Fill and Sign the Final Divorce Forms with Children Tennessee Administrative

DOMESTIC RELATIONS INTERVIEW FORM (For Divorce or Separation)PERSONAL INFORMATION CLIENT:First Name Middle and/or Maiden NameLast NameStreet Address CityStateZip CodeHow long as he/she lived at this address?How long as he/she lived in this State?County of Residence? How long has he/she lived in this County? Home Telephone: ___________________________ Work Telephone: Employer and Address: Income = $________________/________________Job Title or Position: How far did he/she get in school? Date and Place of Birth: Social Security Number: Driver’s License Number: _________________________ State: ADVERSE PARTY (Client’s Spouse)First NameMiddle and/or Maiden NameLast NameStreet Address City StateZip CodeHow long as he/she lived at this address?How long as he/she lived in this State?County of Residence? How long has he/she lived in this County? Home Telephone: ___________________________ Work Telephone: Employer and Address: Income = $________________/________________Job Title or Position: How far did he/she get in school? Date and Place of Birth: Social Security Number: Driver’s License Number: _________________________ State: MARRIAGE INFORMATION Date of ceremony of present marriage? Place of ceremony of present marriage? Have you or your spouse ever been married before? _________________ If so, how many times? You: ______________ Your Spouse: If either have been previously married, how and when were the marriages terminated (divorce, death, etc.)? Date parties separated: Last address at which client and spouse lived together as husband and wife?Street Address City StateZip CodeNames and Ages of all children adopted by client and spouse or which client or spouse have custody of from a previous marriage: DIVORCE TERMS Is this a contested or uncontested divorce? State briefly the facts causing client to want a divorce? Grounds for wanting a divorce (incompatibility; imprisonment, physical cruelty, desertion, adultery, insanity, etc.): Has client given up hope of getting back together? Preference as to custody of children: Visitation desired (reasonable or special times) ALIMONY AND CHILD SUPPORT:Child Support of $______________________ per Alimony of $______________________per First payment is due on and subsequent payments are due on thereafter.It is desirable in many instances to have the husband agree to pay for life insurance in an amount sufficient to guarantee that child support or alimony will continue even after his death. If client desires this, indicate below, giving the insurance company name, policy number, policy face value, and premium rate for each policy to be transferred or put in trust: Who is to be allowed to claim the exemption for which child, for income tax purposes? Who is to pay for medical expenses of the child(ren) which are larger than normal (such as braces, hospital stays, therapy for a long period, etc.)? If client desires such a provision, state the terms below:_______________________________________% of all medical and dental bills in excess of $_________________________ per year per child.Will either party voluntarily continue his or her group coverage on the child(ren)?If so, which one? ________________________ If not, should we seek this as part of what we ask the Court to order? (From whom) List all property of the parties (and value of each item):Real Estate: Personal Property (autos, furniture, boats, etc.): Bank Accounts or Credit Union Accounts: Annuities, I.R.A.’s, Retirement Plans, Stocks, Bonds, Certificates of Deposit, etc.:Special Items (coin collections, gold or silver, jewelry, antiques, etc.): PERSON(S) with client at time of interview: Initial Interview Date: Length of Initial Interview: ___________________________________ hr___. DEADLINES: (1)Client and/or spouse to sign papers (2)File answer to complaint (3) File Summons and Complaint Fee agreed upon: $__________________________________________ Retainer Contract Signed: ___________________________ Money Received = $_______________________ (Receipt #_______________ Given)_______________________________Attorney’s Signature/Initials