PLEASE BE CERTAIN TO COMPLETE ALL THE INFORMATION!
THIS INFORMATION IS ALL VERY IMPORTANT!
Specify if you want a divorce or separation: _______________________________
Your full legal name: ____________________________________________________
First Middle Last
Current street address: ____________________________________________________
City: ________________________________State:_______________Zip:____________
Your county of residence: __________________________________________________
Phone Number: Home: ______________________ Work: ________________________
Gender: ________________________________________________________________
Your age: _______________Date of birth: _____________________________________
Social Security Number - REQUIRED: _________-_______-_______________________
Drivers License Number: ___________________________State: ___________________
E-mail address: ___________________________________________________________
Former and or/maiden names, if any: __________________________________________
Spouse's full legal name: __________________________________________________
First Middle Last
Spouse's current street address? _____________________________________________
City: ____________________________State:____________________Zip:____________
Spouse's county of residence: ________________________________________________
Gender: __________________________________________________
Spouse's age: _______________Date of birth: ___________________
Phone number: ____________________________________________
Social Security Number - REQUIRED: __________________________
Drivers license number: ________________________State:________
E-mail address: ___________________________________________
Spouse's former and/or maiden name: _________________________
Does either party wish to RESTORE a FORMER name?
If so, Wife/Husband: ________________________________________
RESTORE name to: ________________________________________
First Middle Last
Date of Marriage: Month_______________Day______Year_________
City of marriage: ___________________________________________
State of marriage: _____________County of marriage: __________________
Are you presently separated (living apart)? ______________________
If so, approx. date of separation: ______________________________
Is the wife pregnant?: No:__________Yes:_____________________
If so, when is the child due?: _________________________________
Is the husband the father of the child?: _________________________
How many CURRENTLY MINOR children were born to this marriage?:___________
NAME, DATE OF BIRTH, SOCIAL SECURITY NUMBER:
Child's name: __________________DOB: ___/___/___SSN:____-___-____
Child's name: __________________DOB: ___/___/___SSN: ____-___-____
Child's name: __________________DOB: ___/___/___SSN: ____-___-____
Child's name: __________________DOB: ___/___/___SSN: ____-___-____
Child's name: __________________DOB: ___/___/___SSN: ____-___-____
Do you wish to have JOINT, SPLIT, or SOLE custody?: Check one:
JOINT: ___________SPLIT: ___________SOLE: ___________
If SOLE custody, which parent shall have physical custody of the children?
________________________________________________________________________
(This must be agreeable to both parent's)
If there is joint custody, what percent of time will the child spend with each parent?
Mother: ______________% Father: ______________%
If SPLIT custody, which child(ren) will live with the MOTHER?: ________________
_________________________________________________________
If SPLIT custody, which child(ren) will live with the FATHER?: ________________
_________________________________________________________
Who have the children lived with the last 6 months?: _______________________
_________________________________________________________
Who are the children with at the present time?_____________________________________
Who will provide medical insurance for the children?
Father: _____________Mother: _____________Both: ____________
Cost of Insurance: $_______________ Insurance Co. __________________
Who will pay deductibles and uninsured costs?
Father: __________Mother: __________Both: __________
Who will maintain life insurance with the child as beneficiary?
Father: __________Mother: __________Both: __________
WILL THIS BE A CO-PETITION_DIVORCE? Yes: ______No: ______
(BOTH parties willing to sign)
Or will this be a:
SINGLE PETITION DIVORCE? (one party must have the other party served by a process server or sheriff).
(You DO NOT expect the other party to sign the divorce papers voluntarily).
Yes: _______________No: _______________
Below, list the property that should be awarded to each spouse.
If property has already been divided, you may state so. (IE: All property currently in parties possession.)
The husband should be awarded the following property:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
The wife should be awarded the following property:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
REAL ESTATE
List real estate owned by either party; name and address of property:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
(LIST ADDRESSES FOR REAL ESTATE TO BE AWARDED, IF ANY)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
OUTSTANDING DEBTS TO BE PAID BY EACH SPOUSE:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
THE HUSBAND should pay the following bills:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
THE WIFE should pay the following bills:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
How long have you been a resident of your state?: _______Years, _______ Months
How long have you lived in your current county?: ______ Years, _______ Months
HUSBAND'S EMPLOYMENT
Husband's employer: _______________________________________________________
Address of employer: ______________________________________________________
Phone # of employer: ______________________________________________________
Length of employment: _____________________________________________________
Job Title: ______________________________________________________________
Hourly wage: ________________________Amount of last paycheck:________________
Husband's gross MONTHLY pay (before taxes): $_______________________________
Husband's MONTHLY take home pay (after taxes) $______________________________
WIFE'S EMPLOYMENT
Wife's employer: __________________________________________________________
Address of employer: _______________________________________________________
Phone # of employer: _______________________________________________________
Length of employment: ______________________________________________________
Hourly wage: _____________________________________________________________
Amount of last paycheck: __________________________________________________
Wife's gross MONTHLY pay (before taxes) $____________________________________
Wife's MONTHLY take home pay (after taxes) $__________________________________
_________________________________________
Does anyone receive Spousal Support (Alimony) from a previous marriage?
If so, who: ______________________________How much per month? $______________
Does either party WISH to receive SPOUSAL MAINTENANCE as a result of this divorce?
Yes: __________________No:_______________
If so, who:__________________________How much per month?$__________________
For how long? Total number of MONTHS: ______For a TOTAL dollar amount of:$_______
Cash Child Support: Child support should be paid by _____________________________
beginning on ________________following the date of judgment. The total payment per
month should be:__________OR Determined under the State child support guidelines.____.
Does anyone receive child support from a previous marriage or relationship?
If so, who?: _________________________How much per month? $_________________
Are there any pending child support proceeding in this or any state?___________________
If so, which state?_______________________
Are there any Day-Care costs paid out-of-pocket relating to the children of this marriage?
Yes:_______No: ________
If so, How much? _______________Who pays:__________________________________
Is there or will there be health insurance coverage for the children of this marriage?
Yes:_______No:________Not available:_______________
Who pays or will be paying for health insurance? Mother:_________Father: _________
How much per month? $_____________________
Who will pay the filing fees? ________________________________________________
_____________ ______
FEE WAIVER
A fee waiver is available if you qualify.
If you want a fee waiver, answer the following questions:
1. Does either spouse receive welfare or food stamps? If so, who? Mother:_____Father:_____
Source of income (describe): Amount How long received? How often received?
_____________________________$____________ _____________ ________________
2. MONTHLY LIVING EXPENSES
Rent/Mortgage $____________Gas $_________Electric $_________Car Payment $_____
Credit Card Payment $__________Water $_________Sewer $________Car Ins $_______
Child Support Payment $________Trash $________Phone $_________Medical $______
Transportation Costs $___________Food $________Cable TV $_________Internet $_____
Cell Phone $_____________ Other $__________________
Any other individuals who help pay your living expenses:
Relationship: Amount: Payment for what (describe)?
_________________________ $_______________ ________________________
3. MONEY ON HAND/IN BANK
Cash $_____________
Checking Account Number: Bank/Credit Union: Balance:
_______________________ _____________________ $__________________
Savings Account Number: Bank/Credit Union: Balance:
_____________________ __________________ $_________________
4. MOTOR VEHICLES
Year, Make, and Model: Value: Amount owing: Payments made to:
____________________________ $___________ $_____________ ________________
5. REAL ESTATE (if you don't own any, write 'none')
Address, city & state- Year purchased-Purchase price-Value-Amt. owing- Payments made to
____________________ _____ $___________$_____ $_______ __________________
6. ALL OTHER PROPERTY OR ASSETS(for example:RV's, boats, livestock, guns,etc)
Description:_______________________________Value: ______________________
____________________________________________________________________
7. MONEY OWED TO YOU BY OTHERS (tax refunds, judgments, settlements, etc)
_________________________________________________________________
8. ARE YOU SEEKING AN AWARD OF TEMPORARY CHILD AND/OR SPOUUSAL SUPPORT?
Yes ________No_______ If so, how much? $_____________________
9. Wifes employment and income:
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I (we) request that Legal Document Preparation Service, prepare our uncontested divorce.
I (we) understand that Legal Document Preparation Service employees are not lawyers, they are independant paralegals.
We agree and attest that no legal advice has been given to us.
We have chosen of our own free will to have Legal Document Preparation Service fully prepare these documents for a fee.
We have selected the forms and provided all the information used in our divorce documents.
Signed: ________________________________________________________
Date: _________________________________________________________
Signed: ________________________________________________________
Date: __________________________________________________________
(We are not attorneys and do not give legal advice)
IF YOU NEED LEGAL ADVICE, WE SUGGEST YOU CONTACT AN ATTORNEY!