Family law
MOLLYMOONNY
CLIENT INTERVIEW SHEET
Date: ___________________
Lawyer: ___________________ Referred by: _____________
Hourly Rates: ___________________
Retainer: ___________________
Legal Assistant: ___________________
Client Information
Client’s Full Name: ____________________________________________
Present Address: ____________________________________________
____________________________________________
Mailing Address: ____________________________________________
(If different from above) ___________________________________________
E-mail Address: ___________________________________________
Home Phone: _______________ Work Phone: ______________
Fax: _____________ Cell (or other contact):___________
Date of Birth: ____________________ Present Age: __________
Place of Birth: ___________________________________________
Surname at Birth: _________________________________________________
Surname Before this Marriage: _________________________________
Marital Status at the Time of Marriage: Single__ Widowed__ Divorced__
Occupation: _____________________________________________
Employer’s Name and Address: _________________________________
_____________________________________________________________________
How Long at that Employer? _______________________________________
Gross Annual Income: $___________
Frequency of Payment: Bi-Weekly ____ Bi-Monthly: ___ Monthly: ___
Total Income on Last Tax Return: $______________
Net Taxable Income on Last Tax Return: $___________
Occupation at Marriage: _______________________________________
Do You Have a Valid Will: _______________________________________
If So, Who Are the Beneficiaries: _________________________________
Who Is the Executor/Executrix: _________________________________
Do You Want to Change Your Will: _____________________________
If your matter is against an ex-spouse and you have a new spouse, do mention your current spouse’s name and date of birth:
Name: __________________________________________________________________
Date of Birth: ____________________________________________________________
Information about Your Spouse (Opposing Party)
Spouse’s Full Name: ____________________________________________
Spouse’s Present Address: ______________________________________
____________________________________________________________________
Spouse’s Home Phone: _____________ Work Phone: ______________
Spouse’s Date of Birth: _____________________Present Age: ______
Place of Birth: _________________________________________________
Surname at Birth: ________________________________________________
Surname Before This Marriage: ________________________________
Marital Status at Time of Marriage: Single: ___Widowed: ___Divorced: ___
Occupation: __________________________________________________
Employer’s Name and Address: ________________________________
____________________________________________________________________
How Long at That Employer? _____________________
Gross Annual Income: $______________
Frequency of Payment: Bi-Weekly: __ Bi-Monthly: __ Monthly: __
Total Income on Last Tax Return: $___________________________
Net Taxable Income on Last Tax Return: $____________________
Spouse’s Occupation at Marriage: _____________________________
Do You Know That Marriage Counseling, Guidance Facilities, and Mediation Services are Available to You? Yes: ___ No: ___
Children
Full Name: Birth Date and Current AGE: Gender:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Do Any of Your Children Have Special Needs: Yes: ___ No: ___
If Yes, Explain: ________________________________________________________________________
________________________________________________________________________
Proposal for Parenting Arrangements for Children
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Proposal for Child Support:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Other Expenses for Children:
Child Care Expenses: _______________________________________________
Medical/Dental Insurance Premiums: ______________________________
Health-Related Expenses that Exceed Insurance: ________________
Extraordinary Expenses for Education: __________________________
Post-Secondary Education: ________________________________________
Extraordinary Expenses for Extracurricular Activities (List by Individual Activity):
_____________________________________ $_____________________________
_____________________________________ $_____________________________
_____________________________________ $_____________________________
Life Insurance
Do You Have Life Insurance? ________________________________________
Death Benefit Payable ________________________________________
Is There a Cash Surrender Value: _____________________________
Does Your Spouse Have Life Insurance? _____________________________
Death Benefit Payable ________________________________________
Is There a Cash Surrender Value: _____________________________
Matrimonial Home |
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Address: |
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In Whose Name: |
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(1) MKT Value |
(2) 1st Mortgage |
(3) 2nd Mortgage |
Equity |
|
(Balance Owing) |
(Balance Owing) |
1-(2+3) |
$ |
$ |
$ |
$ |
Other Real Estate |
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Address: |
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In Whose Name: |
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(1) MKT Value |
(2) 1st Mortgage |
(3) 2nd Mortgage |
Equity |
|
(Balance) |
(Balance) |
1-(2+3) |
$ |
$ |
$ |
$ |
Address: |
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In Whose Name: |
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(1) MKT Value |
(2) 1st Mortgage |
(3) 2nd Mortgage |
Equity |
|
(Balance) |
(Balance) |
1-(2+3) |
$ |
$ |
$ |
$ |
Vehicles: (include Motor homes, Motorcycles, Snowmobiles, etc.)
Year: |
Make/Model: |
Value: $ |
Debts: $ |
Who drives it? |
Registered in whose name? |
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Year: |
Make/Model: |
Value: $ |
Debts: $ |
Who drives it? |
Registered in whose name? |
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Year: |
Make/Model: |
Value: $ |
Debts: $ |
Who drives it? |
Registered in whose name? |
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Year: |
Make/Model: |
Value: $ |
Debts: $ |
Who drives it? |
Registered in whose name? |
Registered Retirement Savings Plans:
Current value: |
$ |
In whose name? |
|
Where held? |
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Current value: |
$ |
In whose name? |
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Where held? |
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Current value: |
$ |
In whose name? |
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Where held? |
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Current value: |
$ |
In whose name? |
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Where held? |
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Who Is the Beneficiary of RSPs: __________________________________________
Bank Accounts:
In whose name? |
|
Value: |
$ |
Where held? |
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In whose name? |
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Value: |
$ |
Where held? |
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In whose name? |
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Value: |
$ |
Where held? |
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In whose name? |
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Value: |
$ |
Where held? |
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Other Investments/Savings/Term Deposits:
In whose name? |
|
Value: |
$ |
Where held? |
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In whose name? |
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Value: |
$ |
Where held? |
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In whose name? |
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Value: |
$ |
Where held? |
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In whose name? |
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Value: |
$ |
Where held? |
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Your Employment Pensions:
Employer: ____________________________________________________________
How Long Have You Been Contributing: ___________________________
Your Spouse’s Employment Pensions:
Employer: ___________________________________________________________
How Long Have They Been Contributing: __________________________
Business/Corporate Interest:
Company or Business Name:
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Who are Shareholders/Owners and Percentage Owned: |
Who are Officers/Directors? |
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Other Assets:
Description: |
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Owned By: |
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Value: |
$ |
Description: |
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Owned By: |
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Value: |
$ |
Description: |
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Owned By: |
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Value: |
$ |
Description: |
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Owned By: |
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Value: |
$ |
Description: |
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Owned By: |
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Value: |
$ |
Debts:
Creditor: |
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Balance Owing: |
$ |
Security: |
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Monthly Payment: |
$ |
Creditor: |
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Balance Owing: |
$ |
Security: |
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Monthly Payment: |
$ |
Creditor: |
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Balance Owing: |
$ |
Security: |
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Monthly Payment: |
$ |
Creditor: |
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Balance Owing: |
$ |
Security: |
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Monthly Payment: |
$ |
Creditor: |
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Balance Owing: |
$ |
Security: |
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Monthly Payment: |
$ |
What Assets and Liabilities Did You Have When You Got Married (And/Or Started Living Together) and What Were They Worth at that Time: _____________________________________________________________
What Assets and Liabilities did Your Spouse have When You Got Married (And/Or Started Living Together) and What Were They Worth at that Time: _____________________________________________________________
Did Either You or Your Spouse Receive Any Gifts or Inheritances from Another Person or Receive a Trust, Award, or Insurance Settlement since You Started Living Together.
If so, Describe it, its Value, When Was it Received, and Advise What Was Done With the Gift/Inheritance /Other Payment:
Do You Have Any Reason to Claim an Unequal Division of Property Acquired During Your Marriage?
________________________________________________________________________
________________________________________________________________________
Has Any Property Been Sold or Transferred to Anyone in the Last Year?
________________________________________________________________________
________________________________________________________________________
If You Were to Look at a Year from Today, What Has to Happen in Your Personal and Business Life for You to Be Satisfied with Your Progress?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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Family Law: Client Interview Sheet
© 2012 South University