SAM HASLER

A TTORNEY AT L AW
1106 Meridian Plaza, Suite 251 Anderson, IN 46016

Telephone: 765-641-7906 Fax: (765)-374-3811

Web Page: http://samhasler.justia.net/index.html Web Log: http://haslerlaw2.blogspot.com/

E-mail: samuelhasler@yahoo.com

CLIENT DIVORCE CONSULTATION INFORMATION

Thank you for choosing Hasler Law Office to handle your legal matter. In order to assist you better, please
take a few moments to answer the following questions. The first section concerns general questions, and the second
more specific matters. While lengthy, the idea here is use your time more for answering your questions than in
gathering the information contained in this questionnaire.

1. Please list your full name: ____________________________________________________

2. Current address where you are residing, including the Zip Code:

____________________________________________________

____________________________________________________

3. Do you have another address to which you would like to have any mail sent from this office?

Yes _______ No ________

If yes, please give the complete mailing address as it should appear on the mailing envelope, including the
Zip Code:

____________________________________________________

____________________________________________________

4. Please list any and all telephone numbers where you can be reached, including cell numbers and area codes:

____________________________________________________

____________________________________________________

5. If we are unable to reach you using the telephone numbers provided herein, is there anyone else we can

DIVORCE QUESTIONNAIRE PROVIDED BY SAM HASLER

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 contact to get in touch with you? Yes _______ No ________

If yes, please list their names, full address and telephone numbers, including pager numbers and area codes:
_____________________________________________________

____________________________________________________

____________________________________________________

Do you have an E-Mail address? If so what is it. _____________________________

6. Are you employed? Yes_____ No______

If yes, please state where and the job title and how long you have been there:

____________________________________________________

____________________________________________________

____________________________________________________

Employer’s address and telephone number. ____________________________________

7. Have you been involved in litigation before? If yes, please state when and what type of lawsuit? What was
the outcome? Were you pleased with the legal system?

____________________________________________________

____________________________________________________

8.Your SSN_____________________________________________________________

Your Date Of Birth____________________________________________________________

9. How did you choose Hasler Law Office for your consultation/representation?

____________________________________________________

___________________________________________________

DIVORCE QUESTIONNAIRE PROVIDED BY SAM HASLER

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These questions deal more specifically with the issues of your matter. Not all questions will apply, so do not
worry if you do not have an answer.

I. Why do you want a divorce?

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

II. How long have you lived in Indiana? __________________________

III. What county do you live in? __________________________

A. How long have you lived in this County? ___________________________

Indiana law requires that you live in the state 6 months and in the county 3 months before you

can file for divorce. What county you live in also determines where the case will be filed.

IV. What is your spouse’s name? ___________________________

A. Your spouse’s age? ___________________________

B. Your spouse’s Social Security number? ___________________________

C. Your spouse's Date Of Birth? ________________________

___

D. Is Spouse Employed? ____________________________

E. Where is Spouse Employed? ____________________________

F. Address for Spouse Employer? ____________________________

G. Phone Number for Employer? ____________________________

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V. When did you marry your spouse? ___________________________

VI. Have you separated from your spouse? Yes ________ No _________

A. If your answer is “Yes”, when did you separate from your spouse? _____________________

B. If your answer is “Yes”, what is your spouse’s address? ___________________________

C. Pick the following which best describes your education:

_______ High School Diploma

_______ GED

_______ Vocational Training Graduate

_______ Some College

_______ College graduate

________ Some post college graduate school

________ Post graduate college degree

________ None of the above

G
(1) Do you have any intention of returning to school? Yes _______ No ________

B. Pick the following which best describes your spouse’s education:

A.
_________ High School Diploma

_________ GED

_________ Vocational Training Graduate

_________ Some College

_________ College Graduate

_________ Some post college graduate school

_________ Post graduate college degree

_________ None of the above

G
(1) Does your spouse intend to return to school?

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 Yes _____ No ______

II. Do you and your spouse have any children? Yes _____ No ______

A. If “Yes”, then are any of the children younger than 21? Yes _____ No ______

B. If younger than 21, where do they live? ______________________________

C. Is the wife now pregnant? Yes _____ No ______

D. Names, Date of Birth, age, current addresses, and social security numbers for the children under 21
years of age.

Child’s name Date of Birth Age Current Addresses social security

number
1
2
3

A. Is there a dispute as to custody of the children? Yes _____ No ______

B. What is your weekly gross income? _______________________

(1) If you are not working, please explain why not?

___________________________________________________________________________________

___________________________________________________________________________________

C. Do you pay child support? Yes _____ No ______

(1) If so, how much a week?

______________________

D. Do you have custody of children from a prior marriage? Yes _____ No ______

E. What is your spouse’s weekly gross income? ______________________

F. Does your spouse pay child support? Yes _____No ______

(1) If so, how much a week?

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 ______________________

G. Does your spouse have custody of children? Yes _____ No ______

H. Are there child care expenses so that you can work? Yes _____No ______

(1) How much in work related child care expenses? Yes _____ No ______

(2) Who pays this? _____________________

(3) Cost of Health Insurance _____________________

(4) Maintance from former Marriage _______________________

Indiana law presumes a 50-50 split on all property and debts. Property includes real estate, and personal

property (everything that is not land).

II. Do you and your spouse own any real estate? Yes _____ No ______

A. Was the real estate acquired during the marriage? Yes _____ No ______

B. Was it purchased by you and your spouse? Yes _____No ______

C. Was it inherited by you? Yes _____ No ______

D. Was it inherited by your spouse? Yes _____No ______

E. Was it owned by you before this marriage? Yes _____No ______

F. Was it owned by your before this marriage? Yes _____No ______

G. Location-where is it? _____________________________

_____________________________

H. What is the value? _____________________________

I. Where did the value come from? _____________________________

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 J. What is the date of the value? _____________________________

K. Is there any debt on property? _____________________________

L. How much is owed? _____________________________

M. What is the monthly payment? _____________________________

N. Any agreement on division of real estate? Yes _____ No ______

III. Do you have a pension, 401K or other retirement plan? Yes _____ No ______

IV. Does your spouse have a pension, 401K or other retirement? Yes _____No ______

V. Did you and your spouse own your own business? Yes _____No ______

A. If “Yes”, what is the name of the business? ______________________________

B. What kind of business is it? ______________________________

VI. Do you and your spouse have any joint debts? Yes _____ No ______

A. If “Yes”, list the debts and the approximate amounts owed:

B. Do you think there can be an agreement on these debts? Yes _____ No ______

I. What do you want from this divorce?

__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

DIVORCE QUESTIONNAIRE PROVIDED BY SAM HASLER

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Date: _____________________

_________________________________________________
Your name

DIVORCE QUESTIONNAIRE PROVIDED BY SAM HASLER

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