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:
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|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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