Dissolution (Divorce) Intake Form Page 2

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Your Spouse’s Personal Information
Full Legal Name: ___________________________________________ Birth Date: ________________________
Previous Names: ___________________________________________________________________________________
Address: _____________________________________________________________________________________________
Last Prior Address: ________________________________________________________________________________
How long has your spouse lived at this address? ____________________
How long has your spouse been a resident of Minnesota? ________________________
U.S. Citizen? ________________
Nationality if not a U.S. Citizen: _____________________
Home Phone: ______________________ Cell: ______________________ Work: _________________________
E-Mail Address: _________________________________________
Social Security Number: ___________________________
Is your spouse presently a member of the U.S. Military? ____________________________________
Marital Information
Marriage Date: ______________________________ Separation Date: ________________________________
Ceremony (City/County/State): _________________________________________________________________
Are you and your spouse currently living together? _________________________________________
Is there any chance at reconciliation? _________________
Was abuse present in the marriage relationship? _______________
Briefly Describe: ___________________________________________________________________________
Have you or your present spouse ever started a separate divorce action in this
marriage? __________________________
If yes, in which county?
________________________________________
Date action was started: ________________________________________

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