Family Law Case Information Sheet	Case Number (Clerk fills in case #):
	
	Exempt from Public Disclosure	
Fill out this form to start a Family Law case. 
The information you give us is private.

1.	Describe your case:   Divorce   Custody   Paternity   Guardianship   Adoption   Protective Order
	 Other 											
2.	Information about Petitioner
	Name: 					 
First 	Middle 	Last 
Any other names used: 	

Address: 	 
	Street 	City 	State 	Zip 

Mailing Address: 					

Phone numbers: 	 				
	Home 	Work 	Cell 	 
Employer’s name: 	
Social Security Number: 	 Date of Birth: 	 Sex:  Male   Female
Is English your first language?  Yes   No   If no, what language? 	
Do you speak, read and write English?     Yes   No   
3.	Information about Respondent 
	Name: 					
First 	Middle 	Last 
Any other names used: 	

Address: 	
	Street 	City 	State 	Zip 

Mailing Address: 												

Phone numbers: 	 				
	Home 	Work 	Cell 	 
Employer’s name: 	
Social Security Number: 	 Date of Birth: 	 Sex:  Male   Female
Is English your first language?  Yes   No   If no, what language? 	
Do you speak, read and write English?     Yes   No   

4.	Children under 18 in this case (List your children and the children of the person in .)
Child’s name	Date of birth	Social Security No.	Whose child?	
1.					 		 Mine   Ours   Other*	
2.					 		 Mine   Ours   Other*	
3.					 		 Mine   Ours   Other*	
4.					 		 Mine   Ours   Other*	
* If Other, whose? (If there is more than one other parent, list name and specify relationship): 	
	
Who do the children live with now? (name and relationship): 	

5.	Other Cases Involving Children
	List any child support, custody, adoption, or guardianship order for any child listed on this form:
Case Number	Date of Order
(or date requested)	County / State	For which children?	Type of case	
1.				 Support	 Custody 
 Adoption	 Guardianship	
2.				 Support	 Custody 
 Adoption	 Guardianship	
3.				 Support	 Custody 
 Adoption	 Guardianship	
4.				 Support	 Custody 
 Adoption	 Guardianship	
6.	Other Cases Involving Violence or Abuse
List any protective order, domestic violence or child abuse cases involving any adult or child listed on this form: 
Case Number	Who was the Order against?	Who did the 
Order protect?	Date of Order
(or date requested)	County / State	Type of case	
1.					 Domestic Violence 
 Child Abuse
 No Contact Order	
2.					 Domestic Violence 
 Child Abuse
 No Contact Order	
3.					 Domestic Violence 
 Child Abuse
 No Contact Order	
4.					 Domestic Violence 
 Child Abuse
 No Contact Order