Client Information - Divorce/Annulment

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CLIENT INFORMATION - Divorce/Annulment

* ALL INFORMATION IS NECESSARY. PLEASE READ CAREFULLY AND FILL OUT ALL PAGES COMPLETELY.

TODAY'S DATE: 02/02/2023
REFERRED BY:
CLIENT INFORMATION:
NAME:*
RACE OR COLOR:
PHYSICAL ADDRESS:*
Street Address County City State ZIP Code
HOW LONG:
MAILING ADDRESS:
Street Address City State ZIP Code
HOME PHONE:
WORK PHONE:
CELL PHONE:
E-MAIL ADDRESS:*
EMPLOYMENT:
BUSINESS ADDRESS:
Street Address City State ZIP Code
GROSS INCOME:
PER:
TAKE HOME INCOME:
PER:
PAID EVERY:
DL#:
STATE:
AGE:
Please enter a value greater than or equal to 18.
DATE OF BIRTH:
CITY, STATE OF BIRTH:
VEHICLE:
DEBT TO:
SECOND VEHICLE:
DEBT TO:
SPOUSE INFORMATION:
NAME:*
RACE OR COLOR:
PHYSICAL ADDRESS:
Street Address County City State ZIP Code
HOW LONG:
MAILING ADDRESS:
Street Address City State ZIP Code
HOME PHONE:
WORK PHONE:
CELL PHONE:
E-MAIL ADDRESS:
EMPLOYMENT:
BUSINESS ADDRESS:
Street Address City State ZIP Code
GROSS INCOME:
PER:
TAKE HOME INCOME:
PER:
PAID EVERY:
DL#:
STATE:
AGE:
Please enter a value greater than or equal to 18.
DATE OF BIRTH:
CITY, STATE OF BIRTH:
VEHICLE:
DEBT TO:
SECOND VEHICLE:
DEBT TO:
INFORMATION REGARDING THE MARRIAGE
DATE OF MARRIAGE:
DATE OF SEPARATION:
CITY, COUNTY AND STATE MARRIED IN:
HAVE YOU OR YOUR SPOUSE EVER FILED FOR A DIVORCE FOR THIS MARRIAGE BEFORE?
- Yes
- No
IF YES, WHEN?
WHERE?
WHERE SHOULD THE OTHER PARTY BE SERVED WITH NOTICE AND WHAT TIME OF DAY IS BEST? (IF APPLICABLE)
MARITAL DIFFICULTIES INVOLVING:
(CHECK ANY THAT APPLY)
- DRUGS/ALCOHOL
- PHYSICAL VIOLENCE
- SEXUAL DISAPPOINTMENT
- RELIGION
- SEXUAL INFIDELITY
- INCOMPATIBILITY
- FINANCIAL DISPUTES
- OTHER

CHILDREN ADOPTED OR BORN BY PARTIES OF THIS MARRIAGE:

NAME	SEX	DATE OF BIRTH	CITY, COUNTY, STATE OF BIRTH

CHILDREN RESIDE WITH:
WILL THERE BE A DISPUTE OVER CUSTODY OF THE CHILDREN?
- Yes
- No
IF NOT, CUSTODY WILL BE WITH WHOM?
DO THE CHILDREN OWN ANY PROPERTY?
- Yes
- No
IS FEMALE PREGNANT?
- Yes
- No
ANY CHILDREN NOT CONCEIVED OF THIS MARRIAGE?
MAIDEN NAME:
RESTORE MAIDEN NAME?
FORMER NAME:
RESTORE FORMER NAME?
HAVE YOU BEEN MARRIED BEFORE?
- Yes
- No
IF SO, HOW MANY TIMES? SPOUSE?
IF SO, HOW MANY TIMES?
ASSET AND DEBT INFORMATION
LIST ALL COMMUNITY PROPERTY:
LIST ALL COMMUNITY DEBT:
PLEASE MARK THE ANY OF THE FOLLOWING THAT YOU OR YOUR SPOUSE HAS INTEREST IN:
CLIENTS SEPARATE PROPERTY:
(PROPERTY OWNED PRIOR TO THE MARRIAGE, INHERITED PROPERTY OR GIVEN TO THE MARRIAGE, INHERITED PROPERTY OR BY GIFT)
- REAL ESTATE
IF SO, NO. OF PIECES OF PROPERTY:
- STOCKS, BONDS AND/OR SECURITIES
- IRA'S
- CD'S
- RETIREMENT, ETC.
- OWN
- OR OPERATE A BUSINESS
IF SO, NAME OF BUSINESS:
IS IT A CORPORATION, SOLE PROPRIETORSHIP OR PARTNERSHIP
- A CORPORATION
- SOLE PROPRIETORSHIP
- PARTNERSHIP
OTHER SEPARATE PROPERTY:
SHOULD YOU BE REIMBURSED?
SPOUSE'S SEPARATE PROPERTY:
(PROPERTY OWNED PRIOR TO THE MARRIAGE, INHERITED PROPERTY OR GIVEN TO THE MARRIAGE, INHERITED PROPERTY OR BY GIFT)
- REAL ESTATE
IF SO, NO. OF PIECES OF PROPERTY:
- STOCKS, BONDS AND/OR SECURITIES
- IRA'S
- CD'S
- RETIREMENT, ETC.
- OWN
- OR OPERATE A BUSINESS
IF SO, NAME OF BUSINESS:
IS IT A CORPORATION, SOLE PROPRIETORSHIP OR PARTNERSHIP
- A CORPORATION
- SOLE PROPRIETORSHIP
- PARTNERSHIP
OTHER SEPARATE PROPERTY:
POSSIBLE TORT ACTIONS:

DURING THE DURATION OF YOUR MARRIAGE RELATIONSHIP, HAS YOUR SPOUSE EVER:
1. COMMITTED ASSAULT OR BATTERY ON YOU OR ANY CHILD(REN)?
2. PUBLICLY DEFAMED YOUR CHARACTER:
3. FALSELY IMPRISONED YOU OR YOUR CHILD(REN)
4. SUBJECTED YOU OR YOUR CHILD(REN) TO DURESS?
5. INVADED YOUR OR YOUR CHILD(REN)'S PRIVACY?
6. BREACHED A FIDUCIARY DUTY TO YOU OR YOUR CHILD(REN)?
7. BREACHED A CONTRACTUAL DUTY TO YOU OR YOUR CHILD(REN)?
8. FORGED YOUR NAME OR YOUR CHILD(REN)'S NAME TO ANY INSTRUMENT?
9. CONVERTED ANY PROPERTY OF YOURS OR YOUR CHILD(REN)'S?
10. TRANSFERRED ANY COMMUNITY PROPERTY WITHOUT YOUR KNOWLEDGE:
11. INTENTIONALLY INFLICTED EMOTIONAL DISTRESS ON YOU?
12. NEGLIGENTLY INFLICTED DISTRESS ON YOU?
GENERAL INFORMATION:
WHAT IS YOUR RELIGIOUS PREFERENCE?
WHAT IS YOUR SPOUSE'S RELIGIOUS PREFERENCE?
DO YOU OR YOUR SPOUSE HAVE A PREMARITAL OR POSTMARITAL AGREEMENT?
DOES YOUR SPOUSE CURRENTLY HAVE AN ATTORNEY?
- Yes
- No
IF SO, WHO?
INFORMATION REGARDING PREVIOUS MARRIAGES (IF APPLICABLE)

CLIENT INFORMATION:
NAME OF PREVIOUS SPOUSE:
Address
Street Address City State ZIP Code
HOME PHONE:
WORK PHONE:
DATE OF MARRIAGE:
DATE DIVORCE WAS FINAL:
CAUSE NO. OF DIVORCE: (IF KNOWN)
SPOUSE INFORMATION:
NAME OF PREVIOUS SPOUSE:
Address
Street Address City State ZIP Code
HOME PHONE:
WORK PHONE:
DATE OF MARRIAGE:
DATE DIVORCE WAS FINAL:
CAUSE NO. OF DIVORCE: (IF KNOWN)
DO YOU OR YOUR SPOUSE HAVE CHILDREN OF A PREVIOUS MARRIAGE UNDER 18 YEARS OF AGE?
- Yes
- No
IF SO, COMPLETE THE FOLLOWING:
NAME SEX DATE OF BIRTH CITY, COUNTY, STATE OF BIRTH
WITH WHOM DO THESE CHILDREN RESIDE?
DO YOU PAY OR RECEIVE CHILD SUPPORT?
DOES YOUR SPOUSE?
IF SO, HOW MUCH A MONTH PER CHILD?
HAVE YOU OR YOUR SPOUSE HAD ANY INVOLVEMENT WITH THE OFFICE OF THE ATTORNEY GENERAL, CHILD SUPPORT DIVISION?
CONSULTATION FEE AGREEMENT
I UNDERSTAND AND AGREE TO PAY $100.00 FOR THE INITIAL CONSULTATION, REGARDLESS OF MY DECISION TO ENGAGE THE SERVICES OF THIS LAW OFFICE.*
- Accept

LAW OFFICE OF LORI A. SPEARMAN, P.C.
504 N. Oak Street, Suite 6
Roanoke, Texas 76262
817-490-5075
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