Section I - Personal &
Contact Information:
Note: All information put in Court documents becomes public
record. If you have information you wish to keep private then please
inform us of that when we call for your consultation.
Name (first, m.i., last)
Cell phone
email
Work phone
Home phone
Mailing
address:
Street
Apt.
City
State Zip
Date of birth
(mm/dd/yyyy)
Social Sec. No.
How did you 1st hear about us? Web site Yellow pages Referral I am a previous client
Billboard Other
If you where referred, who
referred you?
Section 2 - Other Party's Contact
Information:
Name (first, m.i., last)
Cell phone
Work phone
Home phone
Mailing or
serveable address:
Street
Apt.
City
State Zip
Date of birth
(mm/dd/yyyy)
Social Sec. No.
Section 3- Child information
Name of child(ren): First,
M.I. Last
Child #1
child lives with
Mother
Father
Child is
Male
Female
Child #2
child lives with
Mother
Father
Child is
Male
Female
Child #3
child lives with
Mother
Father
Child is
Male
Female
Child #4
child lives with
Mother
Father
Child is
Male
Female
Dates of birth for each child (mm/dd/yyyy)
Child #1
Child #2
Child #3
Child #4
Places of birth for each child
(city and state)
Child #1
Child #2
Child #3
Child #4
Social Security Numbers of each
child.
Child #1
Child #2
Child #3
Child #4
Section 4 - Jurisdiction Information
Check
all that apply: Reason why you want to file this case in Arizona
Other party lives in Arizona.
Other party will be served in Arizona.
The other party has agreed to have case heared in Arizona and file papers
in Arizona
The other party lived in Arizona with the child at some point in time.
The other party lived in Arizona and provided pre-birth expenses or support
for the child.
The child lives in Arizona as a result of the acts or directions of the
other party.
You and the other party had sexual intercourse in Arizona as a result
of which the child may have been conceived.
The other party signed the Arizona birth certificate for the child.
Section 5
- Paternity Information
The father signed an Affidavit of Paternity.
The father's name is on the birth certificate which is signed by mother
& father.
A DNA test was done that shows that you or the other party is the natural
father of the child.
Both mother and father were not married to each other at anytime during
the ten months before the birth of the child.
Both mother and father were not living together but had sexual intercourse
at the probable date of conception of the child. The mother did not have
sexual intercourse with anyone else in which the child could have been
conceived.
Section 6
- Paternity Information (cont)
Check
only one box
We do NOT have an order of paternity
We do have an order of paternity.
If
you do have an order of paternity, what is the date?
If
you do have an order of paternity, what is the name of the court it is
from?
If
you do have an order of paternity, what is the case number?
Section 7
- Information about Child Support for Child(ren)
Check
only one box
To my knowlege there is no child support order for the child and
the court should order child support in this case.
An order for child support is established and does not need to
be changed.
An order for child support is established and does need to be changed.
Section 8
- Financial Information
Based upon the figures
below. Discount Divorce will calculate the child support as per Arizona Child
Support Guidelines as required by law. Ariz.Rev.Stat.
25-320.
Note:
If you and
the other party have agreed upon a child support amount please let us know when
we contact you.
Father's gross monthly income: $
Mother's gross monthly income:$
Day care cost (if any) $
Who pays for this?
Mother
Father
Medical insurance premium (if any) $
Who pays for this?
Mother
Father
What percentage of uninsured medical
expense will you be responsible for?
%
What percentage of visitation travel related expenses will you be responsible
for?
%
Does either you or the other party
have minor children residing with them from another relationship?
No
Yes
If, yes list their names, dates of
birth, and who they live with (myself or other party)
Employment information of NON-Custodial
Parent:
Employer
or
Unemployed or
Self-Employed
Address
Street, City, State, & Zip Code
Section
9- Custody
Who will have PHYSICAL custody?
Mother
Father
Both parents (shared or split custody)
What
type of LEGAL custody?
Shared - Child(ren) will reside with both parents equal amount of time.
Joint - Both parents have equal decision making power but the child will
primarly live with the parent with PHYSICAL custody.
Sole - The parent with PHYSICAL custody will make all decisions.
Split - One or more of the children will reside with me and the other
parent.
Type
of Visitation:
Standard - Everyother weekend and shared holidays.
Supervised - Parent is a danger or flight risk.
None - Parent is EXTREME danger.
If
Supervised visitation was checked above, then why do you want supervised
visitation? Check all that apply:
Drug abuse
Alcohol abuse
Anger Management Issues and/or
Flight risk (parent will run off with the children)
Section
10- Address of the Child(ren)
List
all address or major cross roads for where the child(ren) resided for
the last 5 years. Please include month and year. If more address
are applicable then please list them below in Section 12 - Other information
or comments
Example: 3 East Oak, Phoenix, AZ from 03/05 to 07/07
with mother
19th ave. & Bell Rd., Phoenix, AZ from 03/05 to 07/07
with mother
from
to present with
Mother
Father
Both
from
to
with
Mother
Father
Both
from
to
with
Mother
Father
Both
from
to
with
Mother
Father
Both
from
to
with
Mother
Father
Both
Section 11 - Process Service
We
must provide the other party a copy of the legal documents AFTER they
have been filed with the Court. What is the single best way to do
this?
They will come into your office and sign them.
I will take
the other person a copy of the documents.
Send the documents
by certified mail.
They will not sign anything. They must be served by a
Process Server.
I do not know
the whereabouts of the other person.
If you stated you do NOT know
the whereabouts of the other person, then when was the last time you
seen them? (mm/yyyy)
Section 12 -Other
information or comments
Section
13 -Payment Options
Discount
Divorce will immediately begin work on your case as soon as your initial
phone consultation is complete and your payment is received.
Discount
Divorce will call you between the hours of 9AM and 5PM, Monday thru Friday.
What
is the best time to reach you at during those hours?
Payment Options
Choose Option
Option
below.
All
information is kept private and is secured through SSL 128-bit (secure socket
layer) encryption
After
payment option is chosen please click the
submit button
below and your questionnaire will be sent to us.
Service Agreement:
