Custody Intake QuestionnairePlease complete the following questions to the best of your knowledge. Full Name Email Address Phone Number Date of Birth Social Security Number Street Address with City/State/Zip Your County of Residence State or Foreign Country of Your Birth Other Party's Full Name Other Party's Social Security Number Other Party's Address Other Party's County of Residence Other Party's Date of Birth Is either parent on active duty in the military? Yes No State or Foreign Country of Other Party's Birth How Many Children Do You and the Other Party Have Together? 0 1 2 3 4 5 6+ Name, DOB, and SSN of Child #1 (if applicable) Name, DOB, and SSN of Child #2 (if applicable) Name, DOB, and SSN of Child #3 (if applicable) Name, DOB, and SSN of Child #4 (if applicable) Name, DOB, and SSN of Child #5 (if applicable) Any Additional Information How did you find our firm? If referred, please indicate who referred you. Thank you!