Divorce Intake Form

Name (Plantiff-YOU)(Required)

Spouse's Full Name (Defendant)(Required)

Date of Birth (Plaintiff- YOU)

Spouse's Date of Birth (Defendant)

Birth Place (Plantiff- YOU)

Birth Place (Defendant)

Wife's Maiden Name

Alias's

Your Current Address (Plaintiff- YOU)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Length of Residence at Current Address (Years)

County of Residence

Spouse's Current Address (Defendant)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Spouse's Phone

Spouse's Email

Your Place of Employment/Occupation (Plaintiff- YOU)

Spouse's Last Known Place of Employment/Occupation (Defendant)

Any Children of the Marriage?

Yes

Names of children and DOB(s)

Do you own any Real Estate (Homes, Condos, Mobile Homes, Apartments, Co-Ops?)

Yes

Who is to remain in the marital home?

Any other marital property or debts to be equibly distributed, list below:

Is either party requesting maintenance (alimony), a/k/a spousal support? If so, how much?

Date of Marriage

Date of Separation/Abandonment/Constructive Abandonment

Place of Marriage (City / State)

Civil or Religious Ceremony

NOTE: For initial summons and complaint the filing fee (also known as Index Fee) is $210.00. Note: Personal checks are not accepted by New York State Courts. After Filing of Summons and Complaint and Affidavit of Service, the Remainder of Divorce Packet can be filed after both parties have signed off on all the necessary documents. The filing fee for Judgment of Divorce, and Findings of Fact is $125.00. After Judgment of Divorce is obtained, a $30.00 fee to obtain certified copy and service of coypy upon Defendant will be required. Unless you notify the office, your divorce will be filed under No-Fault/Irretrievable Breakdown. Please contact the Attorney at 718-864-2011 if you have any questions about the grounds of your divorce.

On what grounds are you requesting the divorce? (for No-Fault/Irretrievable Breakdown –Leave blank)

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Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If you have been living separate and apart due per a separation agreement, please upload a copy of that agreement to this questionnaire. (Note: You must have been living separate and apart per that agreement for a minimum of 1 year from the date the agreement was signed).

File

Max. file size: 50 MB.

File uploads may not work on some mobile devices. Please call 718-864-2011 to make payment for your divorce. I look forward to representing you in this matter.