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Cansino Blanchette & Oswalt-Smith, LLC
Uncontested Divorce Intake Sheet
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* Indicates required question
Email:
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Your answer
Today's Date:
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MM
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DD
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YYYY
Full Legal Name
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Your answer
Best Contact Phone Number:
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Your answer
Address:
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Your answer
Employment:
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Yes, employed.
No, unemployed.
Monthly Income:
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Your answer
Date of Birth:
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MM
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DD
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YYYY
Opposing Party's Date of Birth:
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MM
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DD
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YYYY
Date of Marriage:
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MM
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DD
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YYYY
Place of Marriage:
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Your answer
Date of Separation:
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MM
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DD
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YYYY
Reason for Divorce:
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Your answer
Opposing Party's Full Legal Name:
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Your answer
Opposing Party's Current Address:
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Your answer
Opposing Party's Best Phone Number:
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Your answer
Opposing Party's Best Email:
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Your answer
Opposing Party's County of Residence:
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Your answer
How Long has Opposing Party Lived at Current Residence?
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Your answer
Opposing Party's Employment:
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Yes, employed.
No, unemployed.
Opposing Party's Monthly Income:
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Your answer
Do you or your spouse wish to restore name to your/ their maiden name?
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Yes, restore name to legal name before marriage.
No, keep married legal name.
If yes above, what is full legal name to be restored?
Your answer
Is there any personal property to be retrieved for either spouse?
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Your answer
Alimony Requested?
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Yes
No
Your Car, Make, Model, and Year?
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Your answer
Do you pay a car loan?
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Yes
No
If so, how much monthly?
Your answer
Who owns the title to the vehicle?
Your answer
Opposing Party's Car, Make, Model, and Year?
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Your answer
Does Opposing Party pay a car loan?
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Yes
No
If so, how much monthly?
Your answer
Who owns this vehicle's title?
Your answer
Do you own your home?
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Yes
No
Monthly rent on home, if applicable:
Your answer
Monthly mortgage, if applicable
Your answer
Name on Mortgage or Lease:
Your answer
Name on title deed:
Your answer
Is there any cash funds that need to be split, and if so how much?
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Your answer
Savings Accounts: Please list any savings accounts and how much is in each account.
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Your answer
Checking Accounts: Please list any savings accounts and how much is in each account.
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Your answer
Are there any investments that need to be split and if so how much?
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Your answer
Are there any retirement funds that need to be split, and if so how much?
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Your answer
Are there any other miscellaneous funds that need to be split, and if so please describe them and how much?
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Your answer
Debts: Please list any known debts and monthly payments per debt.
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Your answer
Credit Cards: Please list any credit card balances and monthly payments per card.
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Your answer
Loans: Please list any loan balances and monthly payments per loan.
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Your answer
Medical Bills: Please list any known medical bills or balances, and monthly payments per listed item.
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Your answer
Children: Are there any children from this marriage?
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Yes
No
Please list full legal names, dates of birth, and age of each child from this marriage below:
Your answer
Children: Are there any children NOT from this marriage, or from a prior marriage?
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Yes
No
Please list full legal names, dates of birth, and age of each child NOT from this marriage below:
Your answer
Are all matters of custody already decided?
Yes
No
Clear selection
Who will the children live with primarily?
Me, the Petitioner.
My Spouse, the Respondent.
Clear selection
Who will have primary physical custody of the children?
Me, the Petitioner.
My Spouse, the Respondent.
There will be an even split in custody.
Clear selection
Who will have legal custody of the children?
Me, the Petitioner.
My Spouse, the Respondent.
We will have joint legal custody.
Clear selection
Please list any agreed visitation arrangements that you would like incorporated into your Settlement Agreement:
Your answer
Holidays: Please list the holiday schedule that you would like incorporated into your Settlement Agreement.
Your answer
Do you and your family have Health Insurance?
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Yes
No
Unsure
If Yes, who is the provider of the health insurance?
Me
My Spouse.
Other
Clear selection
How much is the monthly insurance payment for the children?
Your answer
If either spouse were to move residence, how far in miles would you or your spouse request to receive notice? (Ex: spouse moves 100 miles away or further, I request notice)
Your answer
Who will be the final decision maker for any children listed in this divorce for decisions related to Education?
Me
My Spouse
Clear selection
Who will be the final decision maker for any children listed in this divorce for decisions related to healthcare?
Me
My Spouse
Clear selection
Who will be the final decision maker for any children listed in this divorce for decisions related to religion?
Me
My Spouse
Clear selection
Who will be the final decision maker for any children listed in this divorce for decisions related to extracurricular activities?
Me
My Spouse
Clear selection
Please list any transportation arrangements regarding the children, if any:
Your answer
Please list any tax filling arrangements regarding the children, if any:
Your answer
Special Requests: Is there anything not previously mentioned that you would specifically like listed or included in your settlement agreement?
Your answer
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