Family Law Information - Law Firm The Barbknecht Firm P.C. Attorneys Dallas, Texas

Saturday, July 31, 2010

Appointment:

Date:
Time:	AM/PM
To see:

FAMILY LAW INFORMATION

Type of Representation Needed:

Divorce

Modification

Enforcement

Adoption

Grandparent Custody

Other:

About You:

Full Name (First, Middle, Last, Suffix/Maiden):
Home Address:
City, State, Zip:
Home Telephone No. (with area code):
Business Name:
Business Address:
Business Telephone No. (with area code):	Extension:
Fax No.:
E-mail:
Cell/Pager No.:
Date of Birth:
Place of Birth (City and State or Foreign Country):
Race:
Social Security No.:
Driver's License Number and State:
What address do you prefer to receive mail from this office?
May we email documents and other information to you?	Yes No
May we fax documents and other information to you?	Yes No
Alternate Contact Information:

Spouse/Ex-Spouse:

Full Name (First, Middle, Last, Suffix/Maiden):
Home Address:
City, State, Zip:
Home Telephone No. (with area code):
Business Name:
Business Address:
Business Telephone No. (with area code and extension, if applicable):
Date of Birth:
Place of Birth (City and State or Foreign Country):
Race:
Social Security No.:
Driver's License Number and State:
Does your spouse/ex-spouse have an attorney?	Yes No
If yes, please state name, address and phone number:

Information on Marriage:

Date of Marriage:
Place of Marriage(City and State or Foreign Country):
Date of Separation:

Miscellaneous Information:

Should wife's maiden name be restored?
If yes, please state wife's new name:
How were you referred to this office?
Other information:

Children of the Marriage:

Full Name (First, Middle, Last, Suffix):
Residential Address:
Gender	Male Female
Date of Birth:
Birth Place:
Social Security Number:
Driver's License Number/State:

Full Name (First, Middle, Last, Suffix):
Residential Address:
Gender	Male Female
Date of Birth:
Birth Place:
Social Security Number:
Driver's License Number/State:

Full Name (First, Middle, Last, Suffix):
Residential Address:
Gender	Male Female
Date of Birth:
Birth Place:
Social Security Number:
Driver's License Number/State:

PLEASE SIGN THE ATTACHED STATEMENT

STATEMENT ON ALTERNATIVE DISPUTE RESOLUTION

I AM AWARE THAT IT IS THE POLICY OF THE STATE OF TEXAS TO PROMOTE THE AMICABLE AND NON-JUDICIAL SETTLEMENT OF DISPUTES INVOLVING CHILDREN AND FAMILIES. I AM AWARE OF ALTERNATIVE DISPUTE RESOLUTION METHODS INCLUDING MEDIATION. WHILE I RECOGNIZE THAT ALTERNATIVE DISPUTE RESOLUTION IS AN ALTERNATIVE TO AND NOT A SUBSTITUTE FOR A TRIAL AND THAT THIS CASE MAY BE TRIED IF IT IS NOT SETTLED. I REPRESENT TO THE COURT THAT I WILL ATTEMPT IN GOOD FAITH TO RESOLVE BEFORE FINAL TRIAL CONTESTED ISSUES IN THIS CASE BY ALTERNATIVE DISPUTE RESOLUTION WITHOUT THE NECESSITY OF COURT INTERVENTION.

Signature

Date

EXHIBIT “A”