Your Contact Information

Full Name *

Phone *

Client Information

Maiden Name

Date of Birth

Address

Age

Birthplace

Number of Marriages

Race

Employer

Title / Position

Salary

Pay Period

Other Income

Spouse Information

Spouse Name

Spouse Maiden Name

Spouse Address

Spouse Phone

Spouse Email

Date of Birth

Age

Birthplace

Number of Marriages

Race

Employer

Title / Position

Salary

Pay Period

Other Income

Does the spouse have an attorney?

Yes No

Spouse's Attorney Name

Marriage

Date of Marriage

Date of Separation

Location of Marriage

Minor Children

Are there minor children of this marriage?

Yes No

Child #1

Name

Date of Birth

Address

SSN

Age

Child #2

Name

Date of Birth

Address

SSN

Age

Child #3

Name

Date of Birth

Address

SSN

Age

Child #4

Name

Date of Birth

Address

SSN

Age

Child #5

Name

Date of Birth

Address

SSN

Age

Addresses where children have lived in the last 5 years

Have there been any prior custody actions?

Yes No

Non-Marital Property

Marital Property — Real Property

Property #1

Address

Estimated Value

Mortgage Holder

Mortgage Amount Owed

Property #2

Address

Estimated Value

Mortgage Holder

Mortgage Amount Owed

Vehicles, Boats, ATVs, Other Assets

Description

Value

Description

Value

Description

Value

Description

Value

Description

Value

Household Property in Dispute

Description

Value

Description

Value

Description

Value

Description

Value

Description

Value

Current Debt

Description

Amount Owed

Description

Amount Owed

Description

Amount Owed

Description

Amount Owed

Description

Amount Owed

Additional Questions

Is there an active EPO/DVO (Emergency/Domestic Violence Order)?

Yes No

County

Style (Parties)

Case Number

Is either party active military?

Yes No

Is the wife returning to her maiden name?

Yes No

Additional Notes

Submitting this form does not create an attorney-client relationship. All information provided is kept confidential.

🔒 Your information is transmitted over an encrypted connection (SSL/TLS) and handled in accordance with attorney-client confidentiality obligations under Kentucky law.

Family Law Intake Form

Your Contact Information

Client Information

Spouse Information

Marriage

Minor Children

Non-Marital Property

Marital Property — Real Property

Vehicles, Boats, ATVs, Other Assets

Household Property in Dispute

Current Debt

Additional Questions

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