Divorce Client Intake Form
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4DIVORCE CLIENT INTAKE FORM
Date: _____________
1. STATISTICAL INFORMATION:
CLIENT:
Client Name: _____________________________________________________
Client’s Maiden Name: _____________________________________________
Address: ________________________________________________________
County: _________________________________________________________
Date of Birth: _____________________________________________________
Place of Birth: ____________________________________________________
Social Security Number: ____________________________________________
Race: ___________________________________________________________
Employment: _____________________________________________________
Address of Employment: ____________________________________________
Occupation: ______________________________________________________
Number of Previous Marriages: ______________________________________
How were marriages terminated? _____________________________________
Current Military Service? ____________________________________________
Education: (Highest level completed) __________________________________
SPOUSE:
Spouse’s Name: __________________________________________________
Spouse’s Maiden Name: ____________________________________________
Address: ________________________________________________________
County: _________________________________________________________
Date of Birth: _____________________________________________________
Place of Birth: ____________________________________________________
Social Security Number: ____________________________________________
Race: ___________________________________________________________
Employment: _____________________________________________________
Address of Employment: ____________________________________________
Occupation: ______________________________________________________
Number of Previous Marriages: ______________________________________
How were the marriages terminated? __________________________________
Current Military Service? ____________________________________________
Education: (Highest level completed) __________________________________
MARRIAGE INFORMATION:
Date of Marriage: _________________________________________________
City and State Where Married: _______________________________________
Date of Separation: ________________________________________________
CHILDREN’S INFORMATION:
Names (oldest to youngest): ________________________________________
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