First Steps Towards Dissolution of Marriage in Illinois

Thank you for your interest in legal representation from this firm. This intake form is designed to gather the most important information in relation to your divorce, in order to prepare the necessary documents for filing with the court. Please answer as many of the questions as possible, to the best of your ability.

Please also begin collecting any documentation related to assets and debts acquired during the course of the marriage, as well as any other relevant documentation related to the questions below, and kindly forward to this office at your earliest convenience.

Once the intake form is completed, this office will contact you with further instructions.

Divorce Intake Form

Name

Address

Email Address

Phone Number

Social Security

Race

Birthdate

Birthplace

Highest Level Education Completed

Special Skills or Training

How long have you lived at the above address?

How long have you lived in the County in which you reside?

How long have you lived in Illinois?

What is your maiden name, if any?

Once divorced, do you want to resume using your maiden name? Once divorced, do you want to resume using your maiden name? Yes No

Have you been married before? Have you been married before? Yes No

If you have been married before, please provide the name of the ex-spouse, date of divorce/death, and the names and ages of any children from the previous marriage.

Spouse's Name

Spouse's Address

Spouse's Phone Number

How long has spouse lived at the above address?

How long has spouse lived in the county?

How long has spouse lived in the state of Illinois?

Spouse's Social Security Number

Spouse's Race

Spouse's Driver's License Number

Spouse's Birthdate

Spouse's Birthplace

Spouse's Highest Level of Education Completed

Spouse's Special Skills or Training

Does your spouse use drugs or alcohol? Does your spouse use drugs or alcohol? Yes No

If_yes,_please_list drug(s) and/or alcohol used.

If yes, please list frequency of use.

If your spouse has been married before, please provide the name of your spouse's ex-spouse, date of divorce/death, and the names and ages of any children from the previous marriage.

Your Employer

Your Employer Address

Your Employer Phone

Your Work Hours

Your Length of Employment

Your Type of Employment

List your monthly earnings, including wages, overtime, and any other sources of income.

Is your spouse employed? Is your spouse employed? Yes No

Spouse's Employer

Spouse's Employer Address

Spouse's Employer Phone

Spouse's Work Hours

Spouse's Length of Employment

Spouse's Type of Employment

List spouse's monthly earnings, including wages, overtime, and any other sources of income.

Spouse's Physical Description for Serving Court Documents (Height, Weight, Eye Color, Hair Color, etc.)

Date of Your Marriage

City, County, and State where your marriage took place.

When did you stop living with your spouse?

Are you (or your spouse) pregnant? Are you (or your spouse) pregnant? Yes No

If pregnant, what is the due date?

If pregnant, is the child of the marriage? If pregnant, is the child of the marriage? Yes No

Number of children born during the marriage.

Children(s) Name(s), Date(s) of Birth, Residence(s), Social Security Number(s), School(s) and Grade(s).

Are there any physical, mental, emotional, medical, educational or other specific problems or circumstances regarding any of the children? (List Names and Notes)

Please provide any additional helpful information not covered above.

Do you own a marital residence? Do you own a marital residence? Yes No

Do you own any other real estate? Do you own any other real estate? Yes No

Do you and/or your spouse have a safe deposit box? Do you and/or your spouse have a safe deposit box? Yes No

If you own a lock box, please provide all relevant information including bank/company name, box number, and names associated with the lock box.

Have you ever obtained an Order of Protection? Have you ever obtained an Order of Protection? Yes No

If you have ever obtained an Order of Protection, please provide all details.

If you have never obtained an Order of Protection, have you ever requested one? If you have never obtained an Order of Protection, have you ever requested one? Yes No

Please list any circumstances which caused the need for an order of protection.

Does anyone in the family require protection? If so, list names.

List any specific instances of abuse in the family, if any.

List any specific instances of police involvement with the family, if any.

List any specific instances resulting in a criminal conviction with a member the family, if any.

List any specific criminal sentences involving a member the family, if any.

Does your spouse have a criminal record? Does your spouse have a criminal record? Yes No

Does your spouse have a history of psychiatric treatment? Does your spouse have a history of psychiatric treatment? Yes No

Does your spouse abuse you or the children? Does your spouse abuse you or the children? Yes No

If there is or was verbal abuse in the household, please describe with specificity.

Does your spouse make threats to harm you or the children? Does your spouse make threats to harm you or the children? Yes No

If your spouse has made threats against the you or the children, please describe with specificity.

Do you feel you are in danger right now? Do you feel you are in danger right now? Yes No

Do you want referrals to shelters for victims of domestic violence? Do you want referrals to shelters for victims of domestic violence? Yes No

Have you ever received counseling? Have you ever received counseling? Yes No

Would you like referrals to counseling services for victims of domestic violence? Would you like referrals to counseling services for victims of domestic violence? Yes No