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Divorce Intake Form

CLIENT INFORMATION

Gender Male Female

NAME CHANGE

Are you requesting a name change? Yes No

MARRIAGE DETAILS

Do you already have a signed Separation and Property Settlement Agreement? Yes No

PHONE EMAIL PHYSICAL ADDRESS MAILING ADDRESS

(if different from Physical Address)

CLIENT RESIDENCY STATUS Are you currently a Virginia resident? I have lived in Virginia since (less than 1 year residency) SPOUSE INFORMATION

Will your spouse sign a document agreeing to the divorce? Yes No Unsure Cannot locate spouse

How do you want your spouse to receive the documents? EMAIL the documents to me and I will send/take the documents to my spouse. I will PICK UP the documents at the office. MAIL the documents to me and I will send/take them to my spouse. EMAIL the documents directly to my spouse. My spouse will PICK UP and sign the documents at the office. MAIL the documents directly to my spouse. Not Applicable, I am requesting that the divorce proceed by publication in the newspaper. Unsure.

What is your spouse's gender? Male Female

SPOUSE NAME CHANGE

Is your spouse requesting a name change? Yes No

SPOUSE CONTACT INFORMATION

NOT FILLING IN THE ADDRESS WILL DELAY YOUR CASE. If current address is unknown, what was the last known mailing address?

PHONE EMAIL CHILDREN How many children were born to or adopted by you and your spouse? (Please include all children regardless of age) Do you plan to include custody in the divorce or do you have a signed agreement which includes custody? Do you plan to include child support in the divorce or do you have a signed agreement which includes child support? FINANCIALSDo you and your spouse have any financial assets/property to divide or debts to resolve? (Including houses, cars, bank accounts, personal property, credit cards, etc.) Are you or your spouse requesting spousal support/alimony? Do you or your spouse have any pension, retirement plan, 401(k) that will be divided? UNITED STATES ARMED SERVICESAre you on active duty in the United States Armed Services? Is your spouse on active duty in the United States Armed Services? STATUS OF DIVORCEHas a divorce case already been filed in any court by you or your spouse? CLIENT DEMOGRAPHIC INFORMATION Client's number of marriages SPOUSE DEMOGRAPHIC INFORMATION Spouse's number of marriages OTHER INFORMATION

Client Reviews

Great understanding of my situation, very responsible and detail oriented. I could highly recommend Kublan Khan PLC - I don’t think they have any competition here in Falls Church area.

- Ivo Koytchev

Because of him I saved time, money and my nerves and we reached an agreement with my x. I highly recommend Andrei to all my friends with any complicated case they might have.

- Tina Hassan

Mr. Kublan has my absolute highest rating, this time on my divorce. I have no spousal support payments, no payments in arrears (I stopped paying support 6 months ago), no health insurance payments, no retirement benefits...

- Rick Dunbar

Having been represented before by several attorneys in the area, I've experienced the best service and results with Kublan&Austin. Great professionalism, attentive and knowledgeable staff. Always kept me informed. I...

- Alexandra Xela

I usually don’t take the time to post stuff like this but upon reflecting on my experience with Andrei Kublan and his firm I felt it necessary. Divorce is not a pretty thing and having an attorney represent you that...

- Maha Kandil

I am very grateful to have found Andrei Kublan when I did: at the point of re-litigating child custody. Mr. Kublan works for the result. He knows how to build a case, how to collect the evidence, how to argue, and how to...

- Nadia Ciuha

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