CLIENT INFORMATION
*PLEASE NOTE:  Some of the information requested on this form may be sensitive in nature, such as Social Security numbers, driver’s license numbers and dates of birth.  If you prefer, you may leave these areas blank and we will obtain this information from you by other means, such as telephone or fax transmission.  Please do not list specific bank account or credit card numbers in this form.

Name: Date:

Street Address:

City: State: Zip:

Telephone #’s (Home): (Work): (Cell):

e-mail: Social Security No.:

Employer: Bank Reference:

Driver’s License No.: Expiration Date:

How did you hear about us:

 

Spouse's name:

Spouse's address:

City: State: Zip:

Date of marriage: Date of separation:

Place of marriage (City, County, State):

Number of children of the parties under 18:

 

CLIENT INFORMATION - VITAL STATISTICS FOR STATE OF KANSAS

  Husband Wife
Birthdate:
Soc. Sec. #:
Birthplace:
Race:

(e.g., White, Black, American Indian, Hispanic, Asian, etc.)
Number of this marriage:
Date and how last marriage ended (divorce, annulment, or death):

Educational level (Highest Grade Completed):

 
Maiden name:  

CLIENT INFORMATION - UNCONTESTED DIVORCE

1. How can we get this paperwork to your spouse?

2. How long have you lived in Kansas?

3. When would you like the divorce finalized and is an emergency divorce acceptable?:

4. List all automobiles or motorcycles owned or operated by either you or your spouse:

Year Make Model Who gets it  How is it titled

5. Have all of the cash, deposits in financial institutions, stocks, bonds, retirement benefits, and insurance policies been divided?

6. List all physical personal property that you have in your possession as of today that you want to give to your spouse:

7. List all physical personal property that your spouse has in her or his possession as of today that you want: "

8. List the address and legal description of any real estate in this divorce, how it is titled, and indicate who gets it?

9. Do you or your spouse have retirement plans?

10. How much do you make a month before taxes?

11. How much does your spouse make a month before taxes?

12. Do you think alimony or spousal maintenance should be an issue in your case?

13. Will you pay all debts solely in your name?

14. Will your spouse pay all debts solely in her or his name?

15. List the following information about the joint debts:

Creditor Total Due Who will be responsible

16. Did you and your spouse file tax returns using the short form last tax year?

17. Should you or your spouse have a maiden or former name restored and if yes, please specify name:

 

The following information is needed only if there are minor children of the marriage:

18. Provide the following information about the children of these parties under 18:

Names Dates of Birth Social Security Numbers

19. Any reason why joint legal custody would not be proper?

20. Have any of the minor children lived with anyone else other than the parents?

21. Where will the minor children live?

22. Any reason why reasonable parental access (visitation) would not be proper?

23. Who provides health insurance for the minor children and how much does it cost?

24. Who provides child care for the minor children and how much does it cost?

25. Have you, your spouse, or any of your children received any aid from a government agency after the birth of your first child?

 

CLIENT AND SPOUSE INFORMATION - COURT TRUSTEE COLLECTION

 

Custodial Parent

Non-custodial Parent

26. Residential Telephone Num:

27. Employer’s Name:

28. Employer’s Address:

29. Employer’s Telephone #:

 

COMMENTS, SPECIAL INSTRUCTIONS, QUESTIONS