Fill and Sign the Cooper Lawprofessional and Affordable Legal Services for Form

FAMILY LAW CLIENT INFORMATION OUR CLIENT: H – W Date:______________ Client’s home phone:__________________ Client’s work phone:__________________ HUSBAND: Full name:_____________________________ Social Security #___________________________ Address:_________________________________________________________County:______________ Occupation:________________________ Employer:_________________________ Business address:_________________________________________________________________ Level of education:________________ Date of birth:______________________ Married previously? ____________ If so, how did it end?____________________________ Born in what state/country? ____________________ WIFE : Full name:_____________________________ Social Security #___________________________ Wife’s maiden name:_____________________ Does wife want her maiden name restored? ________ Address:_________________________________________________________County:______________ Occupation:________________________ Employer:_________________________ Business address:_________________________________________________________________ Level of education:________________ Date of birth:______________________ Married previously? ____________ If so, how did it end?____________________________ Born in what state/country? ____________________ Children of this marriage? __________ If so, what are their full names and dates of birth? Names: Ages: Dates of birth: 1. 2.3. 4. MARRIAGE INFO: Place of marriage:________________________________ Date of marriage:________________ Address of last matrimonial domicile:______________________________________________________ Date of separation___________________________________ How long have you been a resident of Virginia? ___________________ CHILDREN OF PREVIOUS MARRIAGE: (Indicate if adopted by your current spouse) Names: Ages: Dates of birth: 1. 2.3.4. Do you both own real estate together? __________ If so, provide copy of deed. Additional info:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________