LIENT FORM


Fill out this form and click the Submit button at the bottom. Be sure to use the TAB key to move from one field to the other.

Or call our offices at 713-861-7777, or simply send us an e-mail AJones@familylawoffices.com, requesting a copy of our Agreement for Legal Services. Be sure to tell us if you wish us to send it via e-mail, fax, or some other means. You will receive a response within one or two business days.

Application for Legal Services

Date: 
  
Referred By: 
  
I. PERSONAL INFORMATION ABOUT YOU
Name (first):
(middle):
(last):
Maiden Name........................................................
Race (State Statistical Requirement).......................
Home Address (Number, Street, Apartment #)......
City, State, Zip......................................................
Can we mail to this address....................................
If No, what address can we mail to........................
E-mail Address......................................................
Home Phone No....................................................
Can we leave messages at this number....................
Mobile Phone No..................................................
Home Fax No.......................................................
Work Fax No........................................................
Current County of Residence.................................
How long in current County....................................
How long in Texas.................................................
Date of Birth..........................................................
Place of Birth (City & State)...................................
Social Security Number..........................................
Texas Driver's License No......................................
Employer's Address (Street, City, State, Zip)..........
Name & Phone of friend/relative (Alt. contact).......
Health / Hospitalization Carrier................................  
Through whose employer do you have this Insurance
Other Party?...........................................................
II. INFORMATION ABOUT OPPOSING PARTIES
Name: (first):
(middle):
(last):
Maiden Name........................................................
Race (State Statistical Requirement).......................
Home Address (Number, Street, Apartment #)......
City, State, Zip......................................................
Current County of Residence.................................
How long in current County...................................
How long in Texas.................................................
Date of Birth.........................................................
Place of Birth (City & State)..................................
Social Security Number.........................................
Texas Driver's License No.....................................
Employer's Name..................................................
Employer's Address (Street, City, State, Zip).........
Work Phone No....................................................
Is respondent a member of Union? please specify..
or receive any government benefits? please specify.
III. MARITAL STATUS

A. Date of Marriage:..............................................

    Common Law Marriage (please specify date).....
B. Place of Marriage (city and state).......................
C. Date of Separation.............................................
D. Have you ever been divorced (when and where).
IV. LIST OF ALL YOUR CHILDREN
First Name
Middle Name
Last Name
Birth Date
Sex
Place of Birth (city,st.)
S. S. N.
   
Do(es) you child(ren) have income or bank account.
What School(s) do(es) the child(ren) attend.............
Are any of the children physically, mentally,
or emotionally handicapped?...................................
Do your children attend year round school...............
Are you asking for custody of each child..................
Is there any reason why we should vary from
standard visitation?..................................................
   
V. PROPERTY
Real Property (land, buildings, houses, etc.).............
Equity.....................................................................
Mortgage................................................................
Retirement (Husband).............................................
Retirement (Wife)...................................................
401K.....................................................................
Certificates of Deposits...........................................
Pension / Annuity....................................................

Automobiles (Husband)..........................................
Automobiles (Wife)................................................
List of Property Owned before Marriage................
Pets........................................................................
Reimbursement.......................................................
VI. DEBTS
Please list all debts, including credit cards,
taxes, car notes, etc................................................
Wife's Maiden Name to be restored
(please specify name to be restored)........................
Premarital or Post-marital Agreements.....................
Restraining Order needed........................................