ADOPTION INTAKE FORM

Thank you so much for contacting our law office. Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Your Social Security number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Security numbers are most often used to positively identify parties. Most courts require Social Security numbers of all parties in a case. Some other examples of how this information may be used include:

initial service
in court orders
in required reports or other documents filed with the State

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you.

ABOUT YOU

Contact Information

First Name

Last Name

Date of birth

Company

Emails

Email Address *

Upon submission, a copy of this form will be sent to this email.

Address

Street Address

Country

City

State/Region

Zip/Postal Code

Address Type

Phone Numbers

Phone Number *

Education:

Previous Marriages ended by death (& month/year marriage(s) ended):

Previous marriages ended by divorce (& month/year marriage(s) ended):

Made in anticipation of marriage?

Yes

Mutual waiver of rights in each other’s estates?

Yes

FUTURE SPOUSE’S INFORMATION

Future Spouse’s Name:

Address:

City:

State

Employer Name:

Last Name:

Middle Initial:

City:

Zip/Postal Code

Phone:

Date of Birth

Education:

Previous Marriages ended by death (& month/year marriage(s) ended):

Previous marriages ended by divorce (& month/year marriage(s) ended):

Does your spouse voluntarily agree to the prenupt?

Yes

Future spouse’s attorney:

MARRIAGE INFORMATION

Place of Marriage:

Date of Marriage:

Currently Reside Together?

Yes

Any Former Names:

Number of Children Under 18 in Either Household:

Names and birth dates of all children (list all children of both parties and complete on separate page if necessary:

EMPLOYMENT INFORMATION

Your Employer Name:

Your Annual Gross Income:

Your Future Spouse’s Employer:

Future Spouse’s Annual Gross Income:

Set forth any additional income either party receives:

Do you or your future spouse expect any substantial gifts or inheritances in the future?

Yes

ADDITIONAL INFORMATION

Approximate value of your separate property?

Approximate value of your future spouse’s separate property?

Do you wish to waive your rights and your future spouse’s rights to the increase in value of separate property?

Yes

Do you wish to waive rights to one another’s inheritances?

Yes

Do you wish to waive your rights and your future spouse’s rights to spousal support?

Yes

Do you and/or your future spouse wish to waive rights to request costs and fees from one another if divorced?

Yes

Do you plan to share joint bank accounts during your marriage?

Yes

Please set forth which expenses and/or debts you will share during your marriage and the percentage each party will pay.

Please set forth which expenses and/or debts each party will be individually responsible to pay from his or her own funds.

Do you each wish to keep your individual earnings separate?

Yes

Do you intend to have children?

Yes

Do you wish to make an agreement regarding filing for taxes jointly or separately?

Yes

Do you wish to make an agreement regarding which party will pay for any joint tax liabilities?

Yes

Does either parent plan to stay home with the children?

Yes

Where will you primarily reside?

Who owns/will own the residence?

Who will own the residence in the event of divorce/death?

How do you wish to provide for one another in your wills/estate plans?

What are your plans regarding medical, disability, life or long-term care insurance?

What are your plans regarding medical insurance for your separate child(ren) and/or child(ren) in common?

Please state any agreements regarding private schooling?

Please state agreements for either party to maintain life insurance?

Please list any agreements regarding either party’s incompetency or disability during the marriage?

Please list any other agreements to be included:

OTHER INFORMATION

Any other details you would like to tell us about your case:

THANK YOU

We will contact you as soon as possible.

Please click the SUBMIT button when you have finished completing this form.