Section 20.92 Dissolution Questionnaire

• Library: Family Law 2014 Supp Forms

[Firm Name]

The following information will be needed to properly advise you and handle your case. Please print and fill out every applicable question. If a question is not applicable, please write N/A in the space. Do not leave blanks. This information will help us help you. This information will be kept confidential.

Today’s Date: __________, 20___.

1. Personal Information?Client

A. Your full name:

_______________________

(Last) (First) (Middle) (Maiden)

B. Have you ever been known by any other names? If so, what names?

_______________________

_______________________

C. Present address:

_______________________

(Street or Apartment Number)

_______________________

(City) (County) (State) (Zip Code)

D. Mailing address, if different from above, for mail during pendency of case where spouse will not have access:

_______________________

(Street) (City) (State) (Zip Code)

E. ____________________ ____________________ _______________________

(Social Security No.) (Home Phone) (Business Phone)

F. How long have you lived at present address? _______________________

G. How long have you lived in Missouri? _______________________

H. Do you: _______ own, _______ rent, or _______ live with relatives?

I. Date of your birth: _____________________________ Age: _______________________

State of your birth: _______________________

J. Highest grade you completed in school:

_______________________

(High School) (College) (Degree)

K. How many times, including the present marriage, have you been married? _______________________

If married previously, how many marriages were ended due to death of your spouse?

_______________________

How many were ended due to divorce or dissolution?

_______________________

Date(s) of such death(s) or divorce(s)? _______________________

2. Client’s Employment Information

A. Are you presently employed? __________ Yes __________ No

B. Name, full address, and telephone number of employer:

_______________________

_______________________

C. How long have you been so employed? _______________________

D. What is your approximate gross salary (before deductions)?

$ ______ per hour _______ per week _______ per month

E. What is your job title? _______________________

F. Do you have a pension or profit-sharing plan through your employment?

____________ Yes ____________ No

G. If you are not presently employed, when and where were you last employed?

When: _______________________

Job Title...