Confidential Divorce Questionnaire Template
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4Abraham & Zoticus, PC
Confidential Divorce Questionnaire
Page 1
It
i s
i mportant
t o
c omplete
t his
q uestionnaire
a s
f ully
a nd
a ccurately
a s
p ossible.
Y ou
w ill
be
p aying
f or
t he
t ime
w e
s pend
o n
y our
c ase
a nd
y ou
w ill
s ave
e xpenses
b y
p roviding
u s
with
c omplete
i nformation.
This
f orm
i s
d esigned
t o
a lert
u s
t o
i tems
t o
w hich
w e
s hould
g ive
a ttention,
a s
w ell
a s
t o
provide
n ecessary
i nformation.
W e
d o
n ot
k now
t he
f acts
o f
y our
c ase
a s
w ell
a s
y ou
d o.
Tell
u s
a s
m uch
a s
y ou
k now
s o
t hat
w e
c an
d o
a
b etter
j ob
f or
y ou.
If
y ou
a re
a lready
d ivorced
a nd
a re
s eeking
a
m odification
o f
y our
d ivorce
d ecree
( for
instance,
a
c hange
o f
c ustody,
i ncrease
o r
d ecrease
i n
s upport),
a ll
r eferences
t o
" spouse"
mean
y our
f ormer
s pouse,
n ot
t he
p erson
t o
w hom
y ou
m ay
n ow
b e
m arried.
1.
What
i s
y our
f ull
n ame?
What
i s
y our
s pouse's
f ull
n ame?
a.
First
a.
First
b.
Middle
b.
Middle
c.
Last
c.
Last
d.
Maiden
d.
Maiden
e.
Former
m arried
n ames:
e.
Former
m arried
n ames:
2.
Please
g ive
t he
f ollowing
v ital
Please
g ive
t he
f ollowing
v ital
statistics
a bout
y ourself:
statistics
a bout
y our
s pouse:
a.
Soc.
S ec.
N o.
a.
Soc.
S ec.
N o.
b.
Driver's
L icense
N o.
b.
Driver's
L icense
N o.
c.
Date
o f
B irth
c.
Date
o f
B irth
d.
Place
o f
B irth
d.
Place
o f
B irth
e.
Current
A ge
e.
Current
A ge
f.
Race
f.
Race
g.
Number
o f
t his
m arriage
g.
Number
o f
t his
m arriage
(specify
1 st,
2 nd,
e tc.)
(specify
1 st,
2 nd,
e tc.)
3.
Marriage:
D ate
City
County
State
4.
Where
a re
y ou
l iving
a nd
w hat
i s
y our
t elephone
n umber?
a.
Address
b.
City,
S tate,
Z ip
c.
Home
t elephone
n umber
d.
E-‐mail
a ddress
( secure
a nd
p rivate)
e.
Cellular/mobile
n umber
How
l ong
i n
O regon?
f.
If
y ou
w ant
m ail
f rom
t his
o ffice
s ent
t o
a
d ifferent
a ddress,
p lease
f urnish
t he
desired
a ddress
h ere:
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