Divorce Intake (with minor children)

Divorce mediation with minor children

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Are you married or registered domestic partners?*

We are married.
We are Registered Domestic Partners.
Both

Not for Registered Domestic Partners: Your partnership must be registered with the California Secretary of State.

Do you want to be divorced or legally separated?*

I want to be divorced.
I want to be legally separated.

Note: With a Legal Separation, you will remain married after the proceeding has completed.

INFORMATION ABOUT YOU

One spouse will be the "Petitioner" and one spouse will be the "Respondent".

Your Name*

Your Email*

Date of Birth

Gender*

Male
Female

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone*

Occupation

Employed by

Annual income from job

Other sources of income

City married

City separated

Do you have a consulting attorney?

Yes
No

Consulting attorney

Have you already filed a petition with the Court?

Yes
No

What is the county and case number?

 Do you want your name to change post-divorce?

Yes
No

Please enter your full new name, including middle name

INFORMATION ABOUT YOUR SPOUSE

Your partner's Name*

Gender*

Male
Female

Date of Birth

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone #*

Cell Phone #*

Occupation

Employed by

Annual income from job

Other sources of annual income

Does your partner have a consulting attorney?

Yes
No

Consulting Attorney

Is your spouse on active military duty?*

Yes
No

INFORMATION FOR PETITION

Mark all that apply regarding you and your spouse’s residency

I have been a resident of California for at least the last 6 months and a resident of the county in which I intend to file the divorce for at least the last 3 months.
My spouse has been a resident of California for at least the last 6 months and a resident of the county in which I intend to file the divorce for at least the last 3 months.

Date of Marriage*

Date of Separation

The date of separation is not yet determined

The date of separation is not yet determined.

INFORMATION REGARDING MINOR CHILDREN

Please enter the following information about your kids.*

Child’s Full Name	Date of Birth (MM/DD/YYYY)	Birthplace	Age	Gender (Male/Female)

If any of the children named above were born BEFORE the date of the marriage, indicate how paternity of any such children will be handled.*

NA – All of the children listed above were born after the date of the marriage.
The biological father will sign a voluntary declaration of parentage.
I would like the court to determine parentage of any such children.

Residence information

Information must be for the past 5 years, beginning with the current address of the child.

Address Details*

Dates (From/To)(From/To Present)	Address Where Child Lived (Include City & State)	Name of Person(s) Child Lived With	Relationship to Child

Do you have information about a custody proceeding pending in any court concerning a child in this case, other than this case?*

Yes
No

Please provide the following information and include a copy of the judgment or court order.

Name of each Child*

Your role in the case*

Dissolution/Divorce
Guardianship
Adoption

Name, State and Location of court*

Date of any court order or judgement*

Are there any domestic violence restraining/protective orders now in effect?*

Yes
No

Please provide the following information.
Note: A copy of each order must be attached to form No. FL-105 (Declaration Under Uniform Child Custody Enforcement Act).

Criminal: County/State*

Case #*

Family: County/State*

Case #*

Juvenile: County/State*

Case #*

Other: County/State*

Case #*

Do you know of any person other than yourself and your spouse who has physical custody -- or claims to have custody or visitation -- of any of the children listed above?*

Yes
No

Name of Each Child*

Name and Address of Person*

Person*

Has physical custody
Claims custody rights
Claims visitation rights

ACKNOWLEDGEMENT

I,*

, acknowledge that

The answers to all questions in this workbook were provided by me. I can update or change my answers in person, by telephone, or by email.
I did not receive any legal advice from CDP or any of its employees in the selection or preparation of my forms.
I hereby direct CDP to type and perform certain services outlined in the Contract.
I declare that the foregoing information which I have provided is, to the best of my knowledge, true and correct.
I agree that I have received the CDP Dissolution Overview and been given the opportunity to read it prior to completing this workbook.

Date*

® PROPRIETARY: This document and information contained herein may not be reproduced, reused or disclosed without the express written permission of California Document Preparers.

Divorce mediation with minor children

INFORMATION ABOUT YOU

INFORMATION ABOUT YOUR SPOUSE

INFORMATION FOR PETITION

INFORMATION REGARDING MINOR CHILDREN

Residence information

ACKNOWLEDGEMENT

Contact Information

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