Legal Family Information Form

LEGAL FAMILY INFORMATION FORM

This Legal Family Information Form (the "Form") is executed on by and between Client Name: (Declarant) and Recipient Name: (Recipient).

RECITALS

WHEREAS, Declarant possesses family, household, and personal information concerning certain individuals related to Declarant that is material to ongoing legal matters, custody, guardianship, estate, or other family law proceedings;

WHEREAS, Recipient requires accurate, complete family information to prepare pleadings, to evaluate legal positions, to serve necessary notices, and to comply with court and administrative obligations; and

WHEREAS, the parties desire to set forth the information provided by Declarant, the permitted uses of such information, and assurances regarding its accuracy and confidentiality.

NOW, THEREFORE

In consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Form, the following terms shall have the meanings set forth below:

"Family Member" means any spouse, domestic partner, parent, child, sibling, step-relative, guardian, or other person with a familial relationship to Declarant whose information is provided pursuant to this Form.

"Court Order" means any existing custody, guardianship, support, protection, or other judicial or administrative order affecting a Family Member that is identified in this Form.

2. FAMILY MEMBER INFORMATION

Declarant shall provide the following information for each Family Member. If additional space is required, attach supplemental pages and mark each attachment with the Family Member number referenced below.

Family Member 1

Family Member 2

Family Member 3 (optional)

3. COURT ORDERS AND PENDING LITIGATION

Are there existing court orders or pending litigation involving any Family Member that materially affect custody, support, visitation, guardianship, or placement? Yes No

4. EMERGENCY CONTACT / NEXT OF KIN

5. CONSENT TO USE AND DISCLOSURE

Declarant authorizes Recipient, and Recipient's agents, employees, and retained professionals, to use, reproduce, store, and disclose the family information provided in this Form to the extent reasonably necessary for legal representation, preparation of pleadings, court filings, mediation, settlement discussions, and compliance with court or administrative obligations. Such disclosures may include transmission to courts, opposing counsel, mediators, social services, child support agencies, and court-appointed professionals when required by law or ordered by a tribunal.

Declarant acknowledges that information submitted to courts or government agencies may become part of the public record in whole or in part and that Recipient will use reasonable efforts to limit disclosures to those necessary for legitimate legal purposes.

6. REPRESENTATIONS, WARRANTIES AND INDEMNITY

Declarant represents and warrants that, to the best of Declarant's knowledge after reasonable inquiry, the information provided in this Form is true, accurate, and complete. Declarant understands that knowingly making a false statement in this Form may subject Declarant to civil liability and could constitute perjury or other sanctions under applicable law.

Declarant agrees to indemnify and hold harmless Recipient from and against any losses, liabilities, costs, or expenses (including reasonable attorneys' fees) arising out of any material inaccuracy in the information provided by Declarant, except to the extent such losses result from Recipient's gross negligence or willful misconduct.

7. RETENTION, SECURITY AND CONFIDENTIALITY

Recipient shall maintain reasonable administrative, technical, and physical safeguards to protect the confidentiality and integrity of the family information provided. Recipient may retain copies of the information in electronic and physical files as required by record retention policies or applicable law.

Notwithstanding the foregoing, Recipient may disclose information if required by law, court order, or in response to valid subpoena or governmental request; Recipient shall, where permitted, provide notice to Declarant prior to such compelled disclosure.

8. NOTICES

Notices under this Form shall be in writing and delivered to the addresses below. Notices are effective upon personal delivery, one business day after delivery by nationally recognized overnight courier, or three business days after deposit in the U.S. mail, postage prepaid.

9. AMENDMENTS; WAIVER; COUNTERPARTS

This Form may be amended only by a written instrument signed by both parties. No waiver of any breach or default shall be deemed a waiver of any subsequent breach or default. This Form may be executed in counterparts, each of which is an original and all of which together constitute one instrument.

10. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Form shall be governed by and construed in accordance with the laws of the State of without regard to conflict-of-laws principles.

This Form constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous oral and written agreements and understandings.

If any provision of this Form is determined by a court of competent jurisdiction to be invalid, illegal or unenforceable, such provision shall be severed and the remaining provisions shall remain in full force and effect.

11. ATTACHMENTS

12. CERTIFICATION

By signing below, Declarant certifies under penalty of perjury that the information provided in this Form and any attachments is true, correct and complete to the best of Declarant's knowledge. Declarant understands that Recipient will rely on this information in representing Declarant and in making disclosures as required by law or court order.

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