Divorce With Children Intake

Your guide to divorce and family law in Michigan.
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Client Information
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Full Name (First/Last):Email AddressPhoneHow did you hear about us?If Referral/Other

Husband Information
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Full Name (First/Last)AddressCityStateZipPhoneEmailEmployerPositionEmployer AddressCityStateZipPhoneGross Weekly IncomeIncome reported on last year's taxesCounty Residing InLength of Residence in StateDriver's License #Date of BirthPlace of Birth (City, State)Number of MarriageLevel of EducationSocial Security Number

Please list any:
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Criminal ConvictionsAlcohol/Drug AbuseDomestic ViolenceAnything else we should know? Please describe:

Wife Information
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Please list any:
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Criminal ConvictionsAlcohol/Drug AbuseDomestic ViolenceAnything else we should know? Please describe:

General Information
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Date of MarriageBy WhomLocation of Marriage (City, County, State)Date of Separation

Previous Divorces of Either Party
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Which PartyLocation, City & StateDate of Divorce

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Husband
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Eye ColorHair ColorWeightScars/TattoosRace

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Wife
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Eye ColorHair ColorWeightScars/TattoosRace

Children
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Full Name (First/Middle/Last) / Birthdate / School/Grade / Social Security NumberIf separated, state the current parenting time routine and for how long

ANY OTHER MINOR CHILDREN RESIDING WITH EITHER PARTY
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Full Name (First/Middle/Last) / Birthdate / Residential Address / Whose Child

HEALTH INSURANCE INFORMATION FOR CHILDREN
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Name of childrenName of Policy HolderName of Insurance CO/HMOPolicy/Certificate/Contract No

OTHER INSURANCE:
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Name of childrenName of Policy HolderName of Insurance CO/HMOPolicy/Certificate/Contract No

Assets, Debts, & Expenses

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Marital Home
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AddressDown Payment (Amount and By Whom)Date PurchasedMortgage Balance DueMortgage in Whose NamePresent ValueTitle in Whose Name

Other Real Estate
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AddressDown Payment (Amount and By Whom)Date PurchasedMortgage Balance DueMortgage in Whose NamePresent ValueTitle in Whose Name

Vehicles
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YEAR/MODEL/PRESENT VALUE/BALANCE DUE/USED BY WHOM)OTHER ASSETS (DESCRIBE):

Debts (Include Credit Card Debt)
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AMOUNT / TO WHOM / FOR WHAT / MONTHLY PAYMENT AMT.

Bank Accounts
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AMOUNT / TYPE OF ACCOUNT / BANK NAME / NAME ON ACCOUNT

Stocks
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COMPANY / NO. OF SHARES / VALUE TOTAL / WHOSE NAME

Bonds
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TYPE / VALUE TOTAL / WHOSE NAME

Life Insurance
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COMPANY / TYPE BENEFICIARY / FACE VALUE / CASH VALUEOTHER TYPES OF INSURANCE AND PREMIUMS PAID

HAS EITHER PARTY APPLIED FOR OR ARE RECEIVING PUBLIC ASSISTANCE? IF YES:
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WHO IS RECEIVING / TYPE OF ASSISTANCE (Bridge card, Medicaid, etc.) / CASE#

RETIREMENT ACCOUNTS
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WHOSE NAME / AMOUNT TODAY / AMOUNT DATE OF MARRIAGE / PENSION/401K/TYPE

Important
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IF YOU DO NOT WISH TO HAVE ANY MAIL SENT TO YOUR ADDRESS, CHECK THE BOX
SignaturePrint NameDate

IF SO, WE NEED AN ALTERNATE ADDRESS IN THE MEANTIME (I.E., FAMILY MEMBER, FRIEND, OR WORK). PLEASE PROVIDE:
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AddressCityStateZip

IF YOU PREFER COURT DOCUMENTS TO BE SENT BY EMAIL, PLEASE PROVIDE:
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Email AddressReCaptcha

PDF Version

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Divorce With Children Intake

Client Information‍

Husband Information‍

Please list any:‍

Wife Information‍

Please list any:‍

General Information‍

Previous Divorces of Either Party‍

Husband‍

Wife‍‍

Children‍

ANY OTHER MINOR CHILDREN RESIDING WITH EITHER PARTY‍

HEALTH INSURANCE INFORMATION FOR CHILDREN‍

OTHER INSURANCE:‍

Assets, Debts, & Expenses

Marital Home‍

Other Real Estate‍

Vehicles‍

Debts (Include Credit Card Debt)‍

Bank Accounts‍

Stocks‍

Bonds‍

Life Insurance‍

HAS EITHER PARTY APPLIED FOR OR ARE RECEIVING PUBLIC ASSISTANCE? IF YES:‍

RETIREMENT ACCOUNTS‍

Important ‍

IF SO, WE NEED AN ALTERNATE ADDRESS IN THE MEANTIME (I.E., FAMILY MEMBER, FRIEND, OR WORK). PLEASE PROVIDE:‍

IF YOU PREFER COURT DOCUMENTS TO BE SENT BY EMAIL, PLEASE PROVIDE:‍

8445 South Saginaw Street,Suite 300Grand Blanc, MI 48439

Client Information
‍

Husband Information
‍

Please list any:
‍

Wife Information
‍

Please list any:
‍

General Information
‍

Previous Divorces of Either Party
‍

Husband
‍

Wife
‍‍

Children
‍

ANY OTHER MINOR CHILDREN RESIDING WITH EITHER PARTY
‍

HEALTH INSURANCE INFORMATION FOR CHILDREN
‍

OTHER INSURANCE:
‍

Marital Home
‍

Other Real Estate
‍

Vehicles
‍

Debts (Include Credit Card Debt)
‍

Bank Accounts
‍

Stocks
‍

Bonds
‍

Life Insurance
‍

HAS EITHER PARTY APPLIED FOR OR ARE RECEIVING PUBLIC ASSISTANCE? IF YES:
‍

RETIREMENT ACCOUNTS
‍

Important
‍

IF SO, WE NEED AN ALTERNATE ADDRESS IN THE MEANTIME (I.E., FAMILY MEMBER, FRIEND, OR WORK). PLEASE PROVIDE:
‍

IF YOU PREFER COURT DOCUMENTS TO BE SENT BY EMAIL, PLEASE PROVIDE:
‍

8445 South Saginaw Street,
Suite 300
Grand Blanc, MI 48439