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					                        CLIENT INTAKE
                   DIVORCE WITHOUT CHILDREN
Date _________________________

Client                              Spouse
Full name ____________________      Full name ____________________
Birth date ___________________      Birth date ___________________
Age __________________________      Age __________________________
Birth place __________________      Birth place __________________
Address ______________________      Address ______________________
______________________________      ______________________________
Work phone ___________________      Work phone ___________________
Home phone ___________________      Home phone ___________________
Fax __________________________      Fax __________________________
Social Security no. __________      Social Security no. __________
Driver's License no. _________      Driver's License no. _________
   State _____________________           State _____________________
Occupational License no(s). __      Occupational License no(s). __
Armed Forces status __________      Armed Forces status __________
Next of kin __________________      Next of kin __________________
   Relation __________________           Relation __________________
   Address ___________________           Address ___________________
   ___________________________           ___________________________


                             MARRIAGE

Place____________________________________________________________
Date of marriage _____________      Date of separation ___________
Lived in Michigan 180 days? __   County 10 days? __
No. of previous marriages:   yours ___   spouse ___
How terminated:   yours ________________   spouse _________________
Maiden name _____________________________________________________
Name before this marriage _______________________________________

Does wife desire name change?
[ ] Yes   To what? ______________________________________________
[ ] No

Is there a prenuptial or postnuptial agreement?
[ ] Yes   Please attach a copy of the agreement.
[ ] No

                        PRIOR LITIGATION

Has either spouse previously filed for divorce, custody, etc., in
this county or elsewhere?
[ ] Yes   Indicate when and where filed, status of case, case
         number, and name of judge. ____________________________
         _______________________________________________________
[ ] No

Has there been any previous domestic relations case filed in this
county involving you and/or your spouse or any other family
member?
[ ] Yes   Indicate when and where filed, status of case, case
         number, and name of judge. ____________________________
         _______________________________________________________
[ ] No

Does anyone else claim custody over children of you or your
spouse?
[ ] Yes   Indicate when and where filed, status of case, case
         number, and name of judge. ____________________________
         _______________________________________________________
[ ] No

Is there an order/judgment for continuing jurisdiction over
children of you or your spouse for any other reason?
[ ] Yes   Indicate when and where filed, status of case, case
         number, and name of judge. ____________________________
         _______________________________________________________
[ ] No


Is there presently on file a case where one of the parties is
currently paying support for another child not of this marriage?
[ ] Yes   Indicate when and where filed, status of case, case
         number, and name of judge. __________________________
         _____________________________________________________
[ ] No
                 FAMILY HEALTH AND SOCIAL ISSUES

Do you, your spouse, or your children have
•    any serious physical or mental disability, disorder,
     handicap or incurable disease?
[ ] Yes   Please explain. _______________________________________
[ ] No

•    any problems with substance abuse (drugs, alcohol)?
[ ] Yes   What type of drugs? ___________________________________
         What treatment and by whom? ___________________________
         When? _________________________________________________
         Place of treatment ____________________________________
[ ] No

Any particular interest in another person by either party _______
_________________________________________________________________
Any problems with debts ___________________ Gambling ____________
Any marriage counseling _________________________________________
Personal counseling (yours/spouse's) ____________________________
Would you begin or continue counseling? _________________________

Would you sign a waiver of confidentiality so that we may have
access to your records?   [ ] Yes   [ ] No

Attitudes (yours/spouse's) toward reconciliation ________________
_________________________________________________________________

Are you or your spouse receiving ADC?
[ ] Yes   Caseworker ______________________ Case no. ____________
[ ] No

                 PHYSICAL INJUNCTION INFORMATION

What physical abuse, if any, has occurred and on what dates? ____
_________________________________________________________________
_________________________________________________________________

Has either spouse ever been arrested, convicted, imprisoned, or
placed on probation?
[ ] Yes   Explain. ______________________________________________
[ ] No

Physical Description of Client:
Race _________________________________ Height _____ Weight ______
Eye color ______________________ Hair color _____________________

Glasses
[ ] Yes   Worn all the time?     [ ] Yes     [ ] No
[ ] No

Mustache/beard
[ ] Yes   Color _________________________________________________
[ ] No

Distinguishing scars or tattoos _________________________________
Any current restraining orders? _________________________________

Physical Description of Spouse:
Race _________________________________ Height _____ Weight ______
Eye color ______________________ Hair color _____________________

Glasses
[ ] Yes   Worn all the time?     [ ] Yes     [ ] No
[ ] No

Mustache/beard
[ ] Yes   Color _________________________________________________
[ ] No

Distinguishing scars or tattoos _________________________________
Any current restraining orders? _________________________________

Is carrying a weapon a condition of his/her employment?
[ ] Yes
[ ] No

                           EMPLOYMENT

Client                               Spouse
Employer _____________________       Employer _____________________
   Address ___________________             Address ___________________
   ___________________________             ___________________________
   Date of hire ______________             Date of hire ______________
Occupation ___________________        Occupation ___________________
Weekly gross pay _____________        Weekly gross pay _____________
Weekly take home _____________        Weekly take home _____________
Pension ______________________        Pension ______________________
Early retirement benefits ____        Early retirement benefits_____
______________________________        ______________________________
Signing bonus or any special          Signing bonus or any special
payments______________________        payments______________________
Profit-sharing________________        Profit-sharing________________
Recognition or other awards           Recognition or other awards
______________________________        ______________________________
Income last year _____________        Income last year _____________

Please attach a copy of your last 3 pay stubs. Indicate if any
deductions are mandatory (other than taxes), for example, union
dues, pension, etc. Please attach the last 2 income tax returns
(personal and business) with their schedules and W-2 forms.

Previous employer ____________        Previous employer ____________
     Address ___________________           Address ___________________
     ___________________________           ___________________________
     Annual income _____________           Annual income _____________

Other income sources (pension, retirement, public assistance or
ADC, veterans' benefits, Social Security, annuity funds):

1.    Type (wage/dividend) _______________________________________
      Gross per year __________       In whose name ________________
2.    Type (wage/dividend) _______________________________________
      Gross per year __________       In whose name ________________
3.    Type (wage/dividend) _______________________________________
      Gross per year __________       In whose name ________________

                               EDUCATION

Client                                Spouse
Highest degree obtained ______        Highest degree obtained ______
High school __________________        High school __________________
   Date of diploma or GED ____           Date of diploma or GED ____
Univ./College ________________      Univ./College ________________
   Degree ____________________           Degree ____________________
   Date obtained _____________           Date obtained _____________
Univ./College ________________      Univ./College ________________
   Degree ____________________           Degree ____________________
   Date obtained _____________           Date obtained _____________
Additional training __________      Additional training __________
______________________________      ______________________________
______________________________      ______________________________

Did either spouse contribute to the education of the other?
[ ] Yes   Describe. _____________________________________________
[ ] No

                               ASSETS
              (Attach additional sheets if necessary.)

A.   Real property
Resident address ________________________________________________
    Date purchased _____________ Purchase price ________________
    Mortgage co. _______________________________________________
    Account no. _______________ In whose name __________________
    Monthly payments ______________ Balance due ________________
    Paid by     [ ] Husband   [ ] Wife    [ ] Both
    Land contract _____________ In whose name __________________
    Home equity loan ___________________________________________
    Account no. _______________ In whose name __________________
Amount of property taxes ________________________________________
Are they included in monthly payment? ___________________________

Additional real estate
    Address ____________________________________________________
    Date purchased _______________ Purchase price ______________
    Mortgage co. _______________________________________________
    Account no. ________________ In whose name _________________
    Monthly payments ______________ Balance due ________________
     Paid by   [ ] Husband   [ ] Wife   [ ] Both
     Land contract ______________ In whose name _________________
     Home equity loan ___________________________________________
     Account no. ________________ In whose name _________________
Amount of property taxes ________________________________________
Are they included in monthly payment? ___________________________
Attach copies of deeds or land contracts.

B.   Vehicles (car, boat, trailer, motorcycle, snowmobile, etc.)
1.   Year/make __________________________________________________
     Vehicle identification number ______________________________
     In whose name _________________ Possession _________________
     Purchase price ______________ Monthly payments _____________
     Lien holder _____________________ Balance due ______________
2.   Year/make __________________________________________________
     Vehicle identification number ______________________________
     In whose name _________________ Possession _________________
     Purchase price ______________ Monthly payments _____________
     Lien holder _____________________ Balance due ______________
3.   Year/make __________________________________________________
     Vehicle identification number ______________________________
     In whose name _________________ Possession _________________
     Purchase price ______________ Monthly payments _____________
     Lien holder _____________________ Balance due ______________
4.   Year/make __________________________________________________
     Vehicle identification number ______________________________
     In whose name _________________ Possession _________________
     Purchase price ______________ Monthly payments _____________
     Lien holder _____________________ Balance due ______________
5.   Year/make __________________________________________________
     Vehicle identification number ______________________________
     In whose name _________________ Possession _________________
     Purchase price ______________ Monthly payments _____________
     Lien holder _____________________ Balance due ______________
C.   Bank accounts or credit union accounts
1.   Name of bank and branch ____________________________________
     Account number _____________________________________________
     Type of account (savings, checking, money market) __________
     Signatories ________________________________________________
     Source of monies ____________________ Balance ______________
2.   Name of bank and branch ____________________________________
     Account number _____________________________________________
     Type of account (savings, checking, money market) __________
     Signatories ________________________________________________
     Source of monies ____________________ Balance ______________


3.   Name of bank and branch ____________________________________
     Account number _____________________________________________
     Type of account (savings, checking, money market) __________
     Signatories ________________________________________________
     Source of monies ____________________ Balance ______________

D.   Individual retirement accounts
1.   Financial institution ______________________________________
     Account number _______ Balance ______ In whose name ________
2.   Financial institution ______________________________________
     Account number _______ Balance ______ In whose name ________
     ____________________________________________________________

E.   Retirement plans, pensions, Keoghs, 401(k) plans, profit-
     sharing plans, stock bonus or option plans, etc. (attach
     copies of plan descriptions and annual reports for each)
1.   Employer or financial institution __________________________
     Name and type of plan _________________ Vested _____________
     Value ________ Account no. __________ In whose name ________
2.   Employer or financial institution __________________________
     Name and type of plan _________________ Vested _____________
     Value ________ Account no. __________ In whose name ________
3.   Employer or financial institution __________________________
     Name and type of plan _________________ Vested _____________
     Value ________ Account no. __________ In whose name ________


F.   Corporate stocks, bonds, notes, securities, bills, brokerage
     accounts
1.   Name of broker and firm holding investments ________________
     Type of investment _________________________________________
     Account no. ________________ In whose name _________________
     Type of account (savings, checking, money market) __________
     Purchase price ______________ Current value ________________
     What was source of stock or funds to purchase? _____________
2.   Name of broker and firm holding investments ________________
     Type of investment _________________________________________
     Account no. ________________ In whose name _________________
     Type of account (savings, checking, money market) __________
     Purchase price ______________ Current value ________________
     What was source of stock or funds to purchase? _____________


G.   Patents, inventions, copyrights, etc.
_________________________________________________________________
_________________________________________________________________

H.   Life insurance

Client                             Spouse
Name of insurer ______________     Name of insurer ______________
Name of insured ______________     Name of insured ______________
Name of beneficiary __________     Name of beneficiary __________
______________________________     ______________________________
Type of insurance (term, whole     Type of insurance (term, whole
life, etc.) __________________     life, etc.) __________________
Policy no. ___________________     Policy no. ___________________
Amount of policy _____________     Amount of policy _____________
Cash surrender value _________     Cash surrender value _________
Loans against policy _________     Loans against policy _________
I.   Business interests (corporations, partnerships, sole
     proprietorships, etc.)
Name and type of business interest ______________________________
Type of ownership interest ______________________________________
Value of interest _______________________________________________
Initial investment and when _____________________________________
Additional amounts invested and when ____________________________

J.   Community property (property acquired with your spouse)
Have you ever lived in a state which has a community property law
(Arizona, California, Idaho, Louisiana, Nevada, New Mexico,
Texas, Washington, or Wisconsin)?
[ ] Yes   Provide details and the status of assets brought into
          this state. ___________________________________________
          _______________________________________________________
[ ] No

K.   Miscellaneous assets
Jewelry _________________________________________________________
______________________________________________ Value ____________
Art work ________________________________________________________
______________________________________________ Value ____________
Antiques ________________________________________________________
______________________________________________ Value ____________
Coin and other collections ______________________________________
______________________________________________ Value ____________
Inheritances _________________________________ Value ____________
Annuities ____________________________________ Value ____________
Safe deposit box ____________ Location __________________________
Accounts receivable _____________________________________________

L.   Gifts
Have you or your spouse made any substantial gifts in the past or
placed property in joint names with anyone other than the spouse?
[ ] Yes   Provide details. ______________________________________
          _______________________________________________________
[ ] No

M.   Trust beneficiaries
Are you or your spouse the beneficiary under any trust?
[ ] Yes   Provide details. ______________________________________
          _______________________________________________________
[ ] No

N.   Assets held at time of marriage
_________________________________________________________________
_________________________________________________________________

O.   Are you aware of assets being given away, sold, or hidden
     from you?
[ ] Yes   Briefly explain. ______________________________________
          _______________________________________________________
[ ] No

                           LIABILITIES

     Please indicate with an asterisk any accounts that you have
reason to believe are delinquent.

Indebtedness (i.e., credit cards, educational loans, personal
loans, etc.)
1.   Creditor __________________________ Account no. ____________
     Type of indebtedness (credit card, etc.) ___________________
     Is the account current?   [ ] Yes   [ ] No
     Present balance due _____________ Monthly payment __________
     Named borrowers ____________________________________________
     Who will pay until the divorce judgment? ___________________
2.   Creditor __________________________ Account no. ____________
     Type of indebtedness (credit card, etc.) ___________________
     Is the account current?   [ ] Yes   [ ] No
     Present balance due _____________ Monthly payment __________
     Named borrowers ____________________________________________
     Who will pay until the divorce judgment? ___________________
3.   Creditor __________________________ Account no. ____________
     Type of indebtedness (credit card, etc.) ___________________
     Is the account current?   [ ] Yes   [ ] No
     Present balance due _____________ Monthly payment __________
     Named borrowers ____________________________________________
     Who will pay until the divorce judgment? ___________________
4.   Creditor __________________________ Account no. ____________
     Type of indebtedness (credit card, etc.) ___________________
     Is the account current?   [ ] Yes   [ ] No
     Present balance due _____________ Monthly payment __________
     Named borrowers ____________________________________________
     Who will pay until the divorce judgment? ___________________
5.   Creditor __________________________ Account no. ____________
     Type of indebtedness (credit card, etc.) ___________________
     Is the account current?   [ ] Yes   [ ] No
     Present balance due _____________ Monthly payment __________
     Named borrowers ____________________________________________
     Who will pay until the divorce judgment? ___________________
6.   Creditor __________________________ Account no. ____________
     Type of indebtedness (credit card, etc.) ___________________
     Is the account current?   [ ] Yes   [ ] No
     Present balance due _____________ Monthly payment __________
     Named borrowers ____________________________________________
     Who will pay until the divorce judgment? ___________________

Delinquent indebtedness
Mortgage ____________ How much? ______ How long overdue? ________
Property ____________ How much? ______ How long overdue? ________
Income taxes ________ How much? ______ How long overdue? ________
Vehicle loan ________ How much? ______ How long overdue? ________
Other _______________ How much? ______ How long overdue? ________

Business debts
What kind? __________ How much? ______ How long overdue? ________
Other obligations (for example, spousal support to a former
spouse) _________________________________________________________
_________________________________________________________________

Is anyone other than the spouse and identified children
financially dependent on you?
[ ] Yes   Give details. _________________________________________
[ ] No

On your spouse?
[ ] Yes   Give details. _________________________________________
[ ] No

                      RELIEF TO BE REQUESTED

[ ]   Divorce
[ ]   Separate maintenance
[ ]   Annulment
[ ]   Custody of children ________________________________________
[ ]   Parenting time rights ______________________________________
[ ]   Child support payments _____________________________________
[ ]   Spousal support ____________________________________________
[ ]   Spouse to vacate home ______________________________________
[ ]   Contribution to your attorney fees _________________________
[ ]   Restoration of former name _________________________________
[ ]   Procurement of $_______ in life insurance to secure child
      support
[ ]   Property division
[ ]   Property injunction
[ ]   Domestic abuse injunction
[ ]   Health insurance for children or yourself __________________
[ ]   Home utility payments ______________________________________
[ ]   Home insurance (Plaintiff/Defendant) _______________________
[ ]   Mortgage payments __________________________________________
[ ]   Debts ______________________________________________________
[ ]   Other ______________________________________________________
[ ]   Attorney fee arrangement ___________________________________
     The items checked below are needed to complete your divorce
case file. Please collect the items that have been checked and
bring in copies or originals to the paralegal as soon as
possible.

Items needed                             Date given to paralegal
[ ] Tax returns with schedules and W-2s -- last two years _____
[ ] Paycheck stubs -- last two months
     [ ] You  [ ] Your spouse                              _____
[ ] Mortgage statement                                     _____

        Document showing legal description
[ ]        Marital home                                      _____
[ ]        Vacation property                                 _____
[ ]        Income property                                   _____

[ ]     Pension or retirement account statement
        [ ] You    [ ] Your spouse                           _____
[   ]   Car titles    [ ] You   [ ] Your spouse              _____
[   ]   Life insurance cash value statement                  _____
[   ]   Savings account statements                           _____
[   ]   Investment account balance statements                _____
[   ]   Appraisal for ____________________________________   _____
[   ]   Appraisal for ____________________________________   _____
[   ]   Prenuptial or postnuptial agreement                  _____
[   ]   __________________________________________________   _____
[   ]   __________________________________________________   _____
[   ]   __________________________________________________   _____
[   ]   __________________________________________________   _____

				
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