Divorce Questionnaire

1) Your Full Name

First Name

Middle Name

Surname

2) Your Social

3) Your Address

Address Line 1

Apartment/building/Floor/Unit No

City

State

Zip Code

Country

Give the date you start living in this COUNTY

4) Your Telephone

5) Your Date Of Birth

Month

Day

Year

6) Your Email

7) Your Name Used On ID

First Name

Middle Name

Surname

8) Your Date Of Marriage

Month

Day

Year

9) Your Wife/Husband's Full Name

First Name

Middle Name

Surname

10) Your Wife/Husband's Telephone Number

11) Your wife/husband's email

12) Wife/Husband's LAST KNOWN Address

Address Line 1

Apartment/building/Floor/Unit No

City

State

Zip Code

Country

13) Date Of Last Known Address Of Wife/Husband

Date Of Separation

14) Wife/Husband's Date Of Birth

Month

Day

Year

15) Place Of Marriage

16) Your Occupation

17) You Are Employed By

18) Your Status Of Employment

Self Employed

UnEmployed

19) Your Work Address

Address Line 1

Apartment/building/Floor/Unit No

City

State

Zip Code

Country

How often do you get paid (Weekly/by-Weekly)

20) Your Salary before tax

Your salary after tax

21) Cash In Hand $

22) Cash In Bank $

23) Your monthly Medicare payments

24) Medical Insurance $

25) Monthly Day Care $

26) Car Payments

27) Car Insurance $

Name of creditor

28) Name Of Creditors

Amount You Owe $

Monthly Payment $

29) Property Own By You

Property Address

Mortgage $

Property Value $

Amount You Owe $

Property Tax $

Association Fee $

30) Cost for Food Per Month $

31) Electricity Bill $

32) Water $

33) Telephone Bill $

34) Rent $

Mortgage $

35) Car Gasoline per month $

Your Car Value $

36) Child Care per month

37) Do You Want To Keep Your Husband's Name

Yes

38) What Is The Name You Want To Keep ?

First Name

Middle Name

Surname

39) What Was Your Previous Name?

First Name

Middle Name

Surname

40)

41) How Did You File your tax - ( Single, Married, Filling Jointly, Single Head Of House )

42) How Many Dependents

NON- LAWYER DISCLOSURE:

Oasis For Immigrants, Inc is not a law firm, and is not acting as your attorney. Oasis For Immigrants, Inc is not a substitute for the advice of an attorney. Oasis For Immigrants, Inc cannot represent you in court nor tell you what to say in court.

Oasis For Immigrants, Inc provides self-help services at your specific direction. We are not permitted to engage in the practice of law and are prohibited from providing any kind of advice, explanation, opinion, or recommendation to a consumer about possible legal rights, remedies, defenses, options, selection of forms or strategies.

Oasis For Immigrants, Inc services are not intended to create an attorney-client relationship, and by using Oasis For Immigrants, Inc a non- attorney client relationship will be created. Therefore, you are representing yourself in any legal matter that you undertake through Oasis For Immigrants, Inc service unless you choose to hire an attorney.

Oasis For Immigrants, Inc includes a review of your answers for completeness, spelling and grammar, as well as internal consistency of names, addresses and the like. At no time do we review your answers for legal sufficiency, draw legal conclusions, provide legal advice or apply the law to the facts of your particular situation.

Oasis For Immigrants, Inc and its services are not a substitute for the advice of an attorney. If you need legal advice for your specific problem, or if your specific problem is complex, you should consult a licensed attorney.

Oasis For Immigrants, Inc is not responsible for any loss, injury, claim, liability, or damage related to use of their services caused from errors or omissions, as all documents will be printed following your review and approval.

Please sign and print your name if you are in agreement with the above disclosure.

Printed name

First Name

Middle Name

Surname

Signature

DATE

Month

Day

Year

Expenses For Child(REN) Common To Both Parties( if children are under 18)

1) $ Monthly nursery, babysitting, or other child care

2) $ Monthly after-school care

3) $ Monthly school tuition

4) $ Monthly school supplies, books, and fees

5) $ Monthly after-school activities

6) $ Monthly lunch money

7) $ Monthly private lessons/tutoring

8) $ Monthly allowance

9) $ Monthly clothing

10) $ Monthly uniforms

11) $ Monthly entertainment (movies, birthday parties, etc.)

12) $ Monthly health and dental insurance premiums

13) $ Monthly medical, dental, prescription charges (unreimbursed)

14) $ Monthly psychiatric/psychological/counselor (unreimbursed)

15) $ Monthly orthodontic (unreimbursed)

16) $ Monthly grooming

17) $ Monthly non-prescription medications/cosmetics/toiletries/sundries

18) $ Monthly gifts from children to others (other children, relatives, teachers, etc.)

19) $ Monthly camp or other summer activities

20) $ Monthly clubs (Boy/Girl Scouts, etc.) or recreational fees

21) $ Monthly visitation expenses (for nonresidential parent)

$ Expenses

Explain

22) $ Monthly insurance ( life, etc ).

{explain}: Other {explain}:

26) Total Expenses For Child(REN) Common To Both Parties

Full Name Of Child/Ren Under 18

Date Start Living At This Address

First Name

Middle Name

Surname

Address

Month

Day

Year

Place Of Birth

Date of birth of children 1-8

Social Security Number

Month

Day

Year

Sex

Text Input

COMMITTED TO ASSISTING

THE JOURNEY

Oasis For Immigrants is an outlet for indigent immigrants to achieve their immigration goals.

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Divorce Questionnaire

DIVORCE QUESTIONNAIRE

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