COOPER, TANIS & COHEN, P.C.

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1 COOPER, TANIS & COHEN, P.C. Attorneys At Law Robert M. Cooper Leonard D. Tanis Michael I. Cohen Paralegals Karen Kruse Jennifer Anderson Joyce M. Bergmann, Of Counsel Nova M. Frank DOMESTIC RELATIONS INFORMATION - DIVORCE Date: CLIENT Legal Name: (First) (Middle) (Last) Date of Birth: Mailing Address: Social Security Number: What County do you live in? May we mail you paperwork at your mailing address? where we can mail paperwork: If not, please list address Home phone: Home facsimile: Home Pager number: Business phone: Business facsimile: Business Cellular phone: 42 Garden Center Broomfield, Colorado Fax

2 Domestic Relations Information Divorce Page 2 How early may we call you? How late may we call you? May we contact you at work? May we contact you at home? Current Address: Employer: Address: Salary: Driver s License # Title: Are you a US Citizen? SPOUSE Legal Name: (First) (Middle) (Last) Date of Birth: Current Address: What County does your spouse live in? Mailing Address: Home phone: Business phone: Employer: Address: Salary: Title: Social Security Number: Driver s License # Is your Spouse a U.S. Citizen? Does your Spouse have an Attorney? If so, who?

3 Domestic Relations Information Divorce Page 3 Have you filed: YES NO Have you been served? Please complete if applicable: Date Served: Do you have the paperwork? INFORMATION ABOUT MARRIAGE Date of Marriage: Place of Marriage: Date of Separation: Years Married: Is this a Common Law Marriage? Children of the marriage: Legal Name (First, Middle & Last) Birthdate Social Security # Current address of the children: Have you participated as a party or witness in any litigation concerning the allocation of parental responsibility ( custody ) of the child(ren) named above in this state or any other state: no Explain:

4 Domestic Relations Information Divorce Page 4 Do you know of any allocation of parental responsibility ( custody ) proceeding concerning the children named above pending in a court of this state or any other state: no, explain: Do you know of any person not a party to these proceedings who has physical allocation of parental responsibility ( custody ) of the child(ren) or claims to have allocation of parental responsibility ( custody ) or parenting time ( visitation rights ) with respect to the child(ren): no, explain: The following arrangements as to allocation of parental responsibility ( custody ), support, and maintenance have been made: The children live with The father / mother (circle one) pays the following amounts per month for: child support $ maintenance $ mortgage $ debts $ other $ Any children from previous marriages? Yours: Spouse s: Have you lived in Colorado for the past 90 days? Since when? How long has spouse lived in Colorado? Are either you or your spouse in the military? Is wife pregnant? Is husband the father? Has there been domestic violence in your marriage? (If so, please explain.) Do you own your home?

5 Domestic Relations Information Divorce Page 5 Do you own any other real property (land, houses, town homes, condos, etc)? If, what is the address: Who carries medical insurance? RELIEF REQUESTED (What are you asking for?) Do you want decision making responsibility for the child(ren)? Does your spouse want decision making responsibility for the child(ren)? Can you and your spouse make decisions together regarding the child(ren)? Are you seeking child support? Are you seeking maintenance/alimony? If so, how much per month? If so, how much per month? Will your spouse seek maintenance/alimony? Do you want your attorney fees and costs to be paid by your spouse? How would you like property to be divided? Do you want to remain in your home? Do you want to change your name? If so, to what? What parenting time ( visitation ) do you want if you are not the primary caretaker? What parenting time ( visitation ) do you propose for your spouse? How did you hear about COOPER, TANIS & COHEN, P.C.?

Phone: 210.650.9074 12702 Toepperwein, Ste. 140, San Antonio, Texas 78233 Fax: 210.650.3291 w w w. s a l a w y e r. c o m

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