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SINGLE SESSION -- ENTER ALL DATA ON ALL FORMS AT ONE TIME
After entering ALL data, you must click the "Submit Now" button
on the bottom of this form to send your data!

GENERAL INFORMATION	*Press Tab Key to Move From Field to Field
Date of Marriage (if applicable)
Where Married - County and State (if applicable)
Date of Separation (if applicable)
Number of Children (if applicable)
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WIFE/MOTHER'S INFORMATION (*If parties are not married, female's information)	*Press Tab Key to Move From Field to Field
NAME
Title of Wife (i.e., Ms. Mrs., Dr.)	Ms. Mrs. Miss. Dr. Hon. Sen. Rev.
Wife's First Name
Wife's Middle Name
Wife's Last Name
Wife's Nick Name
TELEPHONE
Wife's Day Phone
Wife's Evening Phone
Wife's Cell Phone
Wife's Msg./Pager Phone
Wife's Fax Phone
EMAIL ADDRESS
Wife's Email Address
MAILING ADDRESS
Wife's Mailing Address
Wife's Mailing City
Wife's Mailing State
Wife's Mailing Zip
RESIDENTIAL ADDRESS Leave blank if you wish to use your mailing address as your residential address.
Wife's Residential Address
Wife's Res. City
Wife's Res. State
Wife's Res. Zip
Wife's Res. County
EMPLOYMENT
Wife's Employer Name
Wife's Employer Phone
Wife's Employer Address
Wife's Employer City
Wife's Employer State
Wife's Employer Zip
VITAL STATISTICS/CONFIDENTIAL IDENTIFICATION INFORMATION
Wife's Soc. Sec. Number
Wife's Driver's Lic/ID
Wife's Birthdate
Wife's Birthplace
Wife's Maiden Name
Wife Live in City Limit?	YesNo
Wife's Race	African American Alaskan Native American Indian Asian Black Caucasian Hispanic Latino Middle Eastern Non Minority Pacific Islander White
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HUSBAND/FATHER'S INFORMATION (*If parties are not married, male's information)	*Press Tab Key to Move From Field to Field
NAME
Title of Husband (i.e., Mr., Dr..)	Mr. Dr. Hon. Sen. Rev.
Husband's First Name
Husband's Middle Name
Husband's Last Name
Husband's Nick Name
TELEPHONE
Husband's Day Phone
Husband's Evening Phone
Husband's Cell Phone
Husband's Msg./Pager Phone
Husband's Fax Phone
EMAIL ADDRESS
Husband's Email Address
MAILING ADDRESS
Husband's Mailing Address
Husband's Mailing City
Husband's Mailing State
Husband's Mailing Zip
RESIDENTIAL ADDRESS Leave blank if you wish to use your mailing address as your residential address.
Husband's Residential Address
Husband's Res. City
Husband's Res. State
Husband's Res. Zip
Husband's Res. County
EMPLOYMENT
Husband's Employer Name
Husband's Employer Phone
Husband's Employer Address
Husband's Employer City
Husband's Employer State
Husband's Employer Zip
VITAL STATISTICS/CONFIDENTIAL IDENTIFICATION INFORMATION
Husband's Soc. Sec. Number
Husband's Driver's Lic/ID & State
Husband's Birthdate
Husband's Birthplace
Husband Live in City Limit?	YesNo
Husband's Race	African American Alaskan Native American Indian Asian Black Caucasian Hispanic Latino Middle Eastern Non Minority Pacific Islander White
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CHILDREN INFORMATION
CHILD SUPPORT
Who Will Pay Child Support? (Husband/Wife) HusbandWifeNeither
Who Will Receive Child Support? (Husband/Wife/Neither) HusbandWifeNeither
OLDEST CHILD
Oldest Child's First Name
Oldest Child's Middle Name
Oldest Child's Last Name
Oldest Child's Age
Oldest Child's Sex	Male Female
Oldest Child's Birthdate
Oldest Child's Soc. Sec. #
Oldest Child Resides with	HusbandWifeNeither
Is Wife Oldest Child's Mother?	YesNo
Is Husband Oldest Child's Father?	YesNo
Oldest Child's Race	African American Alaskan Native American Indian Asian Black Caucasian Hispanic Latino Middle Eastern Non Minority Pacific Islander White
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2ND CHILD
2nd Child's First Name
2nd Child's Middle Name
2nd Child's Last Name
2nd Child's Age
2nd Child's Sex	Male Female
2nd Child's Birthdate
2nd Child's Soc. Sec. #
2nd Child Resides with	HusbandWifeNeither
Is Wife 2nd Child's Mother?	YesNo
Is Husband 2nd Child's Father?	YesNo
2nd Child's Race	African American Alaskan Native American Indian Asian Black Caucasian Hispanic Latino Middle Eastern Non Minority Pacific Islander White
3RD CHILD
3rd Child's First Name
3rd Child's Middle Name
3rd Child's Last Name
3rd Child's Age
3rd Child's Sex	Male Female
3rd Child's Birthdate
3rd Child's Soc. Sec. #
3rd Child Resides with	HusbandWifeNeither
Is Wife 3rd Child's Mother?	YesNo
Is Husband 3rd Child's Father?	YesNo
3rd Child's Race	African American Alaskan Native American Indian Asian Black Caucasian Hispanic Latino Middle Eastern Non Minority Pacific Islander White
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4TH CHILD
4th Child's First Name
4th Child's Middle Name
4th Child's Last Name
4th Child's Age
4th Child's Sex	Male Female
4th Child's Birthdate
4th Child's Soc. Sec. #
4th Child Resides with	HusbandWifeNeither
Is Wife 4th Child's Mother?	YesNo
Is Husband 4th Child's Father?	YesNo
4th Child's Race	African American Alaskan Native American Indian Asian Black Caucasian Hispanic Latino Middle Eastern Non Minority Pacific Islander White
5TH CHILD
5th Child's First Name
5th Child's Middle Name
5th Child's Last Name
5th Child's Age
5th Child's Sex	Male Female
5th Child's Birthdate
5th Child's Soc. Sec. #
5th Child Resides with	HusbandWifeNeither
Is Wife 5th Child's Mother?	YesNo
Is Husband 5th Child's Father?	YesNo
5th Child's Race	African American Alaskan Native American Indian Asian Black Caucasian Hispanic Latino Middle Eastern Non Minority Pacific Islander White
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NOTE: You MUST click the "Submit Now" button on the bottom of this form to send your data! Be sure to complete all the sections of this form as requested by your attorney before submitting your data.
Next >> Child Support

To Return to Main Menu, Click Here
SINGLE SESSION -- ENTER ALL DATA ON ALL FORMS AT ONE TIME
After entering ALL data, you must click the "Submit Now" button
on the bottom of this form to send your data!

GENERAL INFORMATION	*Press Tab Key to Move From Field to Field
Name of Father		Name of Mother

INCOME INFORMATION	*Press Tab Key to Move From Field to Field
	Father		Mother
Wages and Salaries
Interest Income
Dividend Income
Business Income
Spousal Maintenance Received
Other Income
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DEDUCTION INFORMATION	Your attorney can calculate monthly taxes for you. Leave tax information blank unless you have a specific
	Father		Mother
Income Taxes (*Optional)
FICA/Self Employment Taxes (*Optional)
Normal Business Expenses
State Industrial Insur.
Mand. Union/Prof. Dues
Mandatory Pension Plan Payments
Voluntary Retirement Contributions
Spousal Maintenance Paid
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CHILDREN EXPENSE INFORMATION	*Press Tab Key to Move From Field to Field
	Father		Mother
Children's Health Insurance Premiums
Children's Uninsured Health Expenses
Day Care Expenses
Education Expenses
Long Distance Transportation Expenses
Other Special Expenses	Father		Mother
Describe
Describe
Describe
Other Ordinary Expenses	Father		Mother
Describe
Describe
Describe
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RESIDENTIAL INFORMATION	*Press Tab Key to Move From Field to Field
	With Father	With Mother
Child 1's Overnights
Child 2's Overnights
Child 3's Overnights
Child 4's Overnights
Child 5's Overnights
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NOTE: You MUST click the "Submit Now" button on the bottom of this form to send your data! Be sure to complete all the sections of this form as requested by your attorney before submitting your data.
Next >> Financial Declaration