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Questionnaire

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Section 1 of  3

Please review Colorado EZ DOCS' Frequently Asked Questions before you attempt to complete this Questionnaire.

 

Petitioner Information

(person starting the case)

 

 
Last Name:

First Name:
Middle Name:

Maiden Name:
Date of Birth:

Social Security Number:

Home Address:

City:

State:

Zip Code:

County:

 

Mail Address:

City:

State:

Zip Code: 

 
Lived In Colorado (yrs):    
Employer:

Title:

Monthly Gross Income:

Work Address:

City:

State:

Zip Code:

Years Employed:

Email:

 
Work Phone:

Home Phone:

 
Fax:

Cell Phone:

 

     

Co-Petitioner or Respondent Information

(person responding to the court)

 

       
Last Name: First Name: 
Middle Name: Maiden Name: 
Date of Birth: Social Security Number

Home Address:

City:

State:

Zip Code:

County:

 

Mail Address:

City:

State:

Zip Code:

Lived In Colorado (yrs):    
Employer:

Title:

Monthly Gross Income:

Work Address:

City:

State:

Zip Code:

Years Employed:

Email:

 
Work Phone:

Home Phone:

 
Fax:

Cell Phone:

 
       
       

Marital / Divorce Information

(current status of marriage)

       
       
Date Married:

Type of Marriage:

Place of Marriage (City):

State:

Zip Code:

How long lived together:

# of Months Separated:

Date Separated (Mth/Yr):

Place of Separation (City/State):

Name After Divorce:

New Name:

Is wife pregnant?:

Who is the father? 

 Who wants support?

Support Agreement?:

Legal Proceeding?:

Restraining Order?:

If your answer was "Yes" to Domestic abuse, Restraining Orders, complete the following:

Restraining Order Info.:

Order Issued Against:

Order Issued By (County):

State:

Case Number:

Why was Order issued?:

 

IF THERE ARE NO CHILDREN OF THE MARRIAGE

SKIP TO SECTION  2

Section 2 of  3

     

 

Child Support Information

  Details about children of the marriage.

Name   

Present Address

Sex

Date of Birth

Soc. Sec. No.

(attach a second sheet, if necessary)

 

Have the parents/guardians participated in the following proceeding about the child(ren) as a party or a witness, or in any other capacity concerning the custody/allocation of decision-making, or visitation/parenting time determination with the child(ren)? If any, state court, case number, state, date of child-custody:

 

Are there any proceeding for enforcement, proceedings relating to domestic violence or domestic abuse, protection/restraining orders, termination of parental rights, and adoptions that could affect the current proceeding?  If so, state the court, case number, state, nature of proceeding.

 

The following people are not parties in this matter, but have physical custody of the child(ren) or claim rights of parental responsibilities, legal custody or physical custody, or visitation/parenting time with the child(ren) (names and addresses of those persons):

 

List the child(ren) address(es) where they have lived over the past five years:

 

List the name(s) and present address(es) of the person/people with whom the child (ren) has/have lived over the past five years are:

 

    Has there been any Human Services Involvement?     

Have the parents or dependent child(ren) listed on this Petition has/have received within the last five years, or is/are currently receiving benefits or public assistance from the state Department of Human Services or the county Department of Social Services. If you checked Yes, answer the following:

Provide details about the children receiving public assistance.

Name of Person Receiving Benefit     

Name of  County or State

Sex

Date of Birth

Case Number

 

 

If you have already come to an agreement about the child(ren), or about support, please list that information here:

 

Section 3 of  3

 

 

RELIEF YOU ARE REQUESTING FROM THE COURT

(details about "What you want the Court to do.")

 

What orders do you want the court to consider in the divorce?

Status of the marriage

Best interests of the child(ren)
Orders for maintenance Orders for child support
Division of property and debts Attorney fees and costs
Restoration of the previous name of a party  

Any other legal orders:  

 

Comments or Special Instructions

 

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