CLIENT INFORMATION SHEET

DATE:_____________ CLIENT HUSBAND/WIFE

HOW DID YOU HEAR ABOUT THIS LAWFIRM:

Attorney:_________________________ Website:__________________

Previous Client: ___________________ Other: _____________________

NAME:_______________________________________________________________________

First Name Middle Name Last Name

ADDRESS:___________________________________________________________________

Street Address City, State Zip

BILLING ADDRESS (If Different): _______________________________________________________

SOCIAL SECURITY NUMBER:_____-____-_______ DATE OF BIRTH:_____________

DRIVERS LICENSE NUMBER:_____-____-_______ COUNTY:____________________

HOME PHONE: ( ) __ ____ WORK PHONE: ( )__________________

CELL/PAGER:_( )_____________________ FAX NUMBER: ( )__________________

E-MAIL ADDRESS:___________________________________________________________

Resident of your County for 30 days (yes/no) and the State of Oklahoma for 6 months (yes/no)

OCCUPATION:_________________________________ SALARY:___________________

Paid: Weekly/Bi-Weekly/Monthly/Semi-Monthly

EMPLOYER: ___________________________________ EMPL. DATE:________________

ADDRESS:___________________________________________________________________

Street Address City, State Zip

Check here if exempt from FICA ڤ and/or Medicare ڤ

DATE MARRIED:_______________ CITY, STATE:________________________________

DATE SEPARATED:__________________

SPOUSE

NAME:_______________________________________________________________________

First Name Middle Name Last Name

CURRENT ADDRESS:_________________________________________________________

Must have for service of Petition Street Address City, State Zip

SOCIAL SECURITY NO.____-____-______ DATE OF BIRTH:___________________

DRIVERS LICENSE NUMBER:____-____-______

OCCUPATION:_________________________________ SALARY:____________________

Paid: Weekly/Bi-Weekly/Monthly/Semi-Monthly

EMPLOYER: ___________________________________ EMPL. DATE:________________

ADDRESS:___________________________________________________________________

Street Address City, State Zip

Check here if exempt from FICA ڤ and/or Medicare ڤ

MINOR CHILDREN: YES NO

HOW MANY: _______________

CHILDREN FROM A PREVIOUS MARRIAGE: YES NO

HOW MANY: ________________

DO YOU PAY SUPPORT ON THESE CHILDREN: YES NO

IF YES, HOW MUCH $______________

DOES SPOUSE HAVE CHILDREN FROM A PREVIOUS MARRIAGE:

YES NO

IF YES, HOW MUCH $________________

WE MUST HAVE ALL OF THE ABOVE INFORMATION AT SOME POINT IN YOUR CASE. PLEASE COMPLETE ALL OF THE ABOVE INFORMATION.

CHILDREN:

First Name Middle Name Social security # DOB Age Live with

1._________________________________________________________________________M/F__

2._________________________________________________________________________M/F__

3._________________________________________________________________________M/F__

4._________________________________________________________________________M/F__

5._________________________________________________________________________M/F__

• Are you of Indian descent? ڤ Yes ڤ No Name of Tribe:___________________
• Are the Children of Indian descent? ڤ Yes ڤ No Name of Tribe:___________________
• Is your spouse of Indian descent? ڤ Yes ڤ No Name of Tribe:___________________
• Are children properly enrolled on Tribal Rolls? ڤ Yes ڤ No
• Are you or your spouse properly enrolled on Tribal Rolls? ڤ Yes ڤ No
• Have either you or your spouse participated as a party, witness or in any other capacity in any type of litigation concerning the custody of your child(ren) in this state or any other state? ڤ Yes ڤ No If YES explain,_________________________________________

__________________________________________________________________________

• Is there any type of custody proceeding concerning your child(ren) now pending in any Court of this State or any other State to your knowledge? ڤ Yes ڤ No If YES explain,

______________________________________________________________________________________________________________________________________________________

• Is there any other person or entity who has physical custody of your child(ren) OR claims some right to have custody or visitation privileges with respect to your child(ren)?

ڤ Yes ڤ No If YES explain,________________________________________________

___________________________________________________________________________

• Who do you propose be the custodial parent? ڤ Father ڤ Mother ڤ Joint
• If joint custody, what percentage of time will the children live with each parent?

a. Father_____________%

b. Mother____________%

§ Please express your proposed Child visitation ___________________________________

___________________________________________________________________________

Expenses paid by Mother/Wife Expenses paid by Father/Husband

Parent’s Health Ins. Cost:_________ Parent’s Health Ins. Cost:_________

Children’s Health Ins Cost:________ Children’s Health Ins. Cost:_______

Employ. Day Care Cost:__________ Employ. Day Care Cost:__________

TEMPORARY ORDERS

If you want a temporary order for support or restraining order, please indicate if, while this proceeding is pending, you want the Court to award you:

Request of the Court	Yes	No
Possession of the marital residence
Custody of the minor children
Temporary Child Support
Temporary Spousal Support
Possession of Vehicle (Describe):
Temporary attorney fees and court costs
Order directing Spouse to leave home immediately
Order directing Spouse to remain away from you and/or children
Order restraining from selling or disposing of any asset

TEMPORARY SUPPORT

1. Since the date of separation, have you received OR paid any Child Support to your spouse? ڤ Yes ڤ No If your answer is YES, how much have you received or paid, give dates and amounts and how paid:

DATE

AMOUNT

RECEIVED/PAID

CHECK/CASH/MO

If your answer is NO, why have you not paid or received child support from your spouse?_______________________________________________________________________________________________________________________________________________

NAMES, ADDRESSES AND DATES OF PERSONS THE MINOR CHILD(ren) HAVE LIVED WITH FOR THE PAST FIVE (5) YEARS:

TO:FROM NAME ADDRESS

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

MUST HAVE THIS INFORMATION TO FILE OR ANSWER ANY PLEADING.
INCOME:

INCOME INFORMATION	HUSBAND	WIFE
Gross monthly income from salary and wages, including commissions, bonuses, allowances and overtime
Income is paid weekly, bi-weekly or monthly
Income from Pensions and Retirement
Income from Social Security
Income from Disability and Unemployment Insurance
Income from Public Assistance (welfare, AFDC payments, etc.)
Child support from any prior marriage
All other Sources (specify)
AMOUNT OF GROSS INCOME:
DEDUCTIONS FROM GROSS INCOME:
State Income Tax
Federal Income Tax
Number of Exemptions taken
Medical Insurance Premium
Life Insurance Premium
Union or other Dues
Retirement or Pension Fund
Savings Plan
401K Plan
Credit Union
Other Deductions (Specify)
TOTAL DEDUCTIONS:
TOTAL GROSS INCOME LESS TOTAL DEDUCTIONS:

MARITAL ASSETS:

Automobiles:

Auto year/make	Vin #	Titled	Value	Owed	Payment
1.		H/W/J
2.		H/W/J
3.		H/W/J
4.		H/W/J

Cash and Deposit Accounts:

Bank/Credit Union	Account #	Type	Bal at marriage	Bal at Petition
1.		CH/SA
2.		CH/SA
3.		CH/SA
4.		CH/SA

Securities – Stocks, bonds, etc.

Name of Company	Account #	Shares	Value
1.
2.
3.
4.
TOTAL:

Life Insurance:

Name of Company	Policy #	Beneficiary	Face Amount	Cash Value
1.
2.
3.
TOTAL:

Profit Sharing, 401K or Retirement

Name of Account	Owner	Bal at Marriage	Balance at Petition
1.
2.
3.
4.

Business Interest:

Name of Business	Share	Type	Value	Debt
1.
2.
3.
TOTAL:

Real Estate:

Legal Description (Attach copy of Deed)

Street Address

Type of Property

Date of Acquisition

Original Cost

Cost of Additions

Total Cost

Total Present Value (Attach most recent Appraisal)

Mortgage Balance

Other liens

Equity

Monthly Mortgage Payment

Mortgage Holder

Taxes

Individual Contributions

**If there is more than one parcel of real estate owned, attach sheet with identical information for all additional property.

Other Marital Assets: Complete Schedule “1”

Separate Assets: Complete Schedule “2”. To be a separate asset it must have been obtained before the marriage, by inheritance, or as a gift.

DEBTS:

Marital Debts: Complete Schedule “3”

Separate Debts: Complete Schedule “4”. Incurred prior to marriage, after separation, without the knowledge of the other party and paid only with separate funds.

CONTESTED ISSUES

1. Will your spouse contest this divorce action as to the custody of the child(ren)?

ڤ Yes ڤ No

If your answer is YES, state the reasons:_____________________________________

________________________________________________________________________

2. Will your spouse contest this divorce action as to the division of property?

ڤ Yes ڤ No

If your answer is YES, state the reasons: ____________________________________

________________________________________________________________________

3. Will your spouse contest payment of support alimony?

ڤ Yes ڤ No

If your answer is YES, state the reasons: ____________________________________

________________________________________________________________________

4. If your spouse will NOT contest this action, will he/she execute a WAIVER?

ڤ Yes ڤ No

5. If your spouse will NOT sign a waiver, where is the best place to have him/her served with the Divorce Petition (address)?___________________________________

6. Have you or your spouse ever filed for Divorce from the other? ڤ Yes ڤ No

If your answer is YES, date the action was filed:_______________________________

In what State and County was the action filed:________________________________

WIFE’S MAIDEN NAME

WOMEN ONLY: At the time of the final Decree, do you wish to be restored to your maiden name or a previous name? ڤ Yes ڤ No

NAME (First, Middle and Last):____________________________________________

COMMENTS

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I have read the above and foregoing document and have provided the information as requested. The information is true and correct to the best of my knowledge and belief.

DATE:_____________________ __________________________________________

Client Signature

FOR OFFICE USE ONLY

Fee Arrangements:

Retainer of $_______ Received on ________ Replenish Trust in $___________ Increments

Estimated Fee of $____________ to $_____________

CASE DESCRIPTION:_____________________________________________________________

NOTES:___________________________________________________________________

___________________________________________________________________________