Domestic Client Questionnaire-Potential Termination Of Parental Rights Case Page 2

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SECTION II
Name of all attorneys involved in prior or current court proceeding:
Current matters that need to be addressed in this new proceeding or issues requiring this new court action:
List all addresses where the children have resided and the persons with whom they have resided during the
last five (5) years:
Please state your current earnings and the current earnings of the other parent responsible for the children:
Please list other information that might be pertinent to with your case(i.e.: visitation, child support,
medical insurance, dental insurance, post-separation support or alimony):

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