Separate Maintenance Questionnaire

Please fill out as much relevant information below as possible. If you are not comfortable sending certain information over the Internet then feel free to call us with the data.

Plaintiff:

Name: Drivers License #:
Address: Dates at Address: From:
City:
To:
State: Zip: Name of Employer:
E-mail Address:
Phone: Was/Is in Military: Yes No
Work Phone: Dates in Military: From:
Social Security #: To:
Date of Birth: Ethnicity:

Defendant:

Name: Drivers License #:
Address: Dates at Address: From:
City:
To:
State: Zip: Name of Employer:
E-mail Address:
Phone: Was/Is in Military: Yes No
Work Phone: Dates in Military: From:
Social Security #: To:
Date of Birth: Ethnicity:

Resident Witness:

Name: Relationship:
Address: Lived at Addr. since:
City:
Lived in NV since:
State: Zip: Known party since:
Phone:    

Marriage Details:

Date of Marriage:    
Marriage City:
   
Marriage State:    
Restore Maiden Name: Restore Waived  
Maiden Name:    

Children:

Child Name: Soc. Sec. #: Date of Birth:
Child Name: Soc. Sec. #: Date of Birth:
Child Name: Soc. Sec. #: Date of Birth:
Child Name: Soc. Sec. #: Date of Birth:
Child Name: Soc. Sec. #: Date of Birth:

Custody:

Who will have legal custody of children: Mother Father Both
Who will have primary physical custody: Mother Father Both
Who will provide medical insurance: Mother Father Both
Who will receive tax exemption: Mother Father Both
Who will pay child support: Mother Father Both
Amount per month:
Does this case involve family violence: Yes No
Proposed Visitation schedule: Every Weekend Every Other Weekend
Other (please describe)

Plaintiff Property:

Real Property: Address: Value:  

City: State: Zip:  
Automobile: Make:    

VIN#: Value:  
Retirement Plan: Name:    

Acct#:    
401K Plan: Name:    

Acct#: Value:  
Checking: Institution:    

Acct#: Balance:  
Savings: Institution:    

Acct#: Balance:  
Stocks: Institution:    

Acct#: Value:  
Military Benefits: Plan:    

Acct#:    
All Other Assets :  

Defendant Property:

Real Property: Address: Value:  

City: State: Zip:  
Automobile: Make:    

VIN#: Value:  
Retirement Plan: Name:    

Acct#:    
401K Plan: Name:    

Acct#: Value:  
Checking: Institution:    

Acct#: Balance:  
Savings: Institution:    

Acct#: Balance:  
Stocks: Institution:    

Acct#: Value:  
Military Benefits: Plan:    

Acct#:    
All Other Assets :  

Plaintiff Debts:

Creditor Account# Balance  

$  

$  

$  

$  

$  

$  
  Mortgage: $  
  Auto Loan: $  

Defendant Debts:

Creditor Account# Balance  

$  

$  

$  

$  

$  

$  
  Mortgage: $  
  Auto Loan: $  

 

Please tell us how you found us:

 


Call us: (702) 636-HELP (4357)
WE ALWAYS RETURN PHONE CALLS
We are a paralegal service and cannot offer legal advice.
If you need advice, we can refer you to an attorney.

 

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