Custody Information Form
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3CUSTODY INFORMATION
It is important to complete this questionnaire as fully and accurately as possible. You will be paying for the time
we spend on your case and you will save expenses by providing us with complete information.
This form is designed to alert us to items to which we should give attention, as well as to provide necessary
information. We do not know the facts of your case as well as you do. Tell us as much as you know so that we can
do a better job for you.
All references to “other parent” below refer to the other parent of the child(ren) who are the subject of your
custody or parenting time dispute.
1.
What is your full name?
What is the other parent’s full name?
a.
First _______________________
a.
First _________________________
b.
Middle _____________________
b.
Middle _______________________
c.
Last _______________________
c.
Last __________________________
d.
Maiden _____________________
d.
Maiden _______________________
e.
Former married names:
e.
Former married names:
___________________________
______________________________
2.
Please give the following vital
Please give the following vital
statistics about yourself:
statistics about the other parent:
a.
Soc. Sec. No. ________________
a.
Soc. Sec. No. __________________
b.
Driver's License No. __________
b.
Driver's License No. ____________
c.
Date of Birth ________________
c.
Date of Birth __________________
d.
Current Age_________________
d.
Current Age ___________________
e.
Highest level of education:
e.
Highest level of education:
Elem/Secondary_____ College_____
Elem/Secondary_____ College_____
4.
Where are you living and what is your telephone number?
a.
Address __________________________________________________________
b.
City, State, Zip ____________________________________________________
c.
Home telephone number _____________________________________________
d.
E-mail address (secure and private) _____________________________________
e.
Cellular/mobile number _______________ How long in Oregon? ____________
f.
If you want mail from this office sent to a different address, please furnish the desired address
here:________________________________________________
5.
Are you currently employed? Yes_____ No_____ If yes, please provide:
a.
Name of employer__________________
Length of employment ___________
b.
Street address ______________________________________________________
c.
City, State, Zip _____________________________________________________
d.
Telephone number _________________
Fax number ___________________
e.
What is your monthly gross salary? $___________
Take home? _____________
f.
What is your job title?________________________________________________
6.
Where is the other parent living and what is his or her telephone number?
a.
Address __________________________________________________________
b.
City, State, Zip _____________________________________________________
c.
Residence telephone number __________________________________________
d.
How long in Oregon? ________________________________________________
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