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PETITIONER:
Email Address
Name: First Middle
Last
Address Apartment
City Zip code County
Home Phone: Area
Code
Number
Work Phone: Area
Code
Number Extension
Date of Birth
Social Security
Number
Employed By
Job Description
Monthly Income
$
Driver's License #
RESPONDENT:
Name: First Middle Last
Address Apartment
City Zip code County
Home Phone: Area
Code
Number
Work Phone: Area
Code
Number Extension
Date of Birth
Social Security
Number
Employed By
Job Description
Monthly Income
$
Driver's License #
INFORMATION:
Marriage Date
Separation
Date
Wife's Maiden
Name
Does Wife Want
To Keep Married Name? Yes No
There are NO children of
this marriage.
Yes, there are children
of this marriage. Please list names, birthdates, sex,
and indicate who the child currently lives with:
Custody Arrangements
Desired:
Physical Custody
(Who the child will live with) Petitioner Respondent
Legal Custody
(Health, Education, etc.) Petitioner Respondent
Visitation (Alternate
weekends, holidays, etc.):
Child Support
Automatic California Guideline
Spousal Support
Automatic California Guideline
Medical Insurance
(Check one): Petitioner Respondent None
Property Information:
There is NO real estate
involved.
Yes, there is real
estate involved and it is described as follows:
Market Value
$ Loan Amount
$ Equity $
Is this your
residence?
Yes
No
Address of Residence
What do you want
to do with this property?
Check One:
All money and/or property has been settled (Included in our fee).
Assets/obligations to be disposed of by notarized Marital Settlement
Agreement.
Assets/obligations to be distributed by Property Declaration.
ASSETS AND
OBLIGATIONS
(Indicate
how the items listed below should be distributed)
Household Goods
and Furnishings
Pension Plans,
IRAs, 401k, etc.
Community Debts
(Credit Cards, Loans, Payments)
Petitioner's
Separate Property and Debts
Respondent's
Separate Property and Debts
PRICING AND
PAYMENT METHODS
Select One
SUMMARY DISSOLUTION
Simplified divorce for couples who have been married less than
5 years.
No children, no real estate, both parties sign the papers, no
court appearance required.
$495.00 plus court filing fee
REGULAR DIVORCE
No children, real
estate or other significant property.
$595.00 plus court filing fee
REGULAR DIVORCE
With Children OR Property
$695.00 plus court filing fee
REGULAR DIVORCE
With Children AND Property
$795.00 plus court filing fee
REGULAR DIVORCE
With Marital Settlement Agreement, no court appearance required.
$995.00 plus court filing fee
PAYMENT MUST ACCOMPANY
THIS FORM
Fill out the following Credit Card information completely and
accurately.
Name on Credit
Card
Credit Card Number
Expiration Date
Signature ______________________________________
Before submitting this
form please double check it to be sure that
all of the appropriate information has been filled in and is
accurate.
Thank You.
NOTE: If you get an error message when you attempt to
submit this form
that is not attributed to incomplete credit card information,
simply print
out the form and fax it to our secure line at (562) 426-6499.
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