DIVORCE QUESTIONNAIRE with MINOR CHILDREN

616.776.3902 info@vandykenlaw.com
Stacy L. Van Dyken P.C. 161 Ottawa Avenue NW, Grand Rapids Michigan
Mon-Fri 9.00 - 17.00 Sat : 10.00 - 14.00 Sunday : Close

Stacy L. Van Dyken, P.C. Attorney at Law

161 Ottawa Avenue, NW Suite 404

Grand Rapids, MI 49503

- CONFIDENTIAL -

Date filled out:

Invalid Input

I. PLEASE ANSWER THESE QUESTIONS ABOUT YOURSELF

Name: First, Middle, Last

Invalid Input

Birthdate(*)

Invalid Input

State of Birthplace(*)

Invalid Input

Mailing Address

Invalid Input

Home Address(if different from above)

Invalid Input

Home Telephone Number

Invalid Input

Social Security Number

Invalid Input

City, State, Zip(*)

Invalid Input

Driver License Number

Invalid Input

Eye Color

Invalid Input

Hair color

Invalid Input

Height

Invalid Input

Weight

Invalid Input

Race

Invalid Input

Scars, tattoos, etc.

Invalid Input

Other names by which you are or have been known:

Invalid Input

Resident of for and of Michigan for. County Years Your Employer How long?

Invalid Input

Work Address

Invalid Input

Shift

Invalid Input

Phone(*)

Invalid Input

Are you able to work?

YesNo Invalid Input

Occupation:

Invalid Input

Is it okay for us to call you at work?

YesNo Invalid Input

Pay period: (Weekly, bi-weekly, monthly) (Circle one)

Gross $

Invalid Input

Net $

Invalid Input

Do you typically work overtime?

YesNo Invalid Input

If so, how often and how many hours?

Invalid Input

Do you make tips, bonuses, or commissions?

YesNo Invalid Input

II. PLEASE ANSWER THESE QUESTIONS ABOUT YOUR SPOUSE

Name: First, Middle, Last(*)

Invalid Input

Birthdate

Invalid Input

State of Birthplace:

Invalid Input

Mailing Address

Invalid Input

Home Address (if different from above)

Invalid Input

City, State, Zip

Invalid Input

Home Telephone Number

Invalid Input

Social Security Number

Invalid Input

Driver License Number

Invalid Input

Eye Color

Invalid Input

Hair color

Invalid Input

Height

Invalid Input

Weight

Invalid Input

Race

Invalid Input

Scars, tattoos, etc.

Invalid Input

Other names by which your spouse has or has been known:

Invalid Input

Resident of

Invalid Input

for

Invalid Input

and of Michigan for

Invalid Input

Your Spouse’s Employer

Invalid Input

How long?

Invalid Input

Work Address

Invalid Input

Shift

Invalid Input

Phone(*)

Invalid Input

Is your spouse able to work?

YesNo Invalid Input

Spouse’s Occupation:

Invalid Input

Is it okay for us to call your spouse at work?

YesNo Invalid Input

Pay period:(Weekly, bi-weekly, monthly) (Circle one)

Gross $

Invalid Input

Net $

Invalid Input

When was it filed? Month

Invalid Input

Year

Invalid Input

County

Invalid Input

State

Invalid Input

Date of marriage:

Invalid Input

Married at:

Invalid Input

Date of separation: (if already separated)

Invalid Input

Have you previously separated and gotten back together?

Invalid Input

Wife’s maiden name:

Invalid Input

Seeking maiden name restored:

Invalid Input

When?

Invalid Input

and/or previous name

Invalid Input

Seeking new name?

Invalid Input

Have you or your spouse ever been married before?

YesNo Invalid Input

If yes, did the marriage(s) end by divorce or death?

You:

1st marriage

Invalid Input

How marriage ended:

Invalid Input

2nd marriage

Invalid Input

How marriage ended:

Invalid Input

what year

Invalid Input

what year

Invalid Input

Spouse:

1st marriage

Invalid Input

How marriage ended:

Invalid Input

2nd marriage

Invalid Input

How marriage ended:

Invalid Input

what year

Invalid Input

what year

Invalid Input

Is wife pregnant now?

YesNo Invalid Input

If yes, due when?

Invalid Input

If yes, is this child of this marriage?

YesNo Invalid Input

If not, father’s name, address and details:

Invalid Input

Has your spouse ever physically or emotionally abused you and/or your child(ren)? If yes, please give details of such abuse and the dates this abuse occurred. (Use back of this form for additional space)

Invalid Input

Have you or your spouse ever obtained a Personal Protection Order (PPO)?

YesNo Invalid Input

Please give details:

Invalid Input

Have you or your spouse ever been involved in any extra-marital relationships?

YesNo Invalid Input

Please explain:

Invalid Input

Have you or your spouse ever had a problem with alcohol, marijuana, cocaine or other drugs?

Invalid Input

Please explain:

Invalid Input

Have you or your spouse ever been accused or convicted of any crime(s)?

Invalid Input

Please explain giving dates and nature of crimes(s):

Invalid Input

V. PLEASE ANSWER THE FOLLOWING QUESTIONS REGARDING YOUR CHILD(REN)

A.How many children were born to, or adopted by, you and your spouse?

Invalid Input

Full Name

Invalid Input

Full Name

Invalid Input

Full Name

Invalid Input

Full Name

Invalid Input

Full Name

Invalid Input

Birthdate

Invalid Input

Birthdate

Invalid Input

Birthdate

Invalid Input

Birthdate

Invalid Input

Birthdate

Invalid Input

Age

Invalid Input

Age

Invalid Input

Age

Invalid Input

Age

Invalid Input

Age

Invalid Input

B. List the addresses where the minor children have lived for the last five (5) years and the person in charge of their care and their relationship to you:

Address

Invalid Input

Address

Invalid Input

Address

Invalid Input

Address

Invalid Input

Address

Invalid Input

Years

Invalid Input

Years

Invalid Input

Years

Invalid Input

Years

Invalid Input

Years

Invalid Input

Person in charge

Invalid Input

Person in charge

Invalid Input

Person in charge

Invalid Input

Person in charge

Invalid Input

Person in charge

Invalid Input

Relationship to you

Invalid Input

Relationship to you

Invalid Input

Relationship to you

Invalid Input

Relationship to you

Invalid Input

Relationship to you

Invalid Input

How much per week?

Invalid Input

How many weeks per year?

Invalid Input

Who is your child care provider?

Invalid Input

I. Who will claim income tax exemption?

Name of child

Invalid Input

Name of child

Invalid Input

Name of child

Invalid Input

Name of child

Invalid Input

Who will claim

Invalid Input

Who will claim

Invalid Input

Who will claim

Invalid Input

Who will claim

Invalid Input

J. Do either of you have children from a previous relationship/marriage?

Invalid Input

Please state names and ages (even if adults) and who has custody:

Name of child

Invalid Input

Name of child

Invalid Input

Name of child

Invalid Input

Name of child

Invalid Input

Captcha(*)

Invalid Input

Ages

Invalid Input

Ages

Invalid Input

Ages

Invalid Input

Ages

Invalid Input

KEEP IN TOUCH

161 Ottawa Avenue NW, Grand Rapids Michigan
616.776.3902
info@vandykenlaw.com

KEEP IN TOUCH

EXPLORE OUR SITE

UTILITY

LOCATION/DIRECTIONS