Clone of Clone of BLLG Family Questionnaire

FAMILY LAW QUESTIONNAIRE
Thank you for providing information to help us with your case. All of the items on this questionnaire are necessary in most cases even if not now. By getting this information early, we will not have to spend time getting it later. Please be thorough.

Each of the bars below is a separate section. Just click on the bar to open or close that section. Depending on your answers to questions, more bars might appear. Be sure to answer the questions within each section.

You may leave this form and return (only on the same computer) and finish as long as you complete it withion four weeks. After that, the information will not be saved.

Contact Information
Full Name *

Prefix First Name Middle Name Last Name Suffix
Commonly used name
Maiden Name, if Applicable
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Work Phone Number

Area Code Phone Number
E-mail *
Birth Date *

Month Day Year
Social Security Number *
Diver's License State
Driver's License Number *
City and county of birth
Name and phone number of person to contact in an emergency, if we can't find you. This should be someone you trust and who will keep confidences.

Case information
Type of case *
Number of Children (Do not list any children if this is a property enforcement case only.)
If the attorney general is involved with one or more of the chidren, pleasse give details, including AG number , case, number, and the AG office involved, if known.
If there has been any other litigation or court action involving the children, please provide the cause number, the court number, and the nemaes of any attorneys that are or may be involved.

For Divorce Cases Only
Date of Marriage

Month Day Year
Date of Separation

Month Day Year
Please list any of YOUR retirment, pension plans, 401(k), IRA,m or similar accounts. Give us the plan name, the type of account, and the current balance.
Please list any of the OTHER PARTY'S retirment, pension plans, 401(k), IRA,m or similar accounts. Give us the plan name, the type of account, and the current balance.

Your Employment information
Your Employer's Name
Date of Employment

Month Day Year
Job Title
Your Employer's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Your Employer's Phone Number

Area Code Phone Number
Annual income (including all investment income, bonuses, overtime, or other pay)
If not currently employed, list date of last employment, name of last employer, salary, and reason for leaving

Client General information
If you have any children OTHER THAN the children involved here, please give their names, birthdates, with whom they currently reside. and whether you pay or receive child support for that child and how much.

Other party information (spouse, other parent, other person)
Other Party's Full Name

Prefix First Name Middle Name Last Name Suffix
Other Party's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Birth Date

Month Day Year
Phone Number

Area Code Phone Number
Social Security Number
Driver's License Number
Driver's License State
City and county of birth

Other party's employee information
Other Party's Employer's Name
His or her Job Title
Date of Employment

Month Day Year
Other party's Employer's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Other party's Employer's Phone Number

Area Code Phone Number
His or her annual income (including all investment income, bonuses, overtime, or other pay)
If not currently employed, list his or her date of last employment, name of last employer, salary, and reason for leaving
If the other party has any children OTHER THAN the children involved here, please give their names, birthdates, with whom they currently reside. and whether you pay or receive child support for that child and how much.

Child's Information
If a child lives with you or the other parent, you do not need to include the address; simply state who the child lives with in the first address field.
Child's Full Name

Prefix First Name Middle Name Last Name Suffix
Child's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Social Security Number
Birth Date

Month Day Year

Second Child
Second Child's Full Name

Prefix First Name Middle Name Last Name Suffix
Child's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Social Security Number
Birth Date

Month Day Year

Three Children
Third Child's Full Name

Prefix First Name Middle Name Last Name Suffix
Child's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Social Security Number
Birth Date

Month Day Year

Four or More Children
Fourth Child's Full Name

Prefix First Name Middle Name Last Name Suffix
Child's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Social Security Number
Birth Date

Month Day Year
If there are more than four children involved, please provide this same information on additional child(ren) to your attorney on paper as soon as possible after submitting this form.

Finish and Submit

This is a new method for us for gathering information. Please let us know your opinion as to ease of use. Don't judge about the amount of information that we need or the difficulty in you obtaining the information, just the method of obtaining it compared to other methods such as paper questionnaires. *

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1 is Easy, 10 is Difficult

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FAMILY LAW QUESTIONNAIRE