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CLIENT INTERVIEW SHEET

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CLIENT INTERVIEW SHEET Powered By Docstoc
					                                                     DANIELS & DANIELS
TIMOTHY J. DANIELS                                                                               JOHN A. DANIELS, INC. (RETIRED)
timdaniels@danielslawfirm.org                                    ATTORNEYS
                                                             11120 WURZBACH ROAD
                                                                    SUITE 301
                                                           SAN ANTONIO, TEXAS 78230
CAROLINE L. HULETT                                      (210) 225-4595; FAX (210) 225-5673
carolinehulett@danielslawfirm.org

                                       FAMILY LAW CLIENT INTERVIEW FORM
         CLIENT NAME:
         DATE:

         INSTRUCTIONS:            Please complete this confidential questionnaire. If you will spend the time
         to complete all items, you will give us the background information necessary to begin to
         understand the complexity of the personal aspects of your family law problem. All information
         will be held in strict confidence.

         1.        Please provide your full name, date and place of birth, Social Security number, and
                   driver’s license number:
                   a.      Name                 : _________________________________________
                           Maiden Name          : _________________________________________
                   b.      Date of Birth        : _________________________________________
                   c.      Place of Birth       : _________________________________________
                   d.      Social Security      : _________________________________________
                   e.      Driver’s License No. : _________________________________________

         2.        Where are you living now?
                   a.    Address                          : _________________________________________
                   b.    How long in State                : _________________________________________
                   c.    County of residence              : _________________________________________
                   d.    How long in county               : _________________________________________
                   e.    Residence telephone              : _________________________________________
                   f.    Mobile telephone                 : _________________________________________
                   g.    Email address                    : _________________________________________

         3.        Please complete the following concerning your employment:
                   a.     Employer              : _________________________________________
                   b.     Job title             : _________________________________________
                   c.     Address               : _________________________________________
                   d.     Telephone number : _________________________________________
                   e.     Gross salary/monthly $ _________________________________________
                   f.     Annual gross (including bonuses, stock options, etc.) $ ________________
                   g.     Length of employment : ________________________________________
                   h.     Education/Training : _________________________________________




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                                     DANIELS & DANIELS
                   ______________________________________________________

4.       Please provide your spouse’s full name, date and place of birth, Social Security number,
         driver’s license number:
         a.      Name                 : _________________________________________
                 Maiden Name          : _________________________________________
         b.      Date of Birth        : _________________________________________
         c.      Place of Birth       : _________________________________________
         d.      Social Security      : _________________________________________
         e.      Driver’s License No. : _________________________________________

5.       Where is your spouse living?
         a.    Address                           : _________________________________________
         b.    How long in state                 : _________________________________________
         c.    County of residence               : _________________________________________
         d.    How long in County                : _________________________________________

6.       Please complete the following concerning your spouse’s employment:
         a.     Employer              : _________________________________________
         b.     Job title             : _________________________________________
         c.     Address               : _________________________________________
         d.     Telephone number : _________________________________________
         e.     Gross salary/monthly $ _________________________________________
         f.     Annual gross (including bonuses, stock options, etc.) $________________
         g.     Length of employment: ________________________________________
         h.     Education/Training : _________________________________________

7.       Please provide the date and place of your marriage:
         a.     Date                   : __________________________________________
         b.     City, State            : __________________________________________

8.       Date of separation                      : __________________________________________

9.       Marriage counseling and/or reconciliation viable? ___________________________

10.     If there are any children of this marriage, please provide all requested information:
      Name:                Sex:      D.O.B.:         S.S.N.: Place of Birth: Residence:
1
2

11.      Do the child(ren) have health insurance?____________________________________
         a.     Name of insurance company:_______________________________________
         b.     Group number:__________________________________________________
         c.     Party responsible for premium:______________________________________
         d.     Monthly cost of premium $_________________________________________

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                                     DANIELS & DANIELS
                   ______________________________________________________

          e.       Is the insurance covered through a parent’s employment?________________

12.       Will there be a dispute over custody of the children? _________________________
          If not, who will have custody? __________________________________________

13.       Special circumstances of children and/or spouses:
          a.     special needs : _________________________________________________
          b.     religious issues: _________________________________________________
          c.     personal injury claims:____________________________________________

14.       What are your grounds for divorce? Insupportability/other:___________________

15.       Have you or your spouse ever filed for a divorce? ___________________________
          If so, when and where? ________________________________________________

16.       Name of your spouse’s attorney, if any: _________________________________

17.       If a divorce is granted, should the wife’s maiden or prior name be restored?_______
          If so, what name will be used? __________________________________________

18.     If you have you been married before, how many times? ________________
        If there are children from a previous marriage or other relationship, please provide all
        requested information:
      Name:                 Sex:      D.O.B.:    S.S.N.:     Place of Birth:      Residence:
1
2

19.       Do you or your spouse pay or receive child support? ____________________________
          Describe child support payments $_____________ per __________________________

20.     If your spouse been married before, how many times? ________________
        If there are children from the previous marriage or other relationship, please provide all
        the requested information:
      Name:            Sex:       D.O.B.:      S.S.N.:     Place of Birth:        Residence:
1
2

                                                         ASSETS
21.       Please list all Real Estate Property:
          Real Estate Property #1
          a.      Address                       : ____________________________________
          b.      Legal description             : ____________________________________


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                                     DANIELS & DANIELS
                   ______________________________________________________

                                               : ____________________________________
                                               : ____________________________________
         c.        Mortgage company            : ____________________________________
                   i. Amount of original note $ ____________________________________
                   ii. Note executed by        : ____________________________________
                   iii. Date of original note  : ____________________________________
         d.        Year bought                 : ____________________________________
         e.        Estimate current mkt. value $ ____________________________________
         f.        Monthly payments            $ ____________________________________
         g.        General comments            : ____________________________________

         Real Estate Property #2
         a.     Address                        : ____________________________________
         b.     Legal description              : ____________________________________
                                               : ____________________________________
                                               : ____________________________________
         c.        Mortgage company            : ____________________________________
                   i. Amount of original note $ ____________________________________
                   ii. Note executed by        : ____________________________________
                   iii. Date of original note  : ____________________________________
         d.        Year bought                 : ____________________________________
         e.        Estimate current mkt. value $ ____________________________________
         f.        Monthly payments            $ ____________________________________
         g.        General comments            : ____________________________________

22.      List all Bank Accounts, Savings Accounts, C.D.’s, Credit Union, Savings bonds:
         Account #1
         a.       Name of bank                 : ___________________________________
         b.       Account type (checking, savings, IRA, etc.): ________________________
         c.       Account number               : ___________________________________
         d.       Amount on deposit            $ ___________________________________
         e.       Authorized users             : ___________________________________

         Account #2
         a.    Name of bank                 : ___________________________________
         b.    Account type (checking, savings, IRA, etc.): ________________________
         c.    Account number               : ___________________________________
         d.    Amount on deposit            $ ___________________________________
         e.    Authorized users             : ___________________________________

         Account #3
         a.    Name of bank                 : ___________________________________
         b.    Account type (checking, savings, IRA, etc.): ________________________

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                                     DANIELS & DANIELS
                   ______________________________________________________

         c.        Account number                          : ___________________________________
         d.        Amount on deposit                       $ ___________________________________
         e.        Authorized users                        : ___________________________________

23.      List all Motor Vehicles, Boats, Airplanes, Cycles, Trailers:
         Vehicle #1
         a.       Year and model               : ___________________________________
         b.       Vehicle ID number            : ___________________________________
         c.       Car driver                   : ___________________________________
         d.       Car loan lender              : ___________________________________
         e.       Loan balance                 $ ___________________________________

         Vehicle #2
         a.     Year and model                             : ___________________________________
         b.     Vehicle ID number                          : ___________________________________
         c.     Car driver                                 : ___________________________________
         d.     Car loan lender                            : ___________________________________
         e.     Loan balance                               $ ___________________________________

24.      List all Retirement, Pensions, and Savings Plans:
         a.       Do you participate in any retirement plan or company savings plan?_____
                  If so, describe the plan(s): ______________________________________
                  ___________________________________________________________
         b.       Does your Spouse participate in any retirement plan or company savings
                  plan? ________________
                  If so, describe the plan(s): ______________________________________
                  ___________________________________________________________

25.      List any other Deferred Compensation Benefits: (e.g., workers' compensation, disability
         benefits, bonuses and other "special payments," employee stock options, and other forms
         of compensation)
         a.      Name or type of your benefit: ____________________________________
                 Please describe the benefit: ______________________________________
                 ____________________________________________________________
         b.      Name or type of your Spouse's benefit: ____________________________
                 Please describe the benefit: ______________________________________
                 ____________________________________________________________

26.      List all Life Insurance or Annuities:
         Insurance #1
         a.       Insurance company            : ___________________________________
         b.       Policy number                : ___________________________________
         c.       Insuring life of             : ___________________________________

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                                     DANIELS & DANIELS
                   ______________________________________________________

         d.        Beneficiary                             : ___________________________________
         e.        Type of policy                          (Whole Life) (Term) (Universal)
         f.        Cash value                              $ ___________________________________
         g.        Loans against policy                    : ___________________________________

         Insurance #2
         a.     Insurance company                          : ___________________________________
         b.     Policy number                              : ___________________________________
         c.     Insuring life of                           : ___________________________________
         d.     Beneficiary                                : ___________________________________
         e.     Type of policy                             (Whole Life) (Term) (Universal)
         f.     Cash value                                 $ ___________________________________
         g.     Loans against policy                       : ___________________________________

27.      List any Brokerage or Mutual Fund Accounts:
         Account #1
         a.     Name of account             : __________________________________
         b.     Estimate amount invested    $ __________________________________

         Account #2
         a.    Name of account                             : __________________________________
         b.    Estimate amount invested                    : __________________________________

28.      List all Stocks, Bonds, and Other Securities (include securities not previously disclosed:
         Investment #1
         a.       Name of stock               : __________________________________
         b.       Estimate amount invested    $ __________________________________
         Investment #2
         a.       Name of stock               : __________________________________
         b.       Estimate amount invested    $ __________________________________

29.      Does anyone owe you or your spouse money? ____________________________
         a.    How much is owed?           $__________________________________
         b.    Owed by whom?               : __________________________________

30.      If you are involved in any lawsuits, please explain: ________________________
                 ___________________________________________________________

31.      Describe any livestock or mineral interest that you own: ___________________
                ___________________________________________________________

32.      List any and all Other Assets or property not named above:
         _________________________________________________________________

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                                     DANIELS & DANIELS
                   ______________________________________________________

         _________________________________________________________________
         _________________________________________________________________
         _________________________________________________________________

                                                              DEBTS

33.      Debts: (Other than house and/or automobiles; e.g., Charge Cards, Personal Loans,
          etc….)
         a. _______________________________________ $ ______________________
         b. _______________________________________ $ ______________________
         c. _______________________________________ $ ______________________
         d. ______________________________________ $ ______________________
         e. ______________________________________ $ ______________________
         f. ______________________________________ $ ______________________
         g. ______________________________________ $ ______________________

34.      Income Tax:
         a.    Have you filed for all previous years? _____________________________
         b.    Prepared by whom? : _________________________________________
         c.    Refund received?       : _________________________________________
         d.    If so, how much?       $ ________________________________________

35.      Last Will and Testament:
         a.    Do you have a will? : _________________________________________
         b.    Prepared by whom? : _________________________________________
         c.    Does your spouse have a will? ___________________________________
         d.    Prepared by whom? : _________________________________________

36.      Separate Property:
         Do you own any separate property (property owned before marriage or property received
         during marriage as a gift or inheritance)? __________________________________
         If so, detail property : ________________________________________________
         ___________________________________________________________________
         ___________________________________________________________________

37.      Does your spouse own separate property? _________________________________
         If so, detail property : ________________________________________________
         ___________________________________________________________________
         ___________________________________________________________________




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