Dissolution (Divorce) Intake Form Page 6
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Is any amount delinquent? ________________________________________
Is spouse obligated to pay child support? ___________ Amount? _____________________________
Number of children: _____________ Ages: ______________________________
Is any amount delinquent? ________________________________________
Is spouse entitled to receive spousal maintenance (alimony)? ________________
If so, in what amount? _______________________________
Is any amount delinquent? ___________________________________
Is spouse entitled to receive child support from previous relationship? ________________
If so, in what amount? ____________________________
Number of children: ______________ Ages: _______________________________
Is any amount delinquent? ____________________________________
Medical Insurance
Do you have health insurance? _____________
If so, who provides? __________________________________________________________
Does your spouse have health insurance? _________________
If so, who provides? __________________________________________________________
Do your children have health insurance? ________________
If so, who provides? __________________________________________________________
Do you have dental insurance? __________________________________
Does your spouse have dental insurance? __________________________________
Do your children have dental insurance? __________________________________
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Parent category: Business