Main Office 245 E. Liberty Street, Suite 530, Reno, NV 89501

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1 Dear Sir/Madam: Please fill out each section fully. If a particular section does not apply, such as children, property, debts, etc. simply leave blank. Should the wife wish to resume a prior name, we include the change at no additional charge. In Nevada, a resident witness is required to attest to the fact that one party has lived in Nevada six weeks prior to the divorce. NRS , Therefore, complete this section. If you are a military personel you do not have to complete this section, but must send a copy of your LES or pay stub. When completed, click the "Click to Submit Form" icon located at the end of the form and it will be automatically ed to our office. Unless already paid please include credit card information or send a check or money order to the Reno office for our deposit fee of $310 for a Joint Petition (when both parties sign) or $450 for a Complaint for Divorce (with only 1 party signing). If we have questions, we will call you. If not we will start preparing the papers to be filed with the District Court Clerk's office. Administrative charges of a minimum of $50 apply if you or this office terminates our services prior to typing the paperwork. Once your papers have been typed our typing fees have been fully earned. Additional costs and fees which are applicable to divorce actions are as follows: 1. A filing fee, including our services of $169; and, 2. For a complaint when only 1 party signs: Either personal service of approximately $50; or service by publication of $100 and due diligence of $50; or a filing fee of $96 if your spouse agrees to the divorce and signs an Appearance & Waiver. Please note for a complaint for divorce, if the party responds you will need to hire an attorney. Our services do not include the preparation of replies, opposition to motions, motions nor any other pleading. The preparation of your paperwork is supervised by Jill K. Whitbeck, an attorney licensed to practice law in the State of Nevada. Please note that I am not your attorney of record. If you have any questions please or call the office. Sincerely, NEVADA DIVORCE & PARALEGAL SERVICES, INC. Jill K. Whitbeck, Supervising Attorney We are a paralegal firm supervised by attorneys Paralegals are not attorneys and are not permitted to give legal advice. NRS Our services are supervised by a licensed Nevada attorney who is responsible for our actions. Any legal question you have may be referred to our attorney for minimal cost.

2 If there is information you do not have available at this moment you can leave it blank and return to your account and complete it later.

3 * Type of Divorce (mark one) Joint Petition - both parties agree to the terms and will sign papers. If both parties do not sign the Joint Petition our typing fees have been fully earned and no refund will be given. However, a credit of $50 will be given toward a Complaint for Divorce. Complaint - when only one party signs Information Regarding Marriage Cause for Divorce NRS Date of your Marriage? State of Marriage? Date you Separated? Does spouse still reside at address? Last date spouse lived here? Yes No Incompatibility The parties lived separate and apart for 1 year without cohabitation Insanity existing for 2 years prior to the commencement of the action(corroboration required)

4 Tell Us About Yourself *bold are required fields First, Middle, Last Street Address City State/Other Zip code County Home Phone Work Phone Social Security # - - Date of Birth Drivers License Dates at Address From: To: Ethnicity White Hisp Black Asian/Pac. Islander Am. Ind/AK Other Employed Yes No Name of Employer Address of Employer Employer Phone Was/Is in Military? Yes No Dates in Military? From: To:

5 Tell Us About Your Spouse *bold are required fields First, Middle, Last Street Address City State/Other Zip code County Home Phone Work Phone Social Security # - - Date of Birth Drivers License Dates at Address From: To: Ethnicity White Hispanic Black Asian/Pac. Islander Am. Ind/AK Other Employed Yes No Name of Employer Address of Employer Employer Phone Was/Is in Military? Yes No Dates in Military? From: To:

6 Witness Information Divorce in Nevada requires you to have someone sign one affidavit that the wife or husband has lived in Nevada a minimum of 6 weeks preceding the commencement of the divorce. NRS , , The witness must have resided in Nevada for at least 6 months and be at least 18 years old. Additional proof of residency may be required if the residency is short-term or questionable. This could include; utility bill, Nevada driver's license or pay stub with Nevada employment. If you are military and Nevada is your Home State of Record, we would need a copy of your LES paperwork or pay stub. I am in the military and have Nevada on my LES paperwork. Please fax LES to Witness for? Husband Wife Name Lived at address since Relationship to Husband/Wife Full Address Lived in NV since Date Witness first saw spouse in NV

7 Additional Information of Wife Wife wants to change name to prior name? Yes No Wife's former name? Is wife pregnant? Yes No If yes, is child a product of the marriage? Yes No Spousal Support - if any - This is support specifically for the spouse, not child support. Nevada State law states if there is no end date included spousal support will cease with one parties death or if the spouse recieving support remarries. Party paying spousal support For how long? Husband Wife Amount $ Deducted from paycheck Yes No Income Tax Obligation - Unknown income tax obligation for any past year, shall be paid: By the party whose income or deductions caused the tax liability By the Husband By the Wife

8 Wife's Property/Debts - Even though the parties may have verbally agreed to a division of assets/debts, it is recommended by the attorney that the distribution of all assets/debts be included in the divorce with all VIN numbers, account numbers and balances. If you and your spouse have already signed separation papers please forward them to the office. Wife's Property Retirement: 401K Plan: Automobile: Military: Real Property: Location Checking: Saving: Stocks: All other Assets: Institution Name or Plan Account # VIN# or ID# Value/Balance Debts - List all debts, bills, contingent debt, all account numbers and balances. Wife's Debt Creditor Account# Balance

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10 Husband's Property Institution Name or Plan Account # VIN# or ID# Value/Balance Retirement: 401K Plan: Automobile: Military: Real Property: Checking: Saving: Stocks: Location All other Assets: Debts - List all debts, bills, contingent debt, all account numbers and balances. Husband's Debt Creditor Account# Balance

11 Minor Children Are there any minor children? Yes No Are there any adopted children? Yes No First, Middle, Last Date of Birth Social Security Number Child Custody - Click for child custody definitions Joint legal; primary physical custody with Wife Joint legal; primary physical custody with Husband Joint legal; primary physical custody shared by Husband and Wife Other, Please Specify: Does this case involve family violence? Yes No List all addresses of children for the last 5 years with dates at each address: Address From To List children's visitation/contact with each parent for the last six months Father Mother Income Tax - Who is to claim the child/ren as dependants on the income tax return? Wife Husband Other, please specify: Child Support - Click for child support guidelines

12 Husband & Wife certify that the amount of child support listed below is consistent with the appropriate formula set forth in paragraph (b) of subsection (1) of NRS 125B.070 and 125B.080, or an appropriate deviation is described below. To review statutory child support requirements go to NRS Chapter 125B. Wife Husband to pay other party child support. Agreed upon child support $ Husband's gross monthly income $ Wifes's gross monthly income $ Is the support to be withheld from employer? Yes No If you deviate from the guidelines list reasons: Click for state allowed allowances Are you requesting Child Support Enforcement services from the District Attorney's Office? Yes No Who will be providing transportation for visitation? Wife Husband Both equally Who will provide health insurance for the child? Wife Husband How much per month? $ Required Visitation Schedule - Edit to meet specific wishes. It must be specific for your papers to be approved by the court. During every summer vacation from to Every other weekend from Friday at 6:00 p.m. until Sunday at 8:00 p.m.; for holidays on even numbered years from 8:00 a.m. to 8:00 p.m. on Christmas Eve, Thanksgiving,,, and for child's birthdays. Each year weeks uninterrupted vacation with the child beginning at 8:00 a.m. on (date) and continuing until 10 p.m. on (date) Other

13 Specific Issues Are there any specific issues you have? Yes No If Yes, please explain How did you hear about us? 1. Internet a. Search Engine b. Keyword Used c. Other Internet Source 2. Paper/Yellow Pages 3. Referred by a prior customer a. Las Vegas Yellow Pages b. Big Nickel c. Reno Yellow Pages d. Nifty Nickel

14 Payment for Service - A deposit of $310 for a Joint Petition or $450 for a Complaint is due when you begin our services. Credit Card Information Included Below This is a secured site so you can feel comfortable providing Credit card information. However, if you prefer you can call the office to give the information over the telephone I will Mail a Check or Money Order to: Reno Office at 245 E. Liberty Street, Suite 530, Reno, NV Card Holder's Name Credit Card Credit Card Number Expiration Date / Zip code on CC Bills Amount $ If a third party credit card is used, that person must also complete and fax to (775) the Authorization Form. By submitting this form to Nevada Divorce I am authorizing the charge to my credit card for this purchase, the same as if I had personally signed a credit card purchase/payment receipt and I will be responsible for all collection fees and any other fees associated with the collection of my payment, should it become necessary. Send Papers: To my home address To my address Address TERMS OF AGREEMENT: Nevada Divorce's costs to type the papers does not include the filing/handling fee ($169). For Complaints the cost to serve is approximately $50. You must attempt to have your spouse personally served. If personal service cannot be effected and/or your spouse cannot be located, the court may order that service be completed by publication. This involves publishing in the newspaper once a week for 4 weeks (approx. $100) and due diligence of $50.00 (takes about 1 month); or a filing fee of $96.00 if your spouse agrees to the divorce and signs an Appearance & Waiver. If your spouse does not respond after service the divorce may proceeds by default. Both parties will need to hire attorneys if the spouse does respond; that even if this becomes a contested case our typing fees have been fully earned and no refund will be given; that these services do not include preparation of replies, opposition to motions, motions nor any other pleading nor any other service. It is the intent of Nevada Divorce to assist clients in representing themselves in legal proceedings. The supervising attorney supervises the typing of the complaint, summons, affidavits of resident witness and plaintiff, filing, service of process, default and decree of divorce. Nevada Divorce & Paralegal Services, Inc. is not responsible for verifying the accuracy, veracity, or comprehensiveness of any information provided to it by the client. Neither Nevada Divorce & Paralegal Services, Inc., nor any attorney supervising the preparation of the paperwork requested by the client, represents any client, as the attorney of record, in any legal proceeding unless specific and separate arrangements are made for such representation. LIMITATION OF LIABILITY FOR ERRORS AND OMMISSIONS: Read Carefully. In the event of any error in or omission of all or any part of our services, the parties agree Nevada Divorce or any supervising attorney's liability shall be limited to a pro rata abatement of the charges payable for such services performed by Nevada Divorce or any supervising attorney in which such error or omission occurs in the same proportion that such error or omission reduces the value of the service. In no event shall Nevada Divorce's or any supervising attorney's liability to customer for claims of any kind whatsoever for loss or damage arising out of or in any way connected with any such error or omission exceed the total of such charges for the services. In no event shall Nevada Divorce or any supervising attorney be liable for any loss or punitive damages of any nature. In no event shall Nevada Divorce or any supervising attorney be liable for errors or omission or other wrongful conduct of any third party. The foregoing provisions shall apply to the full extent permitted by law and regardless of whether the claim is based upon contract, tort (including negligence of whatever degree), strict liability or otherwise and shall constitute Nevada Divorce's or any supervising attorney's sole liability to customer and customer's exclusive remedy against company in the event of such error or omission and customer specifically waives any right to any such claim for loss or damage. However, if customer does not desire to waive such claim for loss or damage, customer can agree to pay additional charges. If customer pays the additional charges, the customer in the event of errors or omissions may pursue all his legal remedies for such errors or

15 omissions. Customers interested in obtaining additional information regarding this option should call the General Manager at Whether or not additional charges are paid, all claims based upon errors or omissions must be made during the case time which begins when the questionnaire is received by Nevada Divorce or any supervising attorney and ends when either the case is signed by the Judge or the case is closed by the customer or Nevada Divorce due to inactivity. All claims not made within the time period for claims are waived. No lawsuit may be brought for any relief based upon any error or omission unless a written claim is first made within the time period for making claims and in no event more than 3 months after the expiration of the time period for making claims. By submitting this form I acknowledge that I read, understand and agree to all disclosures and terms as contained in this document. I Agree I Disagree Copyright by Nevada Divorce & Bankruptcy Services, Inc. All rights reserved. All text, graphics, HTML code and web scripts (Javascript's, PHP, CGI, Perl...) are protected by US and International Patent and Copyright Laws, and may not be copied, reprinted, published, translated, hosted, or otherwise distributed by any means without explicit permission. Any violations will be prosecuted to the fullest extent of the law.