Revised: 02/14/12

Easy asDivorce Online

-With Children-

 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.

What type of case is this going to be?

*Name  

Home phone Work phone   Cell phone    

*Email                            

Mailing address:

Street    Apt.

City  State  Zip

Date of birth

Social Sec. No.

Who did you speak with from our office prior to completing this questionnaire?

Section 2 - Spouse (Other party's) Contact Information:

*Name   

Home phone Work phone  Cell phone

Mailing or severable address:

Street  Apt.

City  State   Zip

Date of birth  

 Social Sec. No.

Section 3 - Marital Information

Is the wife pregnant?

If yes, what is due date of baby?  

 Date of Marriage?   

City and State of Marriage

 Does wife want to change her name?

If yes, what is the name                               

Section 4 - Division of Assets & Debts

Debts

What debts do you wish to assume?

All debts that are in my name  and/or all debts listed below:

 

 

What debts do you wish the other person to assume?

All debts that are in their name  and/or all debts listed below:

 

 Property

What is community property and sole and separate property?

What property do you want to be awarded?

All property currently in my possession  and/or all property listed below:

 

 

What property do you want the other person to be awarded?

All property currently in their possession   and/or all property listed below:

 

We own a home.  This is what I would like done with your home(s):

 

Section 5- Spousal Maintenance (Alimony)

What is spousal maintenance/ alimony?

     If alimony is to be paid or received, how much is going to be paid?   $   

      If alimony is to be paid or received, for how long?  month(s), or  never ending, or

      I do not know how much to ask for or for how long.

Section 6- Retirement Benefits

Other

 

Section 7- Information Regarding Minor Children:

  Child's Name    
Child #1 
Child #2
Child #3
Child #4
  Date of Birth Place of Birth (City and State) Social Security Number
Child #1

 
Child #2

 
Child #3

 
Child #4

 

 

 

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.

How is child support calculated?

If you and your spouse agree on an amount of child support check this box.

Father's gross monthly income:  $  

Mother's gross monthly income: $

Day care cost (if any) $    

Medical insurance premium (if any) $  

What percentage of uninsured medical expense will you be responsible for? %

      If you leave this blank, then the percentage will be calculated proportionate to both incomes.

What percentage of visitation travel related expenses will you be responsible for?   %

     If you leave this blank, then the percentage will be calculated proportionate to both incomes.

Does either you or your spouse have minor children residing with them from another relationship?

If, yes list their names, dates of birth, and who they live with (myself or my spouse)

 

(Example John Public Doe, 07/30/98)

Employment information of NON-Custodial Parent:

Employer  or  Unemployed or   Self-Employed

Address            

Section 9-  Custody

 Select one:

What are the different types of custody?

What about visitation/parental access?

 Shared custody option not recommended for parents living more than 25 mile apart.

If you selected No visitation you are telling the court that the other parent is an EXTREME Danger to the child(ren).

 If Supervised visitation was checked - 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. 

Example: 3 East Oak, Phoenix, AZ from 03/05 to 07/07 with mother

                                    or

19th Ave. & Bell Rd., Phoenix, AZ from 03/05 to 07/07 with mother    

Address   From   Until    
    Present  
     
     
     
     

  If more address are applicable then please list them below in Section 12 - Other information or comments

Section 11 - Process Service

We must provide your spouse a copy of the legal documents AFTER they have been filed with the Court.  What is the single best way to do this?  Select one:

Option 1 My spouse will come into your office and sign them.

Fee: FREE

Option 2 I will take my spouse a copy of the documents.

Fee: FREE

Option 3 Send the documents by certified mail.

Fee: $25

Option 4 My spouse will not sign anything. They must be served by a Process Server.

Fee: $95 Metro Phoenix / $150 Non-Metro Phoenix

Do I need a Process Server? How does Process Service work?

Option 5 I do not know the whereabouts of my spouse.

Fee: $100

How does Publication / Newspaper Divorce work?

If you stated you do NOT know the whereabouts of your spouse,

then when was the last time you seen them? (Example 05-01-1993)

Section 12 -Other information or comments  

Section 13-Payment

Discount Divorce will immediately begin work on your case as soon as your initial phone consultation is complete and your payment is received.

Pricing and cost information:

Discount Divorce will call you between the hours of 9AM and 4PM, Monday thru Friday.

What is the best time to reach you at during the hours listed above? until on

Payment & Acknowledgement

All costs will be discussed with you in advance, and we will not proceed or charge your card until you instruct us to do so.

Card number requiredNote: You are not obligating yourself financially by submitting this form.

*Number *Exp. Date *Type of Card

Terms of Service

*I acknowledge that I have read the "Terms of Service" and agree and understand them.

*Applicant Name/Signature: All information contained herein is true and correct

*Date (mm/dd/yyyy):