Divorce Service Bakersfield CA

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					      DIVORCE CITY 911
      QUESTIONNAIRE

     Phone: 661.868.9606        Email: info@divorcecity911.com          Fax: 661.885.8005



1.   How did you hear about Divorce City 911? ________________________________________



2.   RESIDENCY:        To request a divorce in California, one spouse must have been a resident of
     California for at least six months and reside in the County which you are filing your case
     for at least three months:

     Husband       /     Wife    /   Both      Check Spouse(s) who meet residency requirement



2.   YOUR NAME: ______________________________________ Home Phone______________
3.

     Cell ___________________ Email: _______________________________________________


     Work Phone ____________________________Fax __________________________


     Home Address _______________________________________, Unit # ______


     City ________________________, State __________ Zip Code _________ Birth Date ___________


     Employer: _______________________________________SS# _____________________________


     Employer Address: _____________________________________ Position ______________________


     City _________________________, State _________ Zip Code ________ Work Hours __________


4.   SPOUSE NAME: ______________________________________ Home Phone _____________


     Cell ___________________ Email: _______________________________________________



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        Work Phone ____________________________Fax ______________________________


        Home Address: _______________________________________, Unit # ______


        City ________________________, State __________ Zip Code _________ Birth Date ___________


        Employer _______________________________________SS# ________________________________


        Employer Address _____________________________________ Position ______________________


        City _________________________, State _________ Zip Code ________ Work Hours __________



5.      MARRIAGE

     Date of Marriage _____________________          Date of Separation ____________________


6.      SPOUSAL SUPPORT TO BE AWARDED TO:


        a. Wife        b. Husband          c. Reserved by Court       d. Waived by both parties


7.      ARE THERE ANY RETIREMENT PLANS?

         Myself   /   Spouse   /     N/A

        Name of Plans: Myself _________________________ Spouse _______________________



7.      CHILDREN OF THIS MARRIAGE ONLY:


Complete if you either have children or are expecting a child. If you have no children of this
marriage write N/A in this section.

        Name           Birth Place      Birth Date         Age      Sex         Social Security #




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____________________________________________________________________________________


        a.      Children are presently living with:          Mother /         Father /      Both


        Address: _______________________________________________Zip ____________


        b.      Were any of the children born prior to your marriage?                Yes    /      No


        c.      Physical Custody of children requested:            Joint /     Mother /         Father



        d.      Visitation requested:       Mother /        Father     ( Supervised        Yes /    No)


9.      Do you own any real property, as a couple, individually or in a trust?                  Yes /         No


10.     Do you have joint credit card debts or loans in both of your names?                        Yes    /   No


11.     Do you have credit card debts or loans in your name only?                                   Yes /     No


12.     Wife’s name change: Fill in only if Wife wishes to change her name: __________________


I understand and acknowledge that Divorce City 911 is a legal document preparation service and does not give legal
or tax advice. Our duty is to ask you the proper questions in order to obtain the information necessary to prepare
documents for your court case. If you need legal or tax advice, we encourage you to consult with an attorney or
certified public account licensed to practice in the State of California.




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I have read and understand the above. I hereby instruct Divorce City 911 to use the information contained in this
Questionnaire and any other information I am asked to provide to Divorce City 911 to help in the preparation of my
legal documents. I declare that the information provided herein is true and correct to the best of my knowledge.

Dated: ________________________ Customer Signature ________________________________________
                                                                                                       (Rev. 06-12)




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Description: Divorce Intake Questionnaire