Divorce Client Intake Form Page 4
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4PAID BY: ________________________________________________________
PAID BY: ________________________________________________________
CHILDCARE COSTS:
PAID BY: ________________________________________________________
PAID BY: ________________________________________________________
RECURRING MEDICAL EXPENSES:
_________________________________
OTHER EXPENSES ROUTINELY PAID:
______________________________
Such as music, private school, athletics etc. describe
SUPPORT OF OTHER CHILDREN
If you or your spouse are supporting other children, please provide their names, dates of
birth, amounts paid, and Docket #: ____________________________
Please send this completed form to .
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