Divorce City 911 specializes in the preparation and process of court documents in uncontested family law matters without the high cost of hiring an attorney. As a document preparation service,we do not give legal advice.

1. DIVORCE CITY 911
QUESTIONNAIRE
Phone: 661.868.9606 Email: info@divorcecity911.com Fax: 661.885.8005
1. How did you hear about Divorce City 911? ________________________________________
2. RESIDENCY: To request a divorce in California, one spouse must have been a resident of
California for at least six months and reside in the County which you are filing your case
for at least three months:
Husband / Wife / Both Check Spouse(s) who meet residency requirement
2. YOUR NAME: ______________________________________ Home Phone______________
3.
Cell ___________________ Email: _______________________________________________
Work Phone ____________________________Fax __________________________
Home Address _______________________________________, Unit # ______
City ________________________, State __________ Zip Code _________ Birth Date ___________
Employer: _______________________________________SS# _____________________________
Employer Address: _____________________________________ Position ______________________
City _________________________, State _________ Zip Code ________ Work Hours __________
4. SPOUSE NAME: ______________________________________ Home Phone _____________
Cell ___________________ Email: _______________________________________________
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2. Work Phone ____________________________Fax ______________________________
Home Address: _______________________________________, Unit # ______
City ________________________, State __________ Zip Code _________ Birth Date ___________
Employer _______________________________________SS# ________________________________
Employer Address _____________________________________ Position ______________________
City _________________________, State _________ Zip Code ________ Work Hours __________
5. MARRIAGE
Date of Marriage _____________________ Date of Separation ____________________
6. SPOUSAL SUPPORT TO BE AWARDED TO:
a. Wife b. Husband c. Reserved by Court d. Waived by both parties
7. ARE THERE ANY RETIREMENT PLANS?
Myself / Spouse / N/A
Name of Plans: Myself _________________________ Spouse _______________________
7. CHILDREN OF THIS MARRIAGE ONLY:
Complete if you either have children or are expecting a child. If you have no children of this
marriage write N/A in this section.
Name Birth Place Birth Date Age Sex Social Security #
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3. ____________________________________________________________________________________
a. Children are presently living with: Mother / Father / q Both
Address: _______________________________________________Zip ____________
b. Were any of the children born prior to your marriage? Yes / No
c. Physical Custody of children requested: Joint / Mother / Father
d. Visitation requested: Mother / Father ( Supervised Yes / No)
9. Do you own any real property, as a couple, individually or in a trust? Yes / No
10. Do you have joint credit card debts or loans in both of your names? Yes / No
11. Do you have credit card debts or loans in your name only? Yes / No
12. Wife’s name change: Fill in only if Wife wishes to change her name: __________________
I understand and acknowledge that Divorce City 911 is a legal document preparation service and does not give legal
or tax advice. Our duty is to ask you the proper questions in order to obtain the information necessary to prepare
documents for your court case. If you need legal or tax advice, we encourage you to consult with an attorney or
certified public account licensed to practice in the State of California.
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4. I have read and understand the above. I hereby instruct Divorce City 911 to use the information contained in this
Questionnaire and any other information I am asked to provide to Divorce City 911 to help in the preparation of my
legal documents. I declare that the information provided herein is true and correct to the best of my knowledge.
Dated: ________________________ Customer Signature ________________________________________
(Rev. 06-12)
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