INTAKE FORM FAMILY
Last name:
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First name:
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Date of Birth:
MM
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DD
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YYYY
Address:
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Cell Phone:
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Home Phone:
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E-mail:
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Spouse Last name:
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Spouse First name:
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Spouse Address:
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Spouse Phone Number:
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Date of marriage
MM
/
DD
/
YYYY
Place of marriage
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Date of separation
MM
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DD
/
YYYY
Are there any children from this marriage?
Name and age:
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Where and who do the children live with?
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Do you and your spouse own any property together?
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Do you pay/receive any child support to/from spouse?
Are there any related cases existing in court? If so, where?
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What are your requests for the court?
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