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Divorce/Separation Agreement intake form
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This form is for intake purposes only and does not create a client relationship with Mathews Law. All information provided is confidential.
What is your name?
Your answer
What is your spouse's name?
Your answer
What is your address?
Your answer
If your spouse lives at a different address, what is his/her address?
Your answer
What is your phone number?
Your answer
What is your date of birth?
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What is your spouse's date of birth?
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How long have you resided in Virginia?
Your answer
What city or county and state where you born in? (this is required for all divorces in VA)
Your answer
What city or county and state was your spouse born in? (this is required for all divorces in VA)
Your answer
What is your SSN? (this is required for all divorces in VA)
Your answer
What is your spouse's SSN? (this is required for all divorces in VA)
Your answer
What is your highest level of education? (this is required for all divorces in VA)
Your answer
What is your spouse's highest level of education? (this is required for all divorces in VA)
Your answer
What is your approximate annual gross income?
Your answer
What is your spouse's approximate annual gross income?
Your answer
What date were you married?
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Where were you married (city, state or city, country if outside of the United States).
Your answer
Have you separated from your spouse?
Yes
No
Clear selection
If yes, what was your date of separation?
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Briefly describe the cause of the separation. (i.e. adultery, abuse, marriage fizzled, etc.)
Your answer
Is your spouse represented by an attorney?
Yes
No
Unknown
Clear selection
If so, what is the name and/or firm of his/her attorney?
Your answer
Has either spouse filed for divorce already?
Yes
No
Clear selection
If you answered yes to the question above, where was the divorce filed and when?
Your answer
What is the last address where you and your spouse lived together?
Your answer
Do you have any children under the age of 18?
Yes
No
Clear selection
If you have children under the age of 18, please list the name and date of birth of each child below.
Your answer
Please list below any major assets obtained during your marriage and the approximate value of those assets. (i.e. home $400,000; car $10,000, etc.)
Your answer
Please list below debts that were acquired during the marriage and the approximate value of the debts. (i.e. Visa card $7000, car payments $4000, etc.)
Your answer
Please list below any agreement you have made with your spouse about how to divide assets and debts.
Your answer
Have you and your spouse agreed to pay spousal support?
Yes
No
Clear selection
If you answered yes to the question above, please describe the arrangement.
Your answer
If you and your spouse have not already agreed to a spousal support arrangement, are you seeking spousal support?
Yes
No
Maybe
Clear selection
List any other provisions of support that should be taken into account such as life insurance, health insurance, survivor benefits, etc.
Your answer
If you have children under the age of 18 who have special needs that will need to be taken into account in your custody/visitation arrangement, please list those needs below.
Your answer
If you have children under the age of 18, what arrangement for LEGAL custody have you and your spouse made for your children (if any)? (legal custody allows the parent to be involved in major decisions regarding the child(ren)'s live)
Your answer
If you have children under the age of 18, what arrangements for PHYSICAL custody have you and your spouse made for your child(ren) (if any)? (physical custody means who the child lives with primarily)
Your answer
If you have children under the age of 18, what arrangements for VISITATION have you and your spouse made for your child(ren) (if any)? (visitation is the time that the child lives with the parent who does not have primary physical custody)
Your answer
If you have children under the age of 18, please state below the child support arrangements, if any, that have been made.
Your answer
Are there any other issues or facts that should be taken into account in a divorce proceeding and/or separation agreement that have not already been addressed above?
Your answer
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