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Intake-Sheet-DV-Woman

VIEWS: 10 PAGES: 10

									                                            Confidential Information Sheet
                                    Domestic Violence / Temporary Protective Order
(NOTICE: No representation is provided until a signed fee contract is received and the retainer is paid).
Please fill out, save to your computer and email back to:                                     info@eafamilylaw.com

 Date:                                                        Your Full Name:

                                                            Contact Information
   (*Do not give us contact information where calls, faxes, emails, texts or voicemails could be received by the other party. If you do not have s
 contact information now, call us later when you obtain such safe contact information." We STRONGLY suggest that you create a new email ac
                                               with a new password for any communications with us).


Home:                                          Work:                                          Cell:

Email:

       Confidential Address:

City:                                          State:                                         Zip:
County:

                                                        Information About Parties

Date of Marriage:                                                             Place of Marriage:
if applicable                                                                 if applicable
Date Separated:
(Date marital union ended regardless of whether you reside in the same household)


Are you and your Husband / Opposing party living together now?
                 Yes                                          No

Your Occupation:
Approx. Salary / year

Husband/other party's Occupation:

Approx. Salary / year

Husband/other party's Information:
Name:
Address:
City:                            State:                        Zip:
County:


                                            Debts / Assets

Please mark an "x" next to the situation that best describes you
You may need to check more than one box

           I am married and my Husband has committed domestic violence against me
           I am married and my Husband is accusing me of domestic violence
           I am not married and the other party has committed domestic violence against me
           I am not married and the other party is accusing me of domestic violence

           I have been served with a Temporary Protective Order
           I have not been served with a Temporary Protective Order yet, but I expect to be soon

               I have obtained a Temporary Protective Order against the other party and I need
                                     representation at the 2nd hearing.

            I have not yet obtained a Temporary Protective Order against the other party but I p
                                                     to.

           COMPLETE BELOW ONLY IF YOU ARE MARRIED TO THE OPPOSING PARTY.
Does your Husband have access to the martial assets?
         Yes                          No

Are you concerned that your Husband might drain these assets in anticipation of divorce?
          Yes                        No

Is there significant marital credit card debt?
           Yes                             No

Does your Husband have in his possession credit cards that are in your name?
         Yes                           No

Are you concerned that your Husband might run up credit cards in anticipation of divorce?
          Yes                        No

                                            Marital Home
Whate is the address of the Marital Home:
What is the approximate value of the house?

What is the balance remaining on the:
                      1st mortgage:
                      2nd mortgage:
                      HELOC

Is it your desire to remain in the home in the event of divorce?
            Yes                           No


                                                   Children
Names of Children of this union
                Child’s Name:                                              DOB:
                Child’s Name:                                              DOB:
                Child’s Name:                                              DOB:
                Child’s Name:                                              DOB:
                Child’s Name:                                              DOB:
                Child’s Name:                                              DOB:

Do you have any major issues with you’re the other party's parenting ability?
                Yes                           No
If yes, please describe below

Names of other children that you have:
                Child’s Name:                                              DOB:
Does this child live with you? Y/ N
Do you pay child support for this child?      If so, how much per month?
                Child’s Name:                                              DOB:
Does this child live with you? Y/ N
Do you pay child support for this child?      If so, how much per month?
                Child’s Name:                                              DOB:
Does this child live with you? Y/ N
Do you pay child support for this child?      If so, how much per month?

Names of other children that your Husband has:
                Child’s Name:                                              DOB:
Does this child live with you? Y/ N
Do they pay child support for this child?     If so, how much per month?
                Child’s Name:                                              DOB:
Does this child live with you? Y/ N
Do they pay child support for this child?     If so, how much per month?


                Child’s Name:                                              DOB:
Does this child live with you? Y/ N
Do they pay child support for this child?          If so, how much per month?


                                                      Summary
 Please describe below as succinctly as you can, the details of your case, and what you would like
                                     attorney to assist you with.




                                            How did you learn of our firm?
                Referral from friend:

                Referral from other attorney:
                                (Please list name so we may thank them for the referral)
                Internet Search
                           Google
                           Yahoo
                           Msn
                           Altavista
                           Other

                Divorcenet.com
                Divorcesource.com
Atlanta Bar Referral
Legalmatch
Findlaw / Legalconnection
Lawyers.com
Order
 iner is paid).
milylaw.com




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