prior to coming to this office? (If yes, please provide name, date retained, and reason to discontinue service.):(Required)

Opposing Party's Name:(Required)

Social Security Number:(Required)

Home Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth:(Required)

State of Birth:(Required)

Home Phone:(Required)

Work Phone:(Required)

Other Number:(Required)

Email Address:(Required)

Facsimile Number:(Required)

Driver's License Number:(Required)

Driver's License Issuing State:(Required)

Is opp. party represented by counsel in this matter (Y or N)?:(Required)

Opp. Party's Attorney:(Required)

Street Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number:(Required)

Facsimile Number:(Required)

Employer's Name (if any):(Required)

Employer's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title(Required)

Nature of Job(Required)

Date of Employment(Required)

Occupation(Required)

Salary(Required)

How Often?(Required)

List any other jobs held during the course of this marriage (indicate employer and annual salary)(Required)

If not currently employed, list date of last employment, name of last employer, and reason currently unemployed(Required)

Indicate any additional plans for future employment

Highest level of education completed(Required)

Describe any other education received such as Post-high school training/education including the name of the school or college, dates attended and degree received(Required)

Describe any plans your spouse may have to enroll in school or complete his/her education(Required)

What is your spouse's religious preference?(Required)

Date of Marriage(Required)

Place of Marriage(Required)

Are you and your spouse currently living together?(Required)

If not, then Date of Separation(Required)

Do you have an interest in reconciliation?(Required)

To the best of your knowledge, does your spouse want reconciliation?(Required)

Describe the circumstances that caused your separation(Required)

If a suit for divorce has been previously filed by either spouse as to this marriage, please provide the date such was filed, the name of the primary attorney involved, the name or location of the court, and the reason the divorce was not finalized(Required)

Detail any family violence with detailed description of the acts and date of each act of violence(Required)

Detail any verbal threats and include date of each threat(Required)

List all children and include dates of birth(Required)

Is the wife currently pregnant?(Required)

Date Child is Due(Required)

Have any of the children have resided with anyone other than you and your spouse during the last five (5) years?(Required)

If Yes, Name of Custodian(Required)

If Yes, Custodian's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If Yes, Dates Resided(Required)

If Yes, Name of Custodian

If Yes, Custodian's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If Yes, Dates Resided(Required)

If Yes, Name of Custodian(Required)

If Yes, Custodian's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If Yes, Dates Resided(Required)

Have you participated as a party, witness or any other way in other litigation or custody proceedings, inc. divorce, separate maintenance, child neglect, dependancy or guardianship, concerning custody or visitation of any child subject to this proceeding?(Required)

If Yes, Please Describe(Required)

Do you have any information of any custody or visitation proceeding currently pending in a court of this or any other state concerning any child subject to this proceeding?(Required)

If Yes, Please Describe(Required)

The Wealth Advisor

The Wealth Counselor

Divorce With Protective Order Questionnaire