Custody Consultation Information
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SAM HASLER A TTORNEY AT L AW 1106 Meridian Plaza, Suite 251
Anderson, IN 46016
Telephone: 765-641-7906
Fax: (765)-374-3811
Web Page: http://samhasler.justia.net/index.html
Web Log: http://haslerlaw2.blogspot.com/
E-mail: [email protected]
CLIENT CUSTODY CONSULTATION INFORMATION Thank you for choosing Hasler Law Office to handle your legal matter. In order to assist you better, please take a few moments to answer the following questions. The first section concerns general questions, and the second more specific matters. While lengthy, the idea here is use your time more for answering your questions than in gathering the information contained in this questionnaire.
1.
Please list your full name: ____________________________________________________
2.
Current address where you are residing, including the Zip Code: ____________________________________________________ ____________________________________________________
3.
Do you have another address to which you would like to have any mail sent from this office? Yes _______ No ________ If yes, please give the complete mailing address as it should appear on the mailing envelope, including the Zip Code: ____________________________________________________ ____________________________________________________
4. Please list any and all telephone numbers where you can be reached, including pager numbers and area codes: ____________________________________________________ ____________________________________________________
CUSTODY QUESTIONNAIRE PROVIDED BY SAM HASLER PAGE 1 OF 5
5. If we are unable to reach you using the telephone numbers provided herein, is there anyone else we can contact to get in touch with you? Yes _______ No ________ If yes, please list their names, full address and telephone numbers, including pager numbers and area codes: _____________________________________________________ ____________________________________________________ ____________________________________________________
6.
Are you employed? Yes_____ No______ If yes, please state where and the job title and how long you have been there: ____________________________________________________ ____________________________________________________ ____________________________________________________
7. Have you been involved in litigation before? If yes, please state when and what type of lawsuit? What was the outcome? Were you pleased with the legal system? ____________________________________________________ ____________________________________________________
8,
How did you choose Hasler Law Office for your consultation/representation? ____________________________________________________ ____________________________________________________
9.
How will you be paying for your consultation today? ________________________________
10.
Would it make any difference to you if you were allowed to pay by credit card? Yes ____ No ______
CUSTODY QUESTIONNAIRE PROVIDED BY SAM HASLER PAGE 2 OF 5
These questions deal more specifically with the issues of your matter. Not all questions will apply, so do not worry if you do not have an answer. I.
II.
What is name of the other parent?
___________________________
A.
The other parent’s age?
___________________________
B.
The other parent’s Social Security number?
___________________________
How many children?
Yes _____
No ______
A.
If “Yes”, then are any of the children younger than 21?
Yes _____
No ______
B.
If younger than 21, where do they live?
______________________________
C.
Is the wife now pregnant?
Yes _____
D.
Names, Date of Birth, age, current addresses, and social security numbers for the children under 21 years of age.
Child’s name
Date of Birth
Age
No ______
Current Addresses
social security number
E. Give me any facts why it is in the child(ren)’s best interests for you to have custody. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
CUSTODY QUESTIONNAIRE PROVIDED BY SAM HASLER PAGE 3 OF 5
F. Give me any facts why it is in the child(ren)’s best interests for you to have custody. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ III. Since child support will be at issue too, I need the following income information: A.
What is your weekly gross income?
_______________________
(1) If you are not working, please explain why not? ___________________________________________________________________________________ ___________________________________________________________________________________ C.
Do you pay child support?
Yes _____
No ______
(1) If so, how much a week? ______________________ D.
Do you have custody of children from a prior marriage?
Yes _____
No ______
E.
What is the other parent’s weekly gross income?
______________________
F.
Does other parent pay child support?
Yes _____No ______
(1) If so, how much a week? ______________________ G.
Does other parent have custody of children?
Yes _____
No ______
H.
Are there child care expenses so that you can work?
Yes _____No ______
(1) How much in work related child care expenses?
Yes _____
(2) Who pays this?
_____________________ CUSTODY QUESTIONNAIRE PROVIDED BY SAM HASLER PAGE 4 OF 5
No ______
IV. Since parenting time will be at issue, please tell me what visitation you would like to have and what visitation you would like to see for the other parent. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Date: _____________________ _________________________________________________ Your name
CUSTODY QUESTIONNAIRE PROVIDED BY SAM HASLER PAGE 5 OF 5
Anderson, IN 46016
Telephone: 765-641-7906
Fax: (765)-374-3811
Web Page: http://samhasler.justia.net/index.html
Web Log: http://haslerlaw2.blogspot.com/
E-mail: [email protected]
CLIENT CUSTODY CONSULTATION INFORMATION Thank you for choosing Hasler Law Office to handle your legal matter. In order to assist you better, please take a few moments to answer the following questions. The first section concerns general questions, and the second more specific matters. While lengthy, the idea here is use your time more for answering your questions than in gathering the information contained in this questionnaire.
1.
Please list your full name: ____________________________________________________
2.
Current address where you are residing, including the Zip Code: ____________________________________________________ ____________________________________________________
3.
Do you have another address to which you would like to have any mail sent from this office? Yes _______ No ________ If yes, please give the complete mailing address as it should appear on the mailing envelope, including the Zip Code: ____________________________________________________ ____________________________________________________
4. Please list any and all telephone numbers where you can be reached, including pager numbers and area codes: ____________________________________________________ ____________________________________________________
CUSTODY QUESTIONNAIRE PROVIDED BY SAM HASLER PAGE 1 OF 5
5. If we are unable to reach you using the telephone numbers provided herein, is there anyone else we can contact to get in touch with you? Yes _______ No ________ If yes, please list their names, full address and telephone numbers, including pager numbers and area codes: _____________________________________________________ ____________________________________________________ ____________________________________________________
6.
Are you employed? Yes_____ No______ If yes, please state where and the job title and how long you have been there: ____________________________________________________ ____________________________________________________ ____________________________________________________
7. Have you been involved in litigation before? If yes, please state when and what type of lawsuit? What was the outcome? Were you pleased with the legal system? ____________________________________________________ ____________________________________________________
8,
How did you choose Hasler Law Office for your consultation/representation? ____________________________________________________ ____________________________________________________
9.
How will you be paying for your consultation today? ________________________________
10.
Would it make any difference to you if you were allowed to pay by credit card? Yes ____ No ______
CUSTODY QUESTIONNAIRE PROVIDED BY SAM HASLER PAGE 2 OF 5
These questions deal more specifically with the issues of your matter. Not all questions will apply, so do not worry if you do not have an answer. I.
II.
What is name of the other parent?
___________________________
A.
The other parent’s age?
___________________________
B.
The other parent’s Social Security number?
___________________________
How many children?
Yes _____
No ______
A.
If “Yes”, then are any of the children younger than 21?
Yes _____
No ______
B.
If younger than 21, where do they live?
______________________________
C.
Is the wife now pregnant?
Yes _____
D.
Names, Date of Birth, age, current addresses, and social security numbers for the children under 21 years of age.
Child’s name
Date of Birth
Age
No ______
Current Addresses
social security number
E. Give me any facts why it is in the child(ren)’s best interests for you to have custody. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
CUSTODY QUESTIONNAIRE PROVIDED BY SAM HASLER PAGE 3 OF 5
F. Give me any facts why it is in the child(ren)’s best interests for you to have custody. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ III. Since child support will be at issue too, I need the following income information: A.
What is your weekly gross income?
_______________________
(1) If you are not working, please explain why not? ___________________________________________________________________________________ ___________________________________________________________________________________ C.
Do you pay child support?
Yes _____
No ______
(1) If so, how much a week? ______________________ D.
Do you have custody of children from a prior marriage?
Yes _____
No ______
E.
What is the other parent’s weekly gross income?
______________________
F.
Does other parent pay child support?
Yes _____No ______
(1) If so, how much a week? ______________________ G.
Does other parent have custody of children?
Yes _____
No ______
H.
Are there child care expenses so that you can work?
Yes _____No ______
(1) How much in work related child care expenses?
Yes _____
(2) Who pays this?
_____________________ CUSTODY QUESTIONNAIRE PROVIDED BY SAM HASLER PAGE 4 OF 5
No ______
IV. Since parenting time will be at issue, please tell me what visitation you would like to have and what visitation you would like to see for the other parent. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Date: _____________________ _________________________________________________ Your name
CUSTODY QUESTIONNAIRE PROVIDED BY SAM HASLER PAGE 5 OF 5
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