1001 Texas Avenue - Suite 500. Houston, TX 77002
Monday - Friday: 8:00am - 5:00pm
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PHONE:
(713) 223-5811
FAX:
(713) 223-1416
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Family Law Form
YOUR INFORMATION
YOUR SPOUSE/EX-SPOUSES INFORMATION, CHILD(REN)’S PARENT
Relationship Info
Children Information
ADDITIONAL INFO
How Did You Hear About Us?
First Name
*
Middle Initial
Last Name
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Maiden Name (If you are a female) OR any other names that you go by or have used
Address
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Is there another address that you would like us to contact you at? (If yes, what is the address)
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Race
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Employer
Job Title
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*
Salary
Length of Employment
May we call you at work?
Yes
No
Other sources of income?
Education
Did not complete high school
High SchoolGED
Some College
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Not sure
Spouse’s/Child(ren)’s Parent’s Full Name
Maiden Name (If Female)
Address
Apt Number
City
State
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Country of Birth
Please select
Afghanistan
Albania
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Austria
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Bahrain
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Belarus
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Belize
Benin
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Brazil
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Bulgaria
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Burundi
Cambodia
Cameroon
Canada
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Chad
Chile
China
Colombia
Comoros
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Croatia
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Denmark
Djibouti
Dominica
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East Timor
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Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
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Greenland
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Guinea
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Guyana
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Iraq
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Japan
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Laos
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Myanmar
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Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
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Tuvalu
Uganda
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Uruguay
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Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
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Zimbabwe
Social Security Number
Date of Birth
Drivers License Number
State
Please select
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Race
Please select
American Inian
Asian
Black or African American
Hispanic or Latino
White or Caucasian
Employer
Employer Address
Job Title
Work Phone
Work Fax
Email
Salary/Income
Other Sources of Income
Date of Marriage
Are you now separated from your spouse?
Yes
No
Date of Separation
Place of Marriage
State
Please select
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Country
Please select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Have you or your spouse/ex-spouse lived in Texas for the last six months?
Yes
No
If not, where have you lived?
What county have you lived in for the last 90 days?
Are both you and your spouse a United State Resident or Citizen?
Yes
No
Have your or your spouse/ex-spouse ever filed for divorce? If so, when and where?
Does your spouse or ex-spouse have an attorney? If so, who (name and phone)?
Have you ever been married before? If so, how many times?
Do either you or spouse already have children where a duty of support is owed? (Please list names, genders, and dates of birth for each.
Where and with whom do these children live?
Do you pay/receive child support? If so how much?
Does your spouse pay/receive child support? If so how much?
Are you or your spouse currently expecting a child?
Yes
No
Has there been any child born since the date of marriage which whom the husband is not the father?
Yes
No
Are there any children under 18 years of age born to or adopted of the marriage?
Yes
No
Do you have children with your spouse/ex-spouse?
Yes
No
Spouse’s monthly earnings?
Is your spouse willing to pay child support?
Yes
No
If so, how much?
If not, why not?
Are the children covered by health insurance?
Yes
No
Which parent provides health insurance for the children?
Mother
Father
Other
Insurance Company Name?
Policy Number
Monthly Premium Amount
Child #1
Child's Full Name
Gender
Male
Female
Date of Birth
Place of Birth
Social Security Number
Does Child Live with Father or Mother?
Mother
Father
Other
Child #2
Child's Full Name
Gender
Male
Female
Date of Birth
Place of Birth
Social Security Number
Does Child Live with Father or Mother?
Mother
Father
Other
Child #3
Child's Full Name
Gender
Male
Female
Date of Birth
Place of Birth
Social Security Number
Does Child Live with Father or Mother?
Mother
Father
Other
Child #4
Child's Full Name
Gender
Male
Female
Date of Birth
Place of Birth
Social Security Number
Does Child Live with Father or Mother?
Mother
Father
Other
Child #5
Child's Full Name
Gender
Male
Female
Date of Birth
Place of Birth
Social Security Number
Does Child Live with Father or Mother?
Mother
Father
Other
Has a Protective Order already been issued?
Yes
No
If no, would you like to request one? (This is an extra charge)
Yes
No
Who can we contact in case of an emergency?
Address
Phone Number
Are there other legal issues or concerns regarding your case we should be aware of?
*
IMPORTANT ISSUES
Will you or a child suffer harassment, abuse, serious harm, harm to health, or injury if information about your address (or the address of your child), your telephone numbers, the name of your employer, the address where you work, or your driver’s license number and social security number were to be released to the opposing party? (§§ 85.007, 105.006, 152.209(e), TFC)
Yes
No
Has the Office of the Attorney General ever been a party to a suit or an advocate in a suit concerning financial support of one or more of your children?
Yes
No
Has any child in your family been the recipient of TANF (formerly AFDC) or been covered by Medicaid?
Yes
No
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