MY FAMILY LAW GROUP PLLC
2325 East Camelback Rd., Suite 400
Phoenix, AZ 85016
+1(888) 870-6354
Divorce (with and without children) Intake Form
Thank you so much for contacting our law office! Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.
Privacy Policy
All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.
Your Social Security number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.
Social Security numbers are most often used to positively identify parties. Most courts require Social Security numbers of all parties in a case. Some other examples of how this information may be used include:
initial service
in court orders
in required reports or other documents filed with the State
If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!
CLIENT'S PERSONAL INFORMATION
Contact information
Prefix
First name
*
Middle name
Last name
*
Date of birth
Company
Emails
Email Address
*
Type
Upon submission, a copy of this form will be sent to the primary email.
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Home
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Primary
Default email false
Add email
Addresses
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---------------
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Primary
Default address false
Add address
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Work
Home
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Primary
Add phone number
Pronouns
Select an option
He/Him
She/Her
They/Them
County
SSN
Driver's License #
Age
Place of Birth
How long at current address?
Address Where Mail Can Be Sent To You Confidentially
Maiden Name
if applicable
Do you require a name change?
Yes
New Name
No
Health Issues
Do you have any military history?
Yes
Please describe
No
Client's Previous Marriages
(if applicable)
Previous Spouse or Partner's Full Legal Name
Date of Marriage
Date of Divorce
How Marriage Terminated
Other previous Marriage Details
Information that you would like to add. Any other marriages?
Client's Children From A previous Marriage
(if applicable)
Child From A Previous Marriage #1
If applicable, please select "Fill Out Child's Information" and complete the following information.
Fill Out Child's Information
Name
Date of Birth
Additional Information
i.e. - Adopted, Special Needs, Current Living Situation
Not Applicable
Child From A Previous Marriage #2
If applicable, please select "Fill Out Child's Information" and complete the following information.
Fill Out Child's Information
Name
Date of Birth
Additional Information
i.e. - Adopted, Special Needs, Current Living Situation
Not Applicable
Child From A Previous Marriage #3
If applicable, please select "Fill Out Child's Information" and complete the following information.
Fill Out Child's Information
Name
Date of Birth
Additional Information
i.e. - Adopted, Special Needs, Current Living Situation
Not Applicable
Child From A Previous Marriage #4
If applicable, please select "Fill Out Child's Information" and complete the following information.
Fill Out Child's Information
Name
Date of Birth
Additional Information
i.e. - Adopted, Special Needs, Current Living Situation
Not Applicable
Child From A Previous Marriage #5
If applicable, please select "Fill Out Child's Information" and complete the following information.
Fill Out Child's Information
Name
Date of Birth
Additional Information
i.e. - Adopted, Special Needs, Current Living Situation
Not Applicable
Maintenance and Child Support Obligations
Client's Education
State the total number of years of formal education you have completed
If you have a college degree, or degrees, state what those degrees are
Client's Employment
Employer
Occupation/Position
Address
Phone No
Length of Employment
How are you paid?
Hourly
Gross Hourly Rate
Net Hourly Rate
How many hours per week?
Salary
Gross Amount
Net Amount
Pay Frequency
Weekly
Bi-Weekly
Twice Per Month
Monthly
Other
Gross Pay
(per pay period)
Net Pay
(per pay period)
Bonus
Commissions
Expense Account
Stock Interests
Do you have a health insurance policy?
Yes
Name of Company
Who is covered?
Cost and Frequency of Payment
No
Employee Life Insurance Policy
Yes
Name of Company
Cost and Frequency of Payment
Dates Contributions Started and Amounts and Frequency of Contributions
No
Pension
Credit Union
401(k) or Savings Plan
Yes
Value of Account
Contribution Amount and Frequency
No
Profit Sharing
Yes
Value of Account
Contribution Amount and Frequency
No
Stock Options
IRA
Do you have Business Interest Income?
Yes
Please describe
No
Client's Other Income Information
Do you have any income other than from your chief employment?
Yes
From Whom Such Income Is Received
Gross Amount
Net Amount
No
Are you currently unemployed?
Yes
Name of Your Last Employer
Occupation
(what you did)
The amount of income you received from your last employment
No
OTHER PARTY'S PERSONAL INFORMATION
Full Name
Address
Home Phone
Cell Phone
Work Phone
Email
Pronouns
Select an option
He/Him
She/Her
They/Them
Country
Date of Birth
Age
Place of Birth
How long at current address?
Maiden Name
(if applicable)
Other Party's Physical Description
(age, ethnicity, height, weight, hair color, eye color, distinctive physical characteristics, tattoos, scars, nicknames, etc.)
Health Issues
Does the other party have any military history?
Yes
Please describe
No
Other Party's Previous Marriages
(if any)
Previous Spouse/Partner's Full Legal Name
Date of Previous Marriage
Date of Divorce
How Marriage Terminated
Other Previous Marriage Details
Information that you would like to add. Any other marriages?
Other Party's Children From A Previous Marriage
(if applicable)
Child From A Previous Marriage #1
If applicable, please select "Fill Out Child's Information" and complete the following information.
Fill Out Child's Information
Name
Date of Birth
Additional Information
i.e. - Adopted, Special Needs, Current Living Situation
Not Applicable
Child From A Previous Marriage #2
If applicable, please select "Fill Out Child's Information" and complete the following information.
Fill Out Child's Information
Name
Date of Birth
Additional Information
i.e. - Adopted, Special Needs, Current Living Situation
Not Applicable
Child From A Previous Marriage #3
If applicable, please select "Fill Out Child's Information" and complete the following information.
Fill Out Child's Information
Name
Date of Birth
Additional Information
i.e. - Adopted, Special Needs, Current Living Situation
Not Applicable
Child From A Previous Marriage #4
If applicable, please select "Fill Out Child's Information" and complete the following information.
Fill Out Child's Information
Name
Date of Birth
Additional Information
i.e. - Adopted, Special Needs, Current Living Situation
Not Applicable
Child From A Previous Marriage #5
If applicable, please select "Fill Out Child's Information" and complete the following information.
Fill Out Child's Information
Name
Date of Birth
Additional Information
i.e. - Adopted, Special Needs, Current Living Situation
Not Applicable
Maintenance and Child Support Obligations
if applicable
Other Party's Education
State the total number of years of formal education the other party has completed
If the other party has a college degree, or degrees, state what those degrees are
Other Party's Employment
Employer
Occupation/Position
Address
Phone No
Length of Employment
How is the other party paid?
Hourly
Gross Hourly Rate
Net Hourly Rate
How many hours per week?
Salary
Gross Amount
Net Amount
Pay Frequency
Weekly
Bi-Weekly
Twice Per Month
Monthly
Other
Gross Pay
(per pay period)
Net Pay
(per pay period)
Bonus
Commissions
Expense Account
Stock Interests
Does the other party have a health insurance policy?
Yes
Name of Company
Who is covered?
Cost and Frequency of Payment
No
Employee Life Insurance Policy
Yes
Name of Company
Cost and Frequency of Payment
Dates Contributions Started and Amounts and Frequency of Contributions
No
Pension
Credit Union
401(k) or Savings Plan
Yes
Value of Account
Contribution Amount and Frequency
No
Profit Sharing
Yes
Value of Account
Contribution Amount and Frequency
No
Stock Options
IRA
Does the other party have any business interests?
Yes
Please describe
No
Other Party's Other Income Information
Does the other party have any other sources of income?
Yes
From Whom Such Income Is Received
Gross Amount
Net Amount
No
Is the other party currently unemployed?
Yes
Last Employer
Occupation
The Amount of Income Received From Last Employment
No
MARRIAGE OR PARTNERSHIP INFORMATION
Date of Present Marriage
Date of Prenuptial Agreement
if applicable
Place Marriage Performed
County
Are Parties Sharing the Same Household?
Yes
Date that 'Irreconcilable Breakdown' Started
No
Give Date of Separation
Date of Separation
if applicable
Reason(s) for Divorce
Did you and the other party ever separate before?
Yes, there were previous separations
Describe your previous separations.
Include dates and reasons
No, this is the first time
Did you and the other party ever try marriage counseling or reconciliation?
(Social Worker, Marriage Counselor, Psychologist, Priest, Rabbi, Minister, Doctor)
Yes, we tried counseling in the past.
Please describe
Include dates and name of counselor.
No, we did not try counseling
Did you or your partner ever file a previous family law court action?
Yes
Case No.
Prior Attorney
Disposition
County & State
Additional Details
No
CHILDREN OF THIS MARRIAGE
Child of This Marriage #1
If applicable, please fill out the following information. If not applicable, kindly skip to the next section.
Child's Full Legal Name
Date of Birth
Resides With
Age
School/Day Care
Child of This Marriage #2
If applicable, please fill out the following information. If not applicable, kindly skip to the next section.
Child's Full Legal Name
Date of Birth
Resides With
Age
School/Day Care
Child of This Marriage #3
If applicable, please fill out the following information. If not applicable, kindly skip to the next section.
Child's Full Legal Name
Date of Birth
Resides With
Age
School/Day Care
Child of This Marriage #4
If applicable, please fill out the following information. If not applicable, kindly skip to the next section.
Child's Full Legal Name
Date of Birth
Resides With
Age
School/Day Care
Children's Additional Information
Children's Additional Information
i.e. - Adopted, Special Needs, Current Living Situation
Day-Care or Baby-Sitters
(Names, Cost per Week, etc.)
Educational Costs
(Registration, Tuition, Books, etc.)
Extracurricular Activities or Lessons
(Soccer, Dance, Swimming, etc.)
Are any children adopted?
Yes
Who?
No
Are you and the other party expecting?
Yes
When is the expected date?
No
Children’s Disabilities
(if any)
Describe any health or psychological challenges of any child.
Are both parents listed on the child/ren’s birth certificate(s)?
Yes
No
Please describe
ASSETS
Real Estate
Real Estate Property #1
If applicable, please select "Fill Out Real Estate Information" and complete the following information.
Fill Out Property Information
Address
How Title Is Held
Purchase Date
Purchase Price
Your Estimate Of Current Value
Balance of Mortgage(s)
Mortgage
(name of bank or savings and loan)
Is there a second mortgage?
If so, please state the original amount of the loan, the loan date, the remaining balance, and due date.
Net Equity of Property
Not Applicable
Real Estate Property #2
If applicable, please select "Fill Out Real Estate Information" and complete the following information.
Fill Out Property Information
Address
How Title Is Held
Purchase Date
Purchase Price
Your Estimate Of Current Value
Balance of Mortgage(s)
Mortgage
(name of bank or savings and loan)
Is there a second mortgage?
If so, please state the original amount of the loan, the loan date, the remaining balance, and due date.
Net Equity of Property
Not Applicable
Real Estate Property #3
If applicable, please select "Fill Out Real Estate Information" and complete the following information.
Fill Out Property Information
Address
How Title Is Held
Purchase Date
Purchase Price
Your Estimate Of Current Value
Balance of Mortgage(s)
Mortgage
(name of bank or savings and loan)
Is there a second mortgage?
If so, please state the original amount of the loan, the loan date, the remaining balance, and due date.
Net Equity of Property
Not Applicable
Checking Accounts, Savings Accounts, Credit Unions, Money on Deposit
Account #1
If applicable, please select "Fill Out Account Information" and complete the following information.
Fill Out Account Information
Bank or Name of Fund
Address
Names on Title
Date Acquired
Last 4 Digits of Account No.
Approximate Balance
Not Applicable
Account #2
If applicable, please select "Fill Out Account Information" and complete the following information.
Fill Out Account Information
Bank or Name of Fund
Address
Names on Title
Date Acquired
Last 4 Digits of Account No.
Approximate Balance
Not Applicable
Account #3
If applicable, please select "Fill Out Account Information" and complete the following information.
Fill Out Account Information
Bank or Name of Fund
Address
Names on Title
Date Acquired
Last 4 Digits of Account No.
Approximate Balance
Not Applicable
Account #4
If applicable, please select "Fill Out Account Information" and complete the following information.
Fill Out Account Information
Bank or Name of Fund
Address
Names on Title
Date Acquired
Last 4 Digits of Account No.
Approximate Balance
Not Applicable
Account #5
If applicable, please select "Fill Out Account Information" and complete the following information.
Fill Out Account Information
Bank or Name of Fund
Address
Names on Title
Date Acquired
Last 4 Digits of Account No.
Approximate Balance
Not Applicable
CD’s, IRA’s, Mutual Funds
Account #1
If applicable, please select "Fill Out Account Information" and complete the following information.
Fill Out Account Information
Bank or Name of Fund
Address
Names on Title
Date Acquired
Last 4 Digits of Account No.
Approximate Balance
Not Applicable
Account #2
If applicable, please select "Fill Out Account Information" and complete the following information.
Fill Out Account Information
Bank or Name of Fund
Address
Names on Title
Date Acquired
Last 4 Digits of Account No.
Approximate Balance
Not Applicable
Account #3
If applicable, please select "Fill Out Account Information" and complete the following information.
Fill Out Account Information
Bank or Name of Fund
Address
Names on Title
Date Acquired
Last 4 Digits of Account No.
Approximate Balance
Not Applicable
Account #4
If applicable, please select "Fill Out Account Information" and complete the following information.
Fill Out Account Information
Bank or Name of Fund
Address
Names on Title
Date Acquired
Last 4 Digits of Account No.
Approximate Balance
Not Applicable
Account #5
If applicable, please select "Fill Out Account Information" and complete the following information.
Fill Out Account Information
Bank or Name of Fund
Address
Names on Title
Date Acquired
Last 4 Digits of Account No.
Approximate Balance
Not Applicable
Stocks and Bonds
Stock or Bond #1
If applicable, please select "Fill Out Stock or Bond Information" and complete the following information.
Fill Out Stock/Bond Information
Name of Company
Number of Shares
Present Value
Title
Not Applicable
Stock or Bond #2
If applicable, please select "Fill Out Stock or Bond Information" and complete the following information.
Fill Out Stock/Bond Information
Name of Company
Number of Shares
Present Value
Title
Not Applicable
Stock or Bond #3
If applicable, please select "Fill Out Stock or Bond Information" and complete the following information.
Fill Out Stock/Bond Information
Name of Company
Number of Shares
Present Value
Title
Not Applicable
Stock or Bond #4
If applicable, please select "Fill Out Stock or Bond Information" and complete the following information.
Fill Out Stock/Bond Information
Name of Company
Number of Shares
Present Value
Title
Not Applicable
Stock or Bond #5
If applicable, please select "Fill Out Stock or Bond Information" and complete the following information.
Fill Out Stock/Bond Information
Name of Company
Number of Shares
Present Value
Title
Not Applicable
Safe Deposit Box(es)
Safe Deposit Box(es)
If applicable, please select "Fill Out Safe Deposit Box Information" and complete the following information.
Fill Out Safe Deposit Box Information
Location
Name(s) on Title
Who has Access
Contents
Not Applicable
Motor Vehicles
(Cars, Boats, Motorcycles, Etc.)
Motor Vehicle #1
If applicable, please select "Fill Out Motor Vehicle Information" and complete the following information.
Fill Out Vehicle Information
Year, Make and Model
Date Purchased
Balance Owed
Driven By
Monthly Payments
Paid To
Who is the lien-holder?
Client, Other Party, Joint
Who is the title-holder?
Client, Other Party, Joint
Not Applicable
Motor Vehicle #2
If applicable, please select "Fill Out Motor Vehicle Information" and complete the following information.
Fill Out Vehicle Information
Year, Make and Model
Date Purchased
Balance Owed
Driven By
Monthly Payments
Paid To
Who is the lien-holder?
Client, Other Party, Joint
Who is the title-holder?
Client, Other Party, Joint
Not Applicable
Motor Vehicle #3
If applicable, please select "Fill Out Motor Vehicle Information" and complete the following information.
Fill Out Vehicle Information
Year, Make and Model
Date Purchased
Balance Owed
Driven By
Monthly Payments
Paid To
Who is the lien-holder?
Client, Other Party, Joint
Who is the title-holder?
Client, Other Party, Joint
Not Applicable
Motor Vehicle #4
If applicable, please select "Fill Out Motor Vehicle Information" and complete the following information.
Fill Out Vehicle Information
Year, Make and Model
Date Purchased
Balance Owed
Driven By
Monthly Payments
Paid To
Who is the lien-holder?
Client, Other Party, Joint
Who is the title-holder?
Client, Other Party, Joint
Not Applicable
Life Insurance
Do you have a life insurance policy?
Yes
Through employment
Private plan
Amount of death benefit: $
Beneficiary
No
Does the other party have a life insurance policy?
Yes
Through employment
Private plan
Amount of death benefit: $
Beneficiary
No
Other Marital Property
Explain in full detail any other property obtained, purchased or acquired by either you or the other party during the marriage.
Non-Marital Property
Explain in full detail any other property obtained, purchase or acquired by either you or the other party before or during (via inheritance or gift only) the marriage.
DEBTS
Debt #1
If applicable, please select "Fill Out Debt Information" and complete the following information.
Fill Out Debt Information
To Whom Owed
Incurred by
Client, Other Party, Joint
Total Amount
Monthly Payments
Not Applicable
Debt #2
If applicable, please select "Fill Out Debt Information" and complete the following information.
Fill Out Debt Information
To Whom Owed
Incurred by
Client, Other Party, Joint
Total Amount
Monthly Payments
Not Applicable
Debt #3
If applicable, please select "Fill Out Debt Information" and complete the following information.
Fill Out Debt Information
To Whom Owed
Incurred by
Client, Other Party, Joint
Total Amount
Monthly Payments
Not Applicable
Debt #4
If applicable, please select "Fill Out Debt Information" and complete the following information.
Fill Out Debt Information
To Whom Owed
Incurred by
Client, Other Party, Joint
Total Amount
Monthly Payments
Not Applicable
Debt #5
If applicable, please select "Fill Out Debt Information" and complete the following information.
Fill Out Debt Information
To Whom Owed
Incurred by
Client, Other Party, Joint
Total Amount
Monthly Payments
Not Applicable
Additional Debts
Special Concerns
Please describe the issues most important to you pertaining to this divorce
Additional Information
Any additional information?
THANK YOU
If you have completed the form, please click
SUBMIT
.