QuestTwo

PLEASE BE CERTAIN TO COMPLETE ALL THE INFORMATION.

THIS INFORMATION IS ALL VERY IMPORTANT.

Legal Alternatives, 6442 SE 91st Ave. Portland, Or 97266

Please email or call with any questions. We are here to help.

divorce@usa.com

(503) 772-5295

Your complete legal name:_______________________________________________________________

PHONE NUMBER:______________________ Drivers License number:________________________

E-mail address:__________________________________(For our communication)

Former and or/maiden names, if any: ___________________________________________________

CURRENT ADDRESS: ________________________________________City:_______________________

STATE:_________________ZIP CODE:___________________

County (within the state) of residence: _________________________________

Your age:______________Date of birth:__________________

Social Security number:_______________________________

SPOUSES FULL LEGAL NAME:____________________________________________________________

Spouses phone number: ______________________

Spouses former and/or maiden names, if any_____________________________________________

Drivers license number (if known)____________________

Current address_______________________________________________City:_______________________

STATE:__________________ZIP CODE:__________________

Spouse's County (within the state) of residence:________________________

Spouse's age:_____________Date of birth:___________________

Spouse's Social Security number:_________________________

Does either party wish to restore a former name?

If so person? Wife/Husband, changed to:_________________________________

Date of marriage: Month__________________Day___________Year____________

City and State of marriage:________________________________________________

Are you presently separated (living apart)?:________________________________

If so approx. date of separation:____________________________________________

Is the wife pregnant?: No:___________Yes:__________

If so when is the child due?: ______________________

Is the husband the father of the child?:__________________

How many children have been born to this marriage?:___________________________

NAME, DATE OF BIRTH, SOCIAL SECURITY NUMBER:

Child's name:___________________________ Birthdate:___/___/____ SSN: ____-___-_____

Who shall have physical custody of the children?: _______________________________

Do you wish to have joint or split custody?: Yes_______N0________

(This must be agreeable to both parents).

If there is joint custody, what percent of time will the child spend with each parent?

Mother:_____________% Father:_____________%

If split custody, which child(ren) will live with the mother?: ________________________

______________________________________________________________________________________

Which child(ren) will live with the father?:___________________________________________

______________________________________________________________________________________

Who have the children lived with for the last 6 months?:____________________________

PARENTING TIME/VISITATION SHOULD BE:

(Please be specific with times, days of week, holidays and birthdays.)

______________________________________________________________________________________

Which holidays will the children spend with the father?:____________________________

______________________________________________________________________________________

Which holidays will the children spend with the mother?: __________________________

______________________________________________________________________________________

Will there be any summer or vacation visitation for the non-custodial parent?

If so, explain:

______________________________________________________________________________________

Who will provide medical insurance for the children?

Father:___________ Mother: __________ Both:________

Who will pay deductibles and uninsured costs?

Father:____________ Mother:___________ Both:________

Who will maintain life insurance with the child as beneficiary?

Father: ______Mother: ________Both: __________.

WILL THIS BE A CO-PETITION DIVORCE? (both parties agree to sign).

Yes:___________ No__________.

or will this be a:

SINGLE PETITION DIVORCE? (one party must have the other party served.

You do not expect the other party to sign divorce papers voluntarily).

Yes:___________ No:__________.

Below, list the property that should be awarded to each spouse.

The Husband should be awarded the following property:__________________________________

___________________________________________________________________________________________

The Wife should be awarded the following property:_______________________________

___________________________________________________________________________________________

(PLEASE REMEMBER TO LIST ADDRESSES FOR REAL ESTATE TO BE AWARDED, IF ANY)

OUTSTANDING DEBTS TO BE PAID BY EACH SPOUSE:

THE HUSBAND should pay the following bills:

___________________________________________________________________________________________

The Wife should pay the following bills:

___________________________________________________________________________________________

How long have you been a resident of your state?: _____years, ____months

How long have you lived in your current county?: _____years, ____months

IMPORTANT INFORMATION REQUIRED IF CHILDREN ARE INVOLVED:

This page must be completed if there are minor children born or adopted to this marriage.

Husband's employer:______________________________________________________________________

Complete address of employer: ___________________________________________________________

___________________________________________________________________________________________

Gross monthly pay (before taxes): $_________________________

Husbands monthly take home pay (after taxes): $___________

Wife's employer___________________________________________________________________________

Complete address of employer: ___________________________________________________________

___________________________________________________________________________________________

Wife's gross monthly pay(before taxes)

$__________

Wife's monthly take home pay(after taxes)

$________

Does anyone recieve Alimony from a previous marriage?

If so who:__________. How much per month? $_______________

Does either party wish to receive Spousal Support? Yes______ No__________

If so, who:_________. How much per month? $______________, and for how long?_____________

(You must list a specific number of months or years.)

Does anyone recieve child support from a previous marriage or relationship?

If so, who?:_______________and how much per month?:______________________

Does anyone pay child support from a previous marriage or relationship?

If so, who?:__________________and how much per month?:________________

Are there any day care costs paid out of pocket relating to the children of this marriage?

If so, how much?: $___________who pays?:___________

Is there, or will there be, health insurance coverage for the children of this marriage?__________

If so, what is the cost each month? $____________________

Who pays or will be paying?__________________________

Does either spouse recieve welfare? If so, who/Father_________or/mother____________

How much per month? $___________.

Where did you hear about our service?

Internet:__________Printed ad:____________Referral:__________Other:____________________

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I (we) hereby request that Legal Alternatives prepare our uncontested divorce.

I (we) understand that Legal Alternatives employees are not lawyers, they are independant paralegals.

We agree and attest that no legal advice has been given to us.

We have chosen of our own free will to have Legal Alternatives fully prepare these documents for a fee.

We have selected the forms and provided all the information used in our divorce documents.

Signed:_____________________________________________

Date:_______________________________________________

Signed:_____________________________________________

Date:_______________________________________________

After completing this form, please return signed questionnaire and our fee to:

Please include payment or make arrangements by phone!

(503) 772-5295

Legal Alternatives, 6442 SE 91st Ave. Portland, Or 97266