Family Law Intake Sheet



Please return all Intake Forms with other documentation to intake@.

Uncontested Divorce with Children Intake Sheet

An Uncontested divorce means that the parties AGREE on ALL terms with both parties willing to sign all prepared paperwork. An Uncontested Divorce does not require a legal consultation with the attorney. If you do not have an agreement on all terms in place, your matter is not uncontested.

If you are unsure of the whereabouts of the opposing party, convinced they will not answer when served, or unsure of their cooperation; your matter is not Uncontested.

Today’s date:           

Personal Data – please fill in all fields

Name                                                             

Street Address                                                             

City, State, Zip                                                             Home Phone            Cell Phone           

Fax No:           

Is it ok to contact you at the phone numbers listed above?      

Personal Email:            work email           

Do you prefer we use your personal email, work email or both?      

All Former Names:                                         

Driver’s License Number:            Issuing State:           years in Nevada     

Soc Sec #:            Age:            Birth date:           

Do you or your spouse want to keep their married last name?           

If no, what is your or her maiden name:                          

Date of Marriage:           

Employment Information:

Job Title:                                                   

Employer Name                                              

Address                                                        

City, State, Zip                                                   

Employer Phone                

Salary: Gross$            Net$           Per:           

Work Hours:                

Date began employment:                

Children at issue in this case:

Name:                Social Security #:                

Age:            Sex:            Birth date:           

Child currently resides with?       City, State                

Name:                Social Security #:                

Age:            Sex:            Birth date:           

Child currently resides with?       City, State                

Name:                Social Security #:                

Age:            Sex:            Birth date:           

Child currently resides with?       City, State                

Opposing Party – your husband or wife

Name                                                             

Street Address                                                             

City, State, Zip                                                             Home Phone            Cell Phone           

Fax No:           

Is it ok to contact you at the phone numbers listed above?      

Personal Email:            work email           

Do you prefer we use your personal email, work email or both?      

All Former Names:                                         

Driver’s License Number:            Issuing State:           years in Nevada     

Soc Sec #:            Age:            Birth date:           

Employer Information:

Job Title:                                                   

Employer Name                                              

Address                                                        

City, State, Zip                                                   

Employer Phone                

Salary: Gross$            Net$           Per:           

Work Hours:                

Date began employment:                

Attorney of Record for Opposing Party (if any):                                    

Resident Witness Information:

The Name and Address of a person that is over the age of 18 years old that will sign an affidavit that you have lived in Nevada for 6 weeks or more prior to the filing of your Complaint for Divorce.

Name:                

Address:                                    

How long has he/she lived in Nevada:                

How long has he/she known you:                

What is your relationship to him/her:      

They see you on an average of       times per week.

CUSTODY

Agreed Upon Custody Arrangement:

Legal custody: Joint Mother Sole Father Sole

Physical custody: Joint Mother Primary Father Primary

Agreed Upon Custody/Visitation Schedule:

CHILD SUPPORT

Desired Child Support Amount? $          

Who will pay? Mother Father

Additional details about child support:                                                                                                                                                                                                                                       

Please specify whether any of the children at issue have special needs that you wish addressed in the Decree, i.e. private school, tutor, medical needs, sports, activity or training:                                                                                                                                                       

Are there any other expenses for the child(ren) you wish expressed in the Decree?YES NO

If yes, please explain:                                                                                                                                                                                                                                       

HEALTH INSURANCE

Who will provide children’s health insurance? Mother Father

Who will pay copays and unreimbursed medical expenses? Mother Father Split

TAXES (select one option):

Mother will claim the minor child(ren) on her income taxes on Even Odd years.

Father will claim the minor child(ren) on his income taxes on Even Odd years.

Mother Father will claim the minor child(ren) on his/her income taxes every year.

on income taxes each year OR       will claim the minor child _____ on _____ income taxes each year and _____ will claim the minor child, _____, every _____ income taxes each year.

VACATION & HOLIDAY TIME SHARE AGREEMENT:

Please review the default holiday schedule and check the appropriate celebrated holidays and indicate the desired timeshare. Please note it is customary that anything indicated in the holiday timeshare supersedes regular timeshare.

Spousal support

Will either spouse receive spousal support? Yes No

If so, which one receiving: Wife Husband

How much per month?           

For how long?       years months, or until dies or remarries

PROPERTY AND DEBT ISSUES:

Has either party ever filed bankruptcy? If so provide details (approximate date)

                                                                                                                                                                                                                                      

Property and Debt

Real Estate

Address/Description Name on title Who will keep Net Equity/Value

                                                                                                           

                                                     

Vehicles :

1:

Vehicle ID No.:                      Value:                

Make:                 Model:           Year:           

Titled jointly? If so - with who?_                               

Who will keep:                     

2:

Vehicle ID No.:                      Value:                

Make:                 Model:           Year:           

Titled jointly? If so - with who?_                               

Who will keep:                     

Other Property (Bonds, IRAs, Bank Accounts, etc)

Description Account # Net Equity Who will keep

                                           husband wife split

                                           husband wife split

                                           husband wife split

                                           husband wife split

                                           husband wife split

Debt

Real Estate Debt:

|Creditor |Name on Account |Balance |Monthly Payment |Acct No. |

|1.       |      |$      |$      |      |

|2.       |      |$      |$      |      |

|3.       |      |$      |$      |      |

Credit Cards:

Creditor Name on account Balance Monthly Payment Acct No.

                 $      $           

                 $      $           

                 $      $           

                 $      $           

                 $      $           

Other Creditors:

Creditor Name on account Balance Monthly Payment Acct No.

                 $      $           

                 $      $           

                 $      $           

                 $      $           

                 $      $           

Summarize Property and Debt Distribution:

Property to Husband:

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

Property to Wife:

                                                                                                                                                                                                                                                                                                                                                                                                 

Debt to Husband:

                                                                                                                                                                                                                                                                                                                                                                                                      

Debt to Wife:

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 

Were you referred to a specific attorney? If so to who? _________________________

How did you hear about us?

U.S. Department of State

Nevada State Bar website list of specialists  

Legal Aid Center of Southern Nevada

American Association of Matrimonial Lawyers ()

International Association of Family Lawyers ()

  



Other internet directory:      



Other internet search:      

Other Attorney, Attorney’s name:      

Friend, Friend’s name:      

Other:      

-----------------------

|Week |Sun. |Mon. |Tues. |Wed. |Thurs. |Fri. |Sat. |

|Sample |Mom |Mom |Dad |Dad |Dad |Mom |Mom |

| |Pick up at | |Pick up | | |Pick up | |

| |11 a.m. | |after school at 3| | |after school at 3| |

| | | |p.m. | | |p.m. | |

|Week | | | | | | | |

| | | | | | | | |

|#1 | | | | | | | |

|Week | | | | | | | |

| | | | | | | | |

|#2 | | | | | | | |

|Week | | | | | | | |

| | | | | | | | |

|#3 | | | | | | | |

|Week | | | | | | | |

| | | | | | | | |

|#4 | | | | | | | |

|Check box if this |Holiday: |Time |Every |Even |Odd |

|holiday | |(circle a.m. or p.m.): |Year |Years |Years |

|applies: | | | | | |

|□ | |From: a.m./p.m. | Mom | Mom | Mom |

| |New Year’s Eve |To: a.m./p.m. | Dad | Dad | Dad |

|□ | |From: a.m./p.m. To: a.m./p.m. | Mom | Mom | Mom |

| |New Year’s Day | | Dad | Dad | Dad |

|□ |Martin Luther |From: a.m./p.m. | Mom | Mom | Mom |

| |King, Jr. Day |To: a.m./p.m. | Dad | Dad | Dad |

|□ | |From: a.m./p.m. To: a.m./p.m. | Mom | Mom | Mom |

| |Presidents’ Day | | Dad | Dad | Dad |

|□ | |From: a.m./p.m. | Mom | Mom | Mom |

| |Passover |To: a.m./p.m. | Dad | Dad | Dad |

|□ | |From: a.m./p.m. | Mom | Mom | Mom |

| |Easter |To: a.m./p.m | Dad | Dad | Dad |

|□ | |From: a.m./p.m. | Mom | Mom | Mom |

| |Memorial Day |To: a.m./p.m | Dad | Dad | Dad |

|□ | |From: a.m./p.m. | Mom | Mom | Mom |

| |Mother’s Day |To: a.m./p.m | Dad | Dad | Dad |

|□ | |From: a.m./p.m. | Mom | Mom | Mom |

| |Father’s Day |To: a.m./p.m | Dad | Dad | Dad |

|□ | |From: a.m./p.m. | Mom | Mom | Mom |

| |4th of July |To: a.m./p.m. | Dad | Dad | Dad |

|□ | |From: a.m./p.m. | Mom | Mom | Mom |

| |Labor Day |To: a.m./p.m. | Dad | Dad | Dad |

|□ | |From: a.m./p.m. | Mom | Mom | Mom |

| |Rosh Hashanah |To: a.m./p.m. | Dad | Dad | Dad |

|□ | |From: a.m./p.m. To: a.m./p.m | Mom | Mom | Mom |

| |Yom Kippur | | Dad | Dad | Dad |

|□ | |From: a.m./p.m. | Mom | Mom | Mom |

| |Nevada Day |To: a.m./p.m. | Dad | Dad | Dad |

|□ | |From: a.m./p.m. To: a.m./p.m. | Mom | Mom | Mom |

| |Halloween | | Dad | Dad | Dad |

|□ | |From: a.m./p.m. | Mom | Mom | Mom |

| |Veterans Day |To: a.m./p.m. | Dad | Dad | Dad |

|□ |Thanksgiving |From: a.m./p.m. | Mom | Mom | Mom |

| |Day |To: a.m./p.m. | Dad | Dad | Dad |

|□ |Chanukkah |From: a.m./p.m. To: a.m./p.m. |͘ Mom |͘ Mom |͘ Mom |

| |(Days): | |͘ Dad |͘ Dad |͘ Dad |

|□ |Chanukkah |From: a.m./p.m. |͘ Mom |͘ Mom |͘ Mom |

| |(Days): |To: a.m./p.m. |͘ Dad |͘ Dad |͘ Dad |

|□ | |From: a.m./p.m. To: a.m./p.m. |͘ Mom |͘ Mom |͘ Mom |

| |Christmas Eve | |͘ Dad |͘ Dad |͘ Dad |

|□ | |From: a.m./p.m. |͘ Mom |͘ Mom |͘ Mom |

| |Christmas |To: a.m./p.m. |͘ Dad |͘ Dad |͘ Dad |

|□ | |From: a.m./p.m. To: a.m./p.m |͘ Mom |͘ Mom |͘ Mom |

| |Father’s Birthday | |͘ Dad |͘ Dad |͘ Dad |

|□ | |From: a.m./p.m. |͘ Mom |͘ Mom |͘ Mom |

| |Mother’s Birthday |To: a.m./p.m. |͘ Dad |͘ Dad |͘ Dad |

|□ | |From: a.m./p.m. |͘ Mom |͘ Mom |͘ Mom |

| |Child’s Birthday |To: a.m./p.m. |͘ Dad |͘ Dad |͘ Dad |

|□ | |From: a.m./p.m. |͘ Mom |͘ Mom |͘ Mom |

| | |To: a.m./p.m. |͘ Dad |͘ Dad |͘ Dad |

|□ | |From: a.m./p.m. |͘ Mom |͘ Mom |͘ Mom |

| | |To: a.m./p.m. |͘ Dad |͘ Dad |͘ Dad |

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