The information you provide here will help us fully understand your situation and to assist you with the most valuable advice and guidance.

*Information indicated is required by NYS.

Disclaimer

Please be aware that the submission of the contact form does not constitute legal advice or form an attorney-client relationship. Parlatore Law Group cannot agree to represent you or to take your case simply because you complete this form or email the firm. Do not use the form below to submit confidential, privileged, or sensitive information. The information submitted on this form is not privileged.

INTAKE SHEET

Contact information: Client Information Form

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Email Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

PERSONAL IDENTIFICATION

MARRIAGE

SPOUSE INFORMATION

ADDITIONAL INFORMATION

THANK YOU

Thank you for completing this intake questionnaire. We will contact you as soon as possible with any updates.

Please click the SUBMIT button below when you have finished answering all questions.

ACKNOWLEDGEMENT AND ACCEPTANCE

INTAKE SHEET

Contact information: Client Information Form

Maiden Name

Mailing address (if different)

PERSONAL IDENTIFICATION

Date of Birth

Place of Birth

Social Security No.

Race

Highest level of education

Number of prior marriages

How did each marriage end?

Employer (name and address)

Your position

Last Year's earnings

Current earnings

Any other income?

MARRIAGE

Date of marriage

Location of marriage (please list town, county, state, and country)

Religious or Civil Ceremony?

Children of this marriage or relationship. List all names, gender, address, social security number, and date of birth for each, regardless of the age of the child(ren). Include any special needs of the child(ren).

Children of prior marriage or relationship. List all names, gender, address, social security number, and date of birth for each, regardless of the age of the child(ren). Include any special needs of the child(ren).

SPOUSE INFORMATION

Legal Name

Preferred Name

Maiden Name

Address

Date of Birth

Place of Birth

Social Security No.

Race

Highest level of education

Employer (name and address)

Position

Last year's earnings

Number of prior marriages

How did each marriage end?

Attorney Information

ADDITIONAL INFORMATION

Are there any current court actions pending?

How did you learn about the firm?

Use this page for any additional assets, comments or agreements.

THANK YOU