Personal Information Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth MM DD YYYY Sex Male Female Intersex Phone (Cell) Phone (Other) Email * Relationship History Are you married? Yes No Date of Marriage MM DD YYYY Date of Separation MM DD YYYY Date of Cohabitation MM DD YYYY Any prior marriages? Yes No Any prior divorces? Yes No Are you currently with a new partner? Do not share this information with your ex-partner/spouse. If you answered YES to the above – do not introduce your children to him/her unless you will be cohabitating, or you are engaged. Yes No Work Information Are you employed or self-employed? Yes (employed) Yes (self-employed) No Name of Employer/Business Annual Income Address of Employer/Business Address 1 Address 2 City State/Province Zip/Postal Code Country Phone of Employer/Business (###) ### #### Do you have a lawyer? Yes No Name of Lawyer First Name Last Name Spouse/Partner/Ex-spouse/Ex-Partner’s Information Name First Name Last Name Date of Birth MM DD YYYY Sex Male Female Intersex Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Is this spouse/partner employed or self-employed? Yes (employed) Yes (self-employed) No Name of Employer/Business Annual Income Address of Employer/Business Address 1 Address 2 City State/Province Zip/Postal Code Country How long has he/she worked there? Does he/she have a lawyer? Yes No Name of Lawyer First Name Last Name Is your matter in court? Yes No Is yes, when is the next court date? MM DD YYYY if yes, where will the next court proceeding take place? Do you have a copy of the most recent court order? If yes, please email a copy to bkold@koldlaw.com after you submit this form. Yes No Children Information How many children do you have? Where do the children live? Who are the children's parents? Child 1 Name First Name Last Name Child 1 Date of Birth MM DD YYYY Child 1 Sex Male Female Intersex Child 2 Name First Name Last Name Child 2 Date of Birth MM DD YYYY Child 2 Sex Male Female Intersex Child 3 Name First Name Last Name Child 3 Date of Birth MM DD YYYY Child 3 Sex Male Female Intersex Child 4 Name First Name Last Name Child 4 Date of Birth MM DD YYYY Child 4 Sex Male Female Intersex Child 5 Name First Name Last Name Child 5 Date of Birth MM DD YYYY Child 5 Sex Male Female Intersex Main Concerns Concern 1 Concern 2 Concern 3 Comments/Additional Information END We aim to get back to you within 48 hours. Thank you!