Family Law Information Questionnaire

Please have this Information Packet completed prior to our initial meeting. We would appreciate your providing us with the information prior to our meeting so that we have enough time to understand the specifics of your situation before our meeting. If you need assistance completing the information, call our office at (925) 933-9047 and we will help you.

DON’T WORRY ABOUT TOTAL ACCURACY - JUST DO THE BEST YOU CAN WE LOOK FORWARD TO SEEING YOU!!!

ALL INFORMATION IS STRICTLY CONFIDENTIAL

Personal Profile

Client Full name*

Client Name

Home Address*

Street Address Address Line 2 City State ZIP Code

Home address*

Is it Ok to Send Mail to the above?

Yes
No

Where*

Home Phone*

Is it Ok to Call the above Number?

Yes
No

What Number*

Work Phone*

Cell Phone*

Is it Ok to Call the above Number?*

Yes
No

What Number*

Email*

Email address*

Is it Ok to Send Mail to the above?

Yes
No

Where*

Occupation*

Employer*

Social Security Number*

Date of Birth*

Period of Residence in California*

County of Residence*

Spouse (or Other Parent) Full name

Other names used*

Other names used

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Work Phone*

Cell Phone*

Email address*

Occupation*

Employer*

Social Security Number*

Date of Birth*

Period of Residence in California*

County of Residence*

Any Agreements

Is there a prenuptial (premarital) agreement?*

Yes
No

Do you have a copy of this agreement?*

Yes
No

who does?*

Is there a nuptial (ante-nuptial) agreement?*

Yes
No

Do you have a copy of this agreement?*

Yes
No

who does?*

County of Residence*

Marriage Information

Date of Marriage:*

Place:*

Date of Separation:*

Why that date?*

County of Residence*

How Long?*

You: Been a Resident of California for the Last Six Months?*

Yes
No

You: Been a Resident of CC for the Last Three Months?*

Yes
No

Spouse: Been a Resident of California for the Last Six Months?*

Yes
No

Spouse: Been a Resident of CC for the Last Three Months?*

Yes
No

Any previous marriage for Client?*

Yes
No

Give the following information for each former marriage:

Name

Name of former spouse

Date of marriage*

Was marriage ended by death or divorce?*

Yes
No

Date the divorce was final (or date of death)?*

How many?*

Any previous marriage for Spouse?*

Yes
No

Give the following information for each former marriage:

Name

Name of former spouse

Date of marriage*

Was marriage ended by death or divorce?*

Yes
No

Date the divorce was final (or date of death)?*

How many?*

What do you want to do?

I want to get divorced?*

Yes
No

I want a legal separation?*

Yes
No

I want an annulment?*

Yes
No

I want child support?*

Yes
No

I want spousal support?*

Yes
No

I want our assets divided?*

Yes
No

I want our debts divided?*

Yes
No

I want to make custody orders?*

Yes
No

I want to make visitation orders?*

Yes
No

I want the other person kicked out?*

Yes
No

I want a restraining order?*

Yes
No

I want to change a prior order?*

Yes
No

Anything else

Other Items to Include or Discuss: Your divorce lawyer should try to address all your questions, fears, needs and wants. Please list any other items you would like addressed or covered.

Is there anything unique about your situation that the attorney should know about?

Anything else?

Physical Description of Spouse (or other Parent) for Service of Documents:

Height

Weight

Eye Color

Hair Color

Distinguishing Features:

Car Make

Model

Color

Year

Can you provide me with a picture of your spouse?*

Yes
No

May I give the picture of your spouse to the process server?*

Yes
No

Children

Child(1)

Male
Female

Name*

Name

Child of*

Client/Spouse
Client
Spouse

Address*

Street Address City State ZIP Code

Phone

Birthdate*

Special Needs of Child

Yes
No

Describe

Child(2)

Male
Female

Name*

Name

Child of*

Client/Spouse
Client
Spouse

Address*

Street Address City State ZIP Code

Phone

Birthdate*

Special Needs of Child

Yes
No

Describe

Child(3)

Male
Female

Name*

Name

Child of*

Client/Spouse
Client
Spouse

Address*

Street Address City State ZIP Code

Phone

Birthdate*

Special Needs of Child

Yes
No

Describe

Child(4)

Male
Female

Name*

Name

Child of*

Client/Spouse
Client
Spouse

Address*

Street Address City State ZIP Code

Phone

Birthdate*

Special Needs of Child

Yes
No

Describe

Child(5)

Male
Female

Name*

Name

Child of*

Client/Spouse
Client
Spouse

Address*

Street Address City State ZIP Code

Phone

Birthdate*

Special Needs of Child

Yes
No

Describe

Are there any deceased children?

Yes
No

did they leave any surviving children?

Yes
No

Names and ages of any surviving children of the deceased children

If Your Children Are Minors

How would you like to address custody and visitation:

Financial Profile

Income*

Husband
Wife
Joint

Monthly Earned Income*

Monthly Social Security Income

Monthly Pension Income

Other Monthly Income

List all Real Property (i.e., land or homes) owned by you and how title is held:

Please provide “Grant Deeds” for all California real property.

FMV

Owe

Total Gross

Total Net

Cash (checking accounts, savings accounts, CDs, or money markets)

FMV

Owe

Total Gross

Total Net

Automobiles, Boats and RV’s

FMV

Owe

Securities (common stock, preferred stock, corporate bonds, mutual funds)

FMV

Owe

Total Gross

Total Net

Retirement or other employee benefits including 401(k), IRA or Keogh accounts, include the names of the beneficiaries of these benefits.

FMV

Owe

Total Gross

Total Net

Life Insurance which you own

Face value

Cash value

Type of Policy (term, whole life)

Name and address of each insurance company and policy number

Business Interests

FMV

Owe

Are you the holder of any promissory notes?*

Yes
No

list name of payor , the name of the payee and the current outstanding balance.*

Are you the beneficiary of any will or trust?*

Yes
No

Name of the trust*

Name of the trustee*

Value of trust principal and income*

List your tangible personal property of significant value

FMV

Owe

Total Gross

Total Net

Anticipated Gifts or Lawsuit Judgment (Please describe)

Total Gross

Other Assets

FMV

Owe

Total Gross

Total Net

Summary of Values

Real Property

Cash

Automobiles

Securities

Retirement

Life Insurance

Business Interests

Notes

Inheritance

Power of Appointments

Personal Property

Gifts of Judgments

Other Assets

TOTAL

Advisors

Personal Attorney

Name

Phone

Accountant

Name

Phone

Financial Advisor

Name

Phone

Life Insurance Agent

Name

Phone

Do you need a referral for any of the above?

Yes
No

Would you like any of the following:

Do you want your former name restored?*

Yes
No

What was your former name?

Former name

Do you want to revoke a joint tenancy?*

Yes
No

Do you want to revoke a trust?*

Yes
No

Do you want to create new estate planning documents such as Wills, Trusts, Durable Powers of Attorney, or Health Care Directives?*

Yes
No

Anything else?

Thank you for allowing us to be of service with your family law needs!

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