Online Intake Form

Name: * E-mail Address: * Address: City: State: AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY -Terr.- AS FM GU MI PR VI Zip: Home Phone: Work Phone: Fax Number: When is the best time to contact you? Morning Afternoon Evening What is the best way to contact you? Phone E-mail Fax Where does your spouse live? * Do you have children under 21 with your spouse? * Is there any marital property to be divided? Are either of you seeking financial support from the other? * Grounds (Basis) for Divorce * Abandonment : you have not lived together for at least one year (Constructive) Sexual abandonment : you have not had sex with your spouse for at least one year Separation agreement: you have lived apart for at least one year pursuant to (1) a judgment of separation or (2) a separation agreement Imprisonment: your spouse has been imprisoned for at least three [3] consecutive years after you were married Cruel & inhuman treatment : your spouse treated you so badly that it endangered your physical or mental health. You will need to specify exact dates, places and details of the cruel & inhuman treatment Adultery : you will need third-party corroboration EVEN WITH your spouses admission, and only if it has been less than 5 years since you found out about the adultery Date of Marriage * Date of Separation * Additional Information * Required