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Domestic Relations Questionnaire

Home » Resources » Forms » Domestic Relations Questionnaire

Domestic Relations Questionnaire

Referred By

Internet

Former Client

Friend

Other

If this attorney has previously represented you, please state the nature of the representation:

I. Personal Data

A. Your Personal Data

Full Name

(Including Maiden Name if Applicable)

Address

Street Address Address Line 2 City State ZIP Code

Phone

Email

SSN

Date of Birth

MM slash DD slash YYYY

Age

Place of Birth

Education Level

Race

Number of Prior Marriages

Number of Children by Prior Marriages(s)

B. Spouse's Personal Data

Full Name

(Including Maiden Name if Applicable)

Address

Street Address Address Line 2 City State ZIP Code

SSN

Date of Birth

MM slash DD slash YYYY

Age

Place of Birth

Education Level

Race

Number of Prior Marriages

Number of Children by Prior Marriages(s)

C. Jurisdiction Informaiton

Where were you maried?

(City and State)

Date of Marriage

MM slash DD slash YYYY

Date of Separation

MM slash DD slash YYYY

Where did you last live together?

(Complete address)

Are either you or your spouse in the military?

Yes

No

If so: what branch?

Rank

Enlistment Date

MM slash DD slash YYYY

Termination Date

MM slash DD slash YYYY

How long have you lived in the Ccmmonwealth of Virginia?

How long has your spouse lived in the Ccmmonwealth of Virginia?

If your spouse is a non - resident, please state his /her complete out of state address

How long has he or she been a non - resident?

II. Children

Please list all children born or adopted of this marriage?

Name

Birth Date

With whom do they reside?

Are there any custoday orders, visitation orders or support orders now in effect?

Do you have any children from a prior marriage?

Yes

No

Does your spouse have children from a prior marriage?

Yes

No

If so, please complete the following, indicating whether the children belong to you or your spouse:

Name

Date of Birth

You or Spouse

Where do the children reside?

Are you or your spouse receiving support for these children?

Yes

No

Amount?

Are you or your spouse paying support for these children?

Yes

No

Amount?

III. Occupation

A. You

Where are you employed?

What is your title or position?

What is your gross salary per month?

What is your Net (after deductions) per month?

What is deducted from your salary?

How often are you paid?

Do you have other benefits such as medical, paid sick leave, stock options, etc?

Yes

No

If so, please state what they are:

B. Spouse

Where is your spouse employed?

What is your spouse’s title or position?

What is your spouse's gross salary per month?

What is your spouse's Net (after deductions) per month?

What is deducted from your spouse's salary?

How often is your spouse paid?

Does your spouse have other benefits such as medical, paid sick leave, stock options, etc.?

Yes

No

If so, please state what they are:

IV. Reason For Separation

When you separated, who left the marital home and why?

V. Major Assets

Please list assets such as real estate, automobiles, stocks, bank certificates etc.

VI. Debts

Please list all separate or joint loans or charge account debt.

VII. Court Information

If there any custody orders, visitation orders or support orders now in effect, please state which Court:

If paperwork has been filed to amend a current order, please list the name of the petitioner and when the petition to amend was filed with the Court:

list the reason(s) for filing the petition to amend (change in income, etc).

Please list the date and time of any upcoming court hearing(s):

Has there been a Guardian ad litem appointed to represent the child(ren)?

Yes

No

If yes, please state the GAL’s name and contact number:

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Stephen B. Plott

Attorney Stephen B. Plott provides personal attention and straight-forward legal advice. As a sole practitioner, Attorney Plott personally handles every case. After practicing law for more than 25 years, Attorney Plott has the legal knowledge and experience that you want by your side.

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Office

15221 Carrollton Boulevard, Suite 104
Carrollton, Virginia 23314

Tel: (757) 745-7711
Fax: (757) 745-7713

By Appointment

5709 Churchland Boulevard, Suite A
Portsmouth, VA 23703

Tel: (757) 745-7711

757.745.7711

Domestic Relations Questionnaire

Domestic Relations Questionnaire

I. Personal Data

A. Your Personal Data

B. Spouse's Personal Data

C. Jurisdiction Informaiton

II. Children

III. Occupation

A. You

B. Spouse

IV. Reason For Separation

V. Major Assets

VI. Debts

VII. Court Information

Call Us (757) 745-7711

Stephen B. Plott

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