YOUR DIVORCE Divorce Client Intake Form ABOUT YOU: First and Last Name Phone Email Address Street City State Select your state AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip Code Have you ever been a service member? Yes No Have you been married previousy? Yes No If yes, which branch, department, or agency? If you were previously married, please provide: Your Former Spouses's Name: The Date of this Marriage The Date of Your Divorce The State You Were Divorced In: Select your state AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY plus1 Add Another Prior Spouse minus1 Remove This Entry ABOUT YOUR SPOUSE: Name Phone Email Address Street City State Select your state AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip Code Has your spouse ever been a service member? Yes No Has your spouse been previously married? Yes No If yes, which branch, department, or agency? If your spouse was previously married, please provide: Your Former Spouses's Name: The Date of this Marriage The Date of Your Spouse's Prior Divorce The State Was Your Spouse Divorced In: Where did they live together? AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY plus1 Add Another Prior Spouse minus1 Remove This Entry ABOUT YOUR MARRIAGE: Have you lived in North Carolina for six months or more? Yes No What county do you live in? What is the Date of your Marriage Your Age at the Time of this Marriage: What City, County & State Were You Married In? Are You and Your Spouse Living Separately? Yes No. What Date the Your Separation Begin Did You or Your Spouse Intend the Separation to be Permanent? Yes No Have You Had Isolated Instances of Sexual Contact with Your Spouse Since Separation? Yes No Do You Have a Prenuptial Agreement Yes No. Have You Entered into a Separation Agreement? Yes No. Are Any of the Following Actions Currently Pending? Equitable Distribution Action Alimony/Post-Separation Support Action Child Custody Action ABOUT YOUR CHILDREN Do You Have Children: Yes No. If yes, please provide: Child's Name Child's Date of Birth Is Your Spouse the Natural Parent of this Child? Yes No. plus1 Add Another Child minus1 Remove This Entry If you are human, leave this field blank. Submit
