Adoption

CLIENT INFORMATION FORM

PLEASE PRINT CLEARLY

Fee Quote

Date_________________ $_____________/___________
Down MF

CLIENT INFORMATION

Full Name_________________________________________________________________________
First Middle Last Maiden

Home Address______________________________________________________________________

Mailing Address___________________________________________________________________

Home Phone _________________________________ Cell_________________________________

Employer______________________________________ Hours______________________________

Address_______________________________________ Phone______________________________

E-mail Address___________________________ Birthdate_______________________________

Social Security #________________________ Driver’s License #______________________

Full Name_________________________________________________________________________
First Middle Last Maiden

Home Address______________________________________________________________________

Mailing Address___________________________________________________________________

Home Phone _________________________________ Cell_________________________________

Employer______________________________________ Hours______________________________

Address_______________________________________ Phone______________________________

E-mail Address___________________________ Birthdate_______________________________

Social Security #________________________ Driver’s License #______________________

Next of Kin for Emergency_________________________________________________________

Full Name Telephone

Address __________________________________________________________________________

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BIRTH PARENTS OF CHILD(REN)

Full Name_________________________________________________________________________
First Middle Last Maiden

Home Address______________________________________________________________________

Mailing Address___________________________________________________________________

Home Phone _________________________________ Cell_________________________________

Employer______________________________________ Hours______________________________

Address_______________________________________ Phone______________________________

Salary/Income___________________________ SS#______________________________________

DL# and State _________________________ E-mail Address____________________________

Birthdate_______________________________ Ethnicity________________________________

Birthplace _______________________________________________________________________
City County State

Full Name_________________________________________________________________________
First Middle Last Maiden

Home Address______________________________________________________________________

Mailing Address___________________________________________________________________

Home Phone _________________________________ Cell_________________________________

Employer______________________________________ Hours______________________________

Address_______________________________________ Phone______________________________

Salary/Income___________________________ SS#______________________________________

DL# and State _________________________ E-mail Address____________________________

Birthdate_______________________________ Ethnicity________________________________

Birthplace _______________________________________________________________________
City County State

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ANY OTHER PARTY TO THIS LEGAL PROCEEDING
OR HAVING A COURT-ORDERED RELATIONSHIP WITH CHILD(REN)

Full Name_________________________________________________________________________
First Middle Last Maiden

Home Address______________________________________________________________________

Mailing Address___________________________________________________________________

Home Phone _________________________________ Cell_________________________________

Employer______________________________________ Hours______________________________

Address_______________________________________ Phone______________________________

Salary/Income___________________________ SS#______________________________________

DL# and State _________________________ E-mail Address____________________________

Birthdate_______________________________ Ethnicity________________________________

Birthplace _______________________________________________________________________
City County State

CHILD(REN) INVOLVED IN THIS LEGAL PROCEEDING

(List only if under the age of 18, or over 18 but suffering from mental or physical
impairment, or not yet graduated from high school)

Full Name_____________________________________ Birthdate_______________________

Birthplace____________________________________ Gender__________________________

Social Security #_____________________________ DL# and State___________________

Full Name_____________________________________ Birthdate_______________________

Birthplace____________________________________ Gender__________________________

Social Security #_____________________________ DL# and State___________________

Full Name_____________________________________ Birthdate_______________________

Birthplace____________________________________ Gender__________________________

Social Security #_____________________________ DL# and State___________________

Full Name_____________________________________ Birthdate_______________________

Birthplace____________________________________ Gender__________________________

Social Security #_____________________________ DL# and State___________________

Present Residence of Children_____________________________________________________

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HEALTH INSURANCE FOR CHILDREN

What health, dental and vision insurance is currently in effect for the children
the subject of this suit?________________________________________________________

If the insurance coverage is through a parent’s employer, which parent is providing

the insurance?___________________________________________________________________

What is the monthly cost for coverage for the children only? $__________________

SERVICE INFORMATION (Complete for Each Person to be Served if Applicable)

Preferred Service Address (Must be a street physical address, the Sheriff or process
server cannot serve post office box number):

_________________________________________________________________________________

Description (Please provide a recent photograph if available)

Height________________ Weight_________________ Hair Color________________________

Eye Color_____________ Facial Hair_______________________________________________
Other Distinguishing Features or Marks___________________________________________
Vehicle Description & Tag #______________________________________________________

Will Respondent try to avoid service? Yes_______ No_______

Is Respondent likely to be violent? Yes_______ No_______
If yes, please specify___________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Additional Service Information___________________________________________________

_________________________________________________________________________________

WILL

Have you made a Will? Yes_______ No_______

Do you wish to review your Will at this time? Yes_______ No_______

[ ] I authorize information to be released to the following person(s):

Name_________________________________________ Relationship____________________

Name_________________________________________ Relationship____________________

[ ] I do not authorize any information to be released.

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How did you choose our firm?_________________ If referred, by whom?________________