General Divorce Client Intake Questions

Date:                     Client: Husband              Wife               

How did you hear about us?_____________________

 

GENERAL INFORMATION

Husband:                                                          

Work Phone No.                                             

Mobile No.                                                       

E-mail.                                                              

Address:                                                            

Occupation:                                                     

Employer:                                                         

Employer’s Address:                                      

Birthdate:                                                         

 

INFORMATION NEEDED TO PREPARE PETITION/ANSWER

 

Client Petitioner/Respondent is a resident of                                                 County,

Oklahoma and has resided in that County for 30 days (yes/no) and

the State of Oklahoma for 6 months (yes/no)?

Date Married:                                        Place:                                                            

 

Date Separated:                                   If minor children, with whom have they lived since separation?

                                                                                                                                  

 

INFORMATION REGARDING CHILDREN

 

  1. Complete this section only if there are minor children born or adopted in this marriage.
Child’s Full Name Age DOB Social Security Number Was Child Born of this Marriage or Previous    Marriage Was Child Adopted by You or Your Spouse

 

  1. List all addresses where you, your spouse, and the minor children have lived for the past five (5) years.
  2. Give dates for each address in chronological order, with your last and current address first.

 

Dates(To – From) Address City State

 

  1. Have either you or your spouse participated as a party, witness or in any other capacity,                                                                                   in any type of litigation concerning the custody of your child(ren) in this state or any other state?    Yes    No
  2. If your answer is YES, give complete details:                                                                            
  3. Is there any type of custody proceeding concerning your child(ren) now pending                                                                                                in any court of this State or any other State to your knowledge?   Yes   No
  4. If your answer is YES, give complete details:                                                                         
  5. Is there any other person or entity who has physical custody of your child(ren) OR                                                                                     claims some right to have custody or visitation privileges with respect to your child(ren)?  Yes    No
  6. If your answer is YES, give complete details:                                                                         
  7. Who do you propose be the custodial parent?  Father   Mother    Joint
    1. If joint custody, what percentage of time will the children live with each parent?
    2. Father               %
    3. Mother             %

 

  1. Please express your proposed Child visitation: ______________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

 

INDIAN DESCENT

 

  1. Are you of Indian descent:  Yes  No
  2. Is your spouse of Indian descent?  Yes  No
  3. If your answers to both of these questions were No, then skip to the next series of questions,                                                                     otherwise complete the following:  If either you and/or your spouse is of Indian descent,                                                                           Name of Tribe:                                              Are you or your spouse properly enrolled on the Tribal Rolls?   Yes  No.                                     Are the children currently enrolled on the Tribal Rolls to your knowledge?  Yes    No,  What is the Roll Number of each child?                                                                                   __Are the children eligible for membership in an Indian Tribe?                                  If so, what tribe?                                                                             

 

HEALTH INSURANCE POLICY

 

  1.  Do you or your spouse maintain health insurance on your children?   I do   Spouse does
  2.  Is the health insurance provided, through a private plan or through the  employer?
  3.  Provided by me
  4.  Provided by spouse
  5.  Provided through my employer
  6.  Provided through spouse’s employer
    1. What is the total cost (premium) of the health insurance per month? $                                         ____
    2. What is the cost (premium) of the health insurance for the children only per month $                       
  7. If the health insurance is provided by your employer or your spouse’s employer,                                                                                            does the employer pay the employee’s, i.e., yours or your spouse’s health insurance premium?  Yes    No
  8. How many individuals are covered by this health insurance policy?                                             ____
  9. Are there any individuals covered under this policy who are not children of this marriage? Yes   No                                                                If your answer is YES,  how many?                                                                                                
  10. Do you, your spouse, or children receive any health insurance through DHS or other state agency?   Yes     No                                             If your answer is YES, explain?                                                                      

 

CHILD CARE FOR CHILDREN

  1. If your children are in child care, what are the name, address, and phone number of the child care provider                                                                                                             
  2. Which children are in child care?                                                                                                                
  3. What is the weekly cost of the child care? $                                                                                                      
  4. Is the cost for summer child care different from the cost during the school year?  Yes   No
  5. Who currently pays for the child care?        Mother    Father   DHS
    1. Does this amount take into consideration any “extras” (field trips, birthday parties, etc.) that the child                                         care provider may charge?   Yes   No
    2. If your answer is NO, what is the average amount per month that the child care provider charges                                                  each month? $               

PRIOR MARRIAGE

(If applicable)

  1. Former Spouse’s Name:                                                                                                                 
  2. Date of Divorce:                                    County where divorce was granted:                                   
  3. Is prior spouse living?   Yes    No.  If dead, date of death:                                                                 
  4. Did you live with a member of the opposite sex prior to this marriage?  Yes No
  5. Did your spouse live with a member of the opposite sex prior to this marriage$   Yes    No
  6. Is it possible that either of you were in a common law marriage as a result?   Yes   No  If “yes”,                                                                        please explain:                                                                                                   

 

MILITARY HISTORY

(Prior service/present status)

  1. You:                                                                                                                  
  2. Spouse:                                                                                                     

 

FAMILY’S PRESENT HEALTH

(Good/poor – explanation)

  1. Yours:                                                                                                              
  2. Spouse:                                                                                                          
  3. Children:                                                                                                          

 

INCOME INFORMATION

  1. Attach copies of State and Federal Income Tax Returns for last three (3) taxable years.
  2. Attach wage statements from your employer for last four (4) pay periods.
Income Information Husband Wife
Gross monthly income from salary and wages, including commissions, bonuses,   allowances and overtime
Income is paid weekly, bi-weekly, or monthly
Income from Pensions and Retirement
Income from Social Security
Income from Disability and Unemployment Insurance
Income from Public Assistance (welfare, AFDC payments, etc.)
Child Support from any prior marriage
All other Sources: (Specify)
AMOUNT OF GROSS INCOME

 

DEDUCTIONS FROM GROSS INCOME

 

Deductions Husband Wife
1.         State Income Taxes
2.         Federal Income Taxes
3.         Number of Exemptions   Taken
4.         Medical Insurance Premium  
5.         Life Insurance Premium
6.         Life Insurance Premium
7.         Union or Other Dues
8.         Retirement or Pension   Fund
9.         Savings Plan
10.      401K Plan
11.      Credit   Union
12.      Other   Deductions: (Specify)
TOTAL DEDUCTIONS

 

 

NET MONTHLY INCOME

                                                                            Husband                 Wife
  1. TOTAL   GROSS INCOME LESS TOTAL DEDUCTIONS

 

 

SEPARATE PROPERTY

 

  1. List all property which was acquired by either you or your spouse (1) before marriage, (2) by inheritance or gift,                                       (3) since the date of separation:
Asset Date Acquired Source of Acquisition Current Possession Current Value

 

MARITAL ASSETS

 

  1. On attached Schedule1: “Assets and Secured Debts Acquired During Marriage”                                                                          complete all information for all property which was acquired by either you or your spouse from                                                                 date of marriage until the date of separation.

 

  1. Automobiles (Year-Make):

Automobile

Year/Make

VIN No. How is Title Held Current Retail Value Amount Owed/ Lienholder Monthly Payment

 

  1. Securities – stocks, bonds:
Name of Company Policy No. Face Amount Cash Value Accumulated
TOTAL

 

  1. Cash and Deposit Accounts (banks, savings & loans, credit unions – savings and checking)

 

Bank/Credit Union Account No. Type of Account Balance on Date of Separation Balance on Date of Petition

 

  1. Life Insurance:
Name of Company Policy No. Owner & Beneficiary Face Amount Cash Value Accumulated
1.
2.
3.

 

  1. Profit-Sharing, 401(k), or Other Retirement:

 

Name of Account Owner Balance on Dateof Marriage Balance on Dateof Petition
1.
2.
3.
4.
5.
6.

 

  1. Real Estate. Where more than one parcel of real estate owned, attach sheet

 

  1. Legal   Description [Attach copy of Deed]

 

  1. Street   Address

 

  1. Type   of Property

 

  1. Date   of Acquisition

 

  1. Original   Cost

 

  1. Cost   of Additions

 

  1. Total   Cost

 

  1. Total   Present Value [Attach most recent   Appraisal]

 

  1. Mortgage   Balance

 

  1. Other   Liens

 

  1. Equity

 

  1. Monthly   Mortgage Payment

 

  1. Mortgage   Holder

 

  1. Taxes

 

  1. Individual   Contributions

 

 

  1. Business Interest
            Name   of Business       Share      Type of Business   Current   Value              Debt
1.
2.
3.

 

  1. Other assets not specified above:
Asset Date Acquired Source of Acquisition Current Possession Current Value

 

SEPARATE DEBTS

  1. List all debts which were acquired by either you or your spouse before marriage or since the date of separation:
            Creditor’s    Name For Date Acquired Balance Monthly Payment
TOTAL

 

MARITAL DEBTS

  1. On attached Schedule 2: “Outstanding Debts Incurred During Marriage”   complete all information for all                           debts  which were acquired by either you or your spouse from the date of marriage until the date of separation.

BUDGET

  1. Number of persons living in household:                                              _______________
  2. What is each person’s relationship to you?                                                                            
  3. Which party is the custodial parent?                                                                                                       
  4. List names and relationship of all members of the household whose expenses are included in the following budget:                                                             
                                                               Expense         Husband             Wife
Rent or mortgage payments (residence)
Real property taxes (residence)
Real property insurance (residence)
Maintenance (residence)
Food and household supplies
Utilities including water, electricity, gas and heat
Telephone, mobile phone and pager
Cable TV and internet
Laundry and cleaning
Clothing
Uninsured medical
Uninsured dental
Insurance (life, health, accident, comprehensive,   liability, and disability)EXCLUDE Payroll Deductions
Child Care
Payment of Child Support/Spousal Support (Prior   Marriage)
School
Entertainment (includes clubs, social obligations,   travel and recreation
Incidentals (grooming, tobacco, alcohol, gifts and   donations)
Transportation (other than auto)
Auto expense (gas, oil, repair, insurance, tag)
Auto payments
Installment payments (insert total and attach an   itemized schedule)
Other expenses (insert total and attach an itemized   schedule)
TOTAL

 

TEMPORARY ORDERS

  1. If you want a temporary order for support or restraining order, please indicate if, while this proceeding is                                pending, you want the court to give you:
Request of the Court Yes No
  1. Possession   of the marital residence

 

  1. Custody   of the minor children

 

  1. Temporary   child support

 

  1. Temporary   spousal support

 

  1. Possession   of vehicle (Describe)

 

  1. Temporary   attorney fees and court costs

 

  1. Order   directing your spouse to:

(a)  Leave the home immediately

(b)   Remain away from you and/or children

(c)   Restrain from selling or disposing of any asset

(a)

 

 

TEMPORARY SUPPORT

 

  1. Since the date of your separation, have you received any child support from, or paid any to, your spouse?   Yes  No                                   If your answer is YES,  give dates and amounts:

 

Date Amount Received or Paid

 

  1. Since the date of your separation, have you received support from, or paid any to, your spouse?                                                                   Yes  No                                                      If your answer is YES, give dates and amounts:

 

Date Amount Received or Paid

 

  1. If your answer is NO, to either child support or support for your spouse, why has no support been paid?

 

CONTESTED ISSUES

 

  1. Will your spouse contest this divorce action as to the custody of the child(ren)?
  2. GYes   G No
  3. If your answer is YES, state the reasons:                                                                
  4. Will your spouse contest this divorce action as to the division of property?
  5. GYes   G No
  6. If your answer is YES, state the reasons:                                                           
    1. Will your spouse execute a WAIVER to avoid cost of service of summons?  GYes  G No
    2. If your spouse will NOT sign a waiver, where is the best place to have him/her served                                                                       with the Divorce Petition (address)?                                                                                   
    3. Have you or your spouse ever filed for Divorce from the other?  G Yes  G No
    4. If your answer is YES, in what State and County was the action filed:                              
    5. Date the action was filed:                                                                                           _

 

WIFE’S FORMER NAME

 

  1. Wife Only: At the time of the final Decree, do you wish to be restored to your maiden name or to another former name?                   Yes   No  State the name and specify whether it is maiden or former name:                    ______

 

COMMENTS

                                                                                                                                          

                                                                                                                                          

                                                                                                                                          

___________________________________________________

___________________________________________________

___________________________________________________

 

I have read the above and foregoing document and have provided the information as requested.                                                                             The information is true and correct to the best of my knowledge and belief.

 

Date:                                                                                                                                                                               Client Signature

SERVICE INSTRUCTIONS

 

SERVE RESPONDENT THE SUMMONS AT                                        

 

Describe the other party:

Age:_________________              Height:____________ Weight:___________

Eye Color:____________                Glasses:___________

Hair Color:____________               Hair length:_________

Normal Dress:_______________________________________

Unusual or identifying marks or tattoos:___________________________________________

 

Describe the other party’s vehicle:

Car Make:______________           Car Model:_____________                Car Year:________

Car Color:______________            2 Door or 4 Door:________

Identifying marks or bumper stickers on car:  _________________

 

Other information:

Best place & time to serve the other party:  ___________________________

_______________________________________________________

 

If serving at the other party’s residence list any other person(s) living in the                                                                                                         residence and the age of the person(s): ____________________

______________________________________________

_______________________________________________

 

Other Special Instructions for Process Server?________________________

_______________________________________________________

_______________________________________________________

___________________________________________________

 

ASSETS and SECURED DEBTS ACQUIRED DURING MARRIAGE

 

List all Household Furnishings, Furniture, Appliances, Equipment, Jewelry, Furs, etc. acquired during the marriage which are not specifically listed in Schedules 3 through 9 above.

Asset Date Acquired Purchase Price Current Value Amount of Debt or Encumbrance Secured Creditor Request Court to Award to Husband or Wife

 

OUTSTANDING DEBTS INCURRED DURING MARRIAGE

 

  1. List all outstanding debts held solely in husband’s name, held solely in wife’s name, or held jointly
  2. Attach to this sheet a copy of the most recent bill from each creditor.
  3. If the debt is based on a promissory note, attach a copy of the promissory note and mortgage or security agreement.
  4. If the debt is based on a written agreement to repay, indicate if both or just one of you signed the written agreement.
  5. Your comments or explanation:                                                        

 

                                 

                        Creditor

           Account Number  Purpose of Debt           Collateral GivenTotalAmount

Due

MonthlyPaymentRequest Court Award to Husband or Wife

TOTALS

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