Domestic QuestionnaireRequired Information

Our Domestic Questionnaire is mandatory for all of our services. The Domestic Questionnaire simply gathers information that we use to determine what services you are interested in, and some personal information about you, so that we can better determine your situation. It should take no longer than 15-20 minutes to complete.

 
 

Client Name




Address



 

 

 

Personal Information

Date of Birth


 

 

 

Yes
No
If yes, please set fourth below:

Death
Divorce











Please Note

  • ATTACH A COPY OF YOUR LAST THREE YEARS PERSONAL TAX RETURNS.
  • ATTACH A COPY OF ALL FINANCIAL STATEMENTS OR CREDIT APPLICATIONS GIVEN WITHIN THE LAST THREE YEARS BY YOU AND YOUR SPOUSE.

Spouse’s Name





Address





North CarolinaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

 

American SamoaDistrict of ColumbiaFederal States of MicronesiaGuamNorth MarianasPuerto RicoU.S. Virgin Islands

Date of Birth

 

 

 

Yes
No
If yes, please set fourth below:

Death
Divorce











 

Children

Children Born or Adopted of the Marriage:

Date of Birth

Date of Birth

 











Pensions

 

No. 1


Download Our Pension Data Release Form

Medical Insurance Information of Client and Spouse

Client














Spouse














Yes
No
If so, by whom?



Please list and rank these priorities and if there are others, add them to the list also.



When you complete this questionnaire, please submit it below, and bring the following items into our offices:

  1. Statements, tax returns, financial statements, deeds, deeds of trust, and any other documents requested at the bottom of the preceding pages.
  2. Twenty to thirty pages of history of your marriage.
  3. The names and addresses of twelve witnesses who could benefit your case. A Witness Trial Checklist Form is available at the bottom of this page. Please use one for each witness.
  4. The names and addresses of all possible witnesses your spouse may subpoena and what they may say to hurt your case.
  5. Write five pages on what your spouse will say bad about you.
  6. Your daily schedule on a weekly basis, that is, an hour by hour explanation of your home and work schedule.
  7. Are there facts which your spouse does not know about which are harmful to your case? What are they?
  8. A picture of yourself, your spouse, and your children.

Copyright © 2013 Benton Family Law