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Divorce Legal Services
 

Divorce Legal Services

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    Divorce Legal Services Divorce Legal Services Document Transcript

    • Legal Services of Northern Virginia Divorce Intake Questionnaire Please fill in this paper the best you can before you come in for your appointment. PRINT your answers. For some answers, you can circle the Yes/No type of choices. Fill in all blanks, and with either an answer or a cross out, so that the form can be scanned by the attorney. Circle whether you are husband wife How well do you understand Good Poor Other (explain) English? What is your preferred language(s) other than English? Do you have a friend who can translate for you during visits to an attorney’s office? If you do, give name and phone number(s): Husband’s information: FULL Name and last known address of Husband: Does the husband actually live there Yes No now? If he does not live there now, what are alternate ways to contact him? www.lsnv.org 9/1/05 Page 1 of 19
    • City/County of husband’s last known address: home work cell phone: phone: phone: Husband’s email addresses: Husband’s race: SSN: Driver’s license # & state Date of State/Foreign birth Country of birth: # prior marriages: Highest grade completed: Wife’s information: FULL Name and last known address of Wife: Does the wife actually live there Yes No now? If she does not live there now, what are alternate ways to contact her? County of the wife’s last known address Wife's FULL former (maiden) name Does the wife want to get her former name back? www.lsnv.org 9/1/05 Page 2 of 19
    • home work cell phone: phone: phone: Wife’s email addresses: Wife’s race: Wife’s email addresses: SSN: Driver’s license # & state Date of State/Foreign birth Country of birth: # prior marriages: Highest grade completed: Your prior address (if you have resided in the Commonwealth of Virginia for less than 6 months) Facts about the marriage and separation: Date of Place of Marriage: marriage: Date of last separation: Circumstances of separation: Have you or your spouse lived in You? Spouse? Virginia and considered Virginia to be his/her home for the last six months? What is the address where you and your spouse last lived City/County of last address www.lsnv.org 9/1/05 Page 3 of 19
    • Have you discussed divorce with your Yes No spouse? If so, what is your spouse’s position? Has your spouse already filed for divorce? If so, have you provided a copy of the pleadings? Is filing for divorce likely to provoke an Yes No adverse reaction from your spouse? If so, explain Has a reconciliation taken place since the Yes No separation? If so, what is the date of the last separation (one not followed by a reconciliation). Corroborating witness (needed to testify to jurisdiction and grounds of divorce): What is the name, address and phone number(s) of a witness you can call to testify to the fact: (a) that you have lived in Virginia and considered Virginia to be your home for the last six months, and (b) that you have been separated the requisite time? (one year except if there is a written separation agreement and no minor children, in which case a six month separation will do). How do you know this witness? How long have you known this witness? www.lsnv.org 9/1/05 Page 4 of 19
    • How often does this witness come to your home? Have you met with an attorney before? Yes No If yes, give the attorney’s name, address and phone number(s). What did the attorney do for you? Has your spouse met with an attorney? Yes No If yes, give the attorney’s name, address and phone number(s), if you know them. What did the attorney do for your spouse? Children www.lsnv.org 9/1/05 Page 5 of 19
    • Were any children born to Yes No both you and your spouse? If so, give the full name, Full name SSN Date Social Security number & date of Birth of birth of each child www.lsnv.org 9/1/05 Page 6 of 19
    • Has custody or visitation for a Yes No minor child ever been determined by a written agreement or by a court order? If so, have you given LSNV a copy of the written agreement and court order? If so, who has custody, for which child? Has paternity ever been Yes No questioned for any of the minor children of both you and your spouse? If so, give details. www.lsnv.org 9/1/05 Page 7 of 19
    • Were any minor children Yes No adopted by both you and your spouse? If so, have you given LSNV a copy of the adoption decree? Were any children born Yes No during the marriage that were not the children of both you and your spouse? If so, have you given LSNV a copy of written any agreement or court order? Child support www.lsnv.org 9/1/05 Page 8 of 19
    • Has child support been Yes No determined for all of the minor children of both you and your spouse? If so, have you given LSNV a copy of written the written agreement or court order? Has a written agreement or court order required either you or your spouse to provide health care coverage to the minor children of you and your spouse? If so, have you given LSNV a copy of the written agreement or court order? www.lsnv.org 9/1/05 Page 9 of 19
    • Are all minor children of both Yes No you and your spouse covered by health insurance? Has a written agreement or Yes No court order required you or your spouse to maintain life insurance for the benefit of your minor children? Have you provided LSNV with Yes No a copy of the written agreement or court order. Is the person paying support Yes No (and providing health and/or life insurance coverage) doing so, and current on those obligations? If not, explain. www.lsnv.org 9/1/05 Page 10 of 19
    • Spousal support: Spousal Support, also known Yes No as alimony, is money paid by one spouse to the other, to enable the other to meet his or her living expenses. Has spousal support been required by a written agreement or court order? If so, have you given LSNV a copy of written the written agreement or court order? Do you need spousal support Yes No from your spouse? Military spouse. Is your spouse on Yes No active duty with one of the armed forces of the U.S.? If so, what is his/her home state of record? Incarcerated spouse. Is your spouse Yes No incarcerated? If so, where, and for how much longer? Agreement between spouses? Is there a written agreement between Yes No you and your spouse or a court order that has not been provided to LSNV? Retirement benefits from employment: www.lsnv.org 9/1/05 Page 11 of 19
    • Do you think your spouse has any Yes No retirement benefits from employment, like a 401k or the right to a pension upon retirement? If you do, describe them What is your best guess as to the value of your spouse’s retirement benefits? www.lsnv.org 9/1/05 Page 12 of 19
    • Unless you are certain that your spouse has no retirement benefits, identify your spouse’s employers from the time of the beginning of the marriage until the last separation www.lsnv.org 9/1/05 Page 13 of 19
    • Do you have any retirement Yes No benefits? If you do, describe them What is your best guess as to the value of your retirement benefits? www.lsnv.org 9/1/05 Page 14 of 19
    • If you do not know the approximate value of your benefits, can you provide LSNV with copies of the statements you have recently received about those benefits? Other property: Did you or your spouse, either alone or Yes No together, own a home purchased during the marriage? If you do, when was it purchased, and what down payment was made? Whose names are on the deed? Whose names are on the mortgages: If the home was sold, how much money would you and your spouse receive? www.lsnv.org 9/1/05 Page 15 of 19
    • Do you or your spouse, either alone or Yes No together, own [or are either of you in the process of buying] a motor vehicle (car, van, truck, motorcycle)? If so, whose names are on the title? If so, is the vehicle worth more than is owed on it? Who signed the notes secured by the vehicles? Who uses(considers as his/her own) which vehicles? Are you in possession of “your” vehicle? Do you or your spouse, either alone or Yes No together, have any checking or savings accounts, or other accounts at a financial institution? If so, name all of the owners, identify the financial institution, and estimate the value of each account. If you suspect that your spouse has valuable financial accounts, but you do not know the details, what details do you know? Did the money in the accounts all come from the earnings of either you or your spouse during the marriage? If not, where did the money came from? www.lsnv.org 9/1/05 Page 16 of 19
    • Do you or your spouse, either alone or Yes No together, have any other valuable property that you got during the marriage? If so, describe it and estimate its value. Marital debt: List all marital debts (debts incurred by either you or your spouse during the marriage prior to the last separation of the parties), and tell me who is liable on each debt. www.lsnv.org 9/1/05 Page 17 of 19
    • Do you need relief from a court with Yes No respect to your burden of existing marital debt? If so, explain. Has any marital debt resulted in a Yes No judgment against you? If so, (1) state (a) creditor’s name, (b) amount of judgment, (c) reason for owing the money, (d) whether there is any co-debtor, and (e) who the codebtor is, and (2) get copy of (a) the court judgment, and (b) any subsequent court papers, such as garnishments against you. Is there a written agreement between Yes No you and your spouse about who is responsible for marital debt? If so, have you provided LSNV with a copy of the written agreement? www.lsnv.org 9/1/05 Page 18 of 19
    • Bankruptcy. Has either you or your Yes No spouse filed for a bankruptcy in the past? If so, was the bankruptcy case filed with the Alexandria bankruptcy court? If not, where was the bankruptcy filed? Do you suspect that your spouse will Yes No want to file for bankruptcy, and leave you alone responsible for marital debt? If so, give details. DOCUMENTS CHECKLIST: ___ Marriage Certificate ___ Current Custody Order (if applicable) ___ Current Child Support Order (if applicable) ___ Current Spousal Support Order (if applicable) ___ Property Settlement Agreement (if applicable) ___ All previous divorce decrees (if applicable) ___ Other Documents _____________________________ ____________________________ _________________________________ Name of Interviewing Attorney or Paralegal Organization of Volunteer (NCAPA, Freddie Mac or LSNV) ________________________________ _________________________________ Name of Interpreter, if any Organization of Interpreter ______________________________________ _________________________________ Date of Interview Time Spent www.lsnv.org 9/1/05 Page 19 of 19