First Name:

Last Name:

Home Phone:

Work Phone:

Other Phone:

 Email Address:

How did you find us?

How did you find us (other)?
What's the best time to contact you? am pm
Where would you like to be contacted?   Home Work Other
Date of Birth: Time Residing in Michigan:

Job Title:
Time at Current Employer:
 Annual Pay Rate:
Opposing Party
First Name:
 Last Name:
 Date of Birth:
Name and Address of Opposing Party's Employer:
Job Title:
 Time at Current Employer:
 Annual Pay Rate:
Case Information
Number of Children:
 Ages of Children:
  
Place of Marriage:
 Date of Marriage:
 Date of Separation:
Is this a pending case? Yes   No
If yes, what is the case number?  
Are there any hearings currently scheduled? Yes No
Have you ever applied for child support through the state? Yes No
If you have children, briefly describe your proposed custody and visitation schedule.
Debts & Assets
Is there a marital residence? Yes No
If so, please describe your proposed resolution of the property?
Please describe your outstanding debts.
Please describe your marital assets.

Additional Comments: