No Fault Divorce Intake ClientFull Legal Name(Required) First Middle Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CountyHome PhoneWork PhoneRace(required by state law)SpouseFull Legal Name First Middle Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CountyHome PhoneWork PhoneRace(required by state law)Date of Marriage Month Day Year County of MarriageState Where MarriedApproximate Date of Separation(does not have to be exact) Month Day Year Were there children born or adopted between the two of you? Yes No If there were children born between the two of you or adopted, please list the following information for each child:NameSexBirthday Month Day Year NameSexBirthday Month Day Year NameSexBirthday Month Day Year NameSexBirthday Month Day Year Have you discussed custody of the minor children with your spouse? Yes No If you have discussed custody, what have you been able to agree to or what have you discussed?Have you discussed a visitation schedule for the party not receiving custody? Yes No If so, please briefly state what your desire is?Has child support been discussed? Yes No Have you agreed upon an amount? Yes No If you have agreed upon an amount, what is that amount?Would you like a wage withhold for child support? Yes No Do the children currently have insurance? Yes No If the children have insurance, who provides the insurance? I do My spouse does State program (Medicaid, Chips, etc) How is the insurance provided?(Private policy, through your work, through your spouse's work, etc)If you pay the insurance or it is payroll deducted, how much does it cost you/your spouse? (Approximately)PropertyDo you own or rent your home?If you own your home, approximately how much do you owe on the home?Whose name is on the home?If you are a home owner, have you discussed what is going to be done with the home? Yes No What is your desire to do with the home?Are there other items of property that will be disputed or need to be specifically listed? Yes No If there are items that need to be specifically listed please list the property below along with the person who will receive the property:(Please be specific but only complete this section if you desire the property to be specifically listed within the divorce property settlement agreement, property doesn't have to be specifically listed it is up to you, but if you feel that a piece of property may present a problem in the future you need to have it listed) Example: 2005 Ford F-150 - I will receive it and pay for it. Brown Leather Couch - They will receive and pay off at Ashley Furniture. Kitchen Dishes - We will split these equally.Debts of the MarriageAre there any debts of the marriage that need to be listed?(If you choose not to list debts, they will be addressed by saying each party will be responsible for the debts in their own name) Yes No If so, please list the debt, the amount, and who will be responsible for the debt.No Fault Divorce EngagementDate Month Day Year This letter is to confirm our understanding of the terms of our engagement and the nature and limitations of the services we will provide. The following services are included in a No Fault Divorce: Initial consultation and one set of papers. One set of revisions to the original set if there are changes to be made. If I made a mistake then of course I will fix my own mistakes for free at any time. Two calls - 20 min max - with me after the consultation. Of course, you can communicate with our office at any time and the staff will communicate your concerns with me. Filing fee. Court appearance to have the papers presented to the Judge. If extra revisions are needed it will be an additional $50 per new set of papers. If a fault-based divorce is needed we will apply the money paid toward that divorce, you do not lose that. Additional fees as needed will apply depending on the specifics of your needs. Any additional phone calls, consultations, letters, or any other work regarding the divorce will be billed out at $150 per hour billed out in 1/4 of an hour (15 minute) increments. Any additional services will be billed monthly, and you will be provided a statement detailing any additional billing at the end of each month. Payment is due in office within 10 days of the statement date. Our fee for these services is a flat fee of $500 due before we proceed. All retainers for services are earned when paid - no refunds. The entire balance of $500 must be paid before the papers will be reviewed with you. We gladly offer a 100% service guarantee on all of our services. While we do not guarantee outcomes, we do guarantee that you will be treated with respect and couresty, and that you will be regularly updated on the status of your case. If at any time during our representation you believe we have failed to honor this commitment in any way, you need merely contact our office and articulate any issues and we will make it right, even if that means a reduction in our fees. Please call us if we can assist you with any other matters or if you have any questions.CAPTCHANameThis field is for validation purposes and should be left unchanged.
