Custody-Child Support Form | Attorneys in Dothan

Today's Date *

Full Name * Address *

City *

State *

Zip *

County *

Home Phone

Cell Phone *

Date of Birth *

Age *

Social Security Number *

Employer (if applicable)

Employer Phone

May We contact you at work? *

Email *

Preferred method of contact *

How did you hear about us? *

What type of case do you have? * Please write a brief statement explaining the events surrounding this case * What is your major concern regarding your case? * Notes: ------

CURRENT SPOUSE

Client’s Current Spouse’s Name: *

Date of Birth *

OTHER PARTY

Name: * Address *

City *

State *

Zip *

County *

Is address inside City Limits? *

Home Phone

Cell Phone *

Date of Birth: *

Age *

Social Security Number: *

Employer (if applicable):

Employer Phone:

GENERAL INFORMATION

Date of Divorce or Custody Order: *

Place of Order (City)(County)(State): *

CHILD/CHILDREN

CHILD 1

Child’s Name: *

Date of Birth: *

Age *

Social Security Number: *

Gender: *

CHILD 2

Child’s Name:

Date of Birth:

Age

Social Security Number:

Gender:

CHILD 3

Child’s Name:

Date of Birth:

Age

Social Security Number:

Gender:

CHILD 4

Child’s Name:

Date of Birth:

Age

Social Security Number:

Gender:

HISTORY

Name(s) and address(es) of person(s) with whom the child/children have lived with in the past five years:

Name: *

Address: *

------

Name:

Address:

------

Name:

Address:

------

Name:

Address:

INCOME

Information for Calculating Child Support

Father’s Monthly Gross Income: *

Insurance Provided for Child by Father: *

Work-Related Child-Care Expense $ per month paid by Father: * ------

Mother’s Monthly Gross Income: *

Insurance Provided for Child by Mother: *

Work-Related Child-Care Expense $ per month paid by Mother: *

What is your desired outcome in this matter? (i.e. What are your desires regarding custody, visitation, child support, health insurance and other important matters relating to your child?) *

Custody-Child Support Intake Form

Custody-Child Support Intake Form

Please fill out the following Custody-Child Support intake form in its entirety and click submit at the end. This form will be securely sent to us.

CURRENT SPOUSE

OTHER PARTY

GENERAL INFORMATION

CHILD/CHILDREN

CHILD 1

CHILD 2

CHILD 3

CHILD 4

HISTORY

Name(s) and address(es) of person(s) with whom the child/children have lived with in the past five years:

INCOME

Information for Calculating Child Support

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