Court Questionnaire {1.1}

A/DR E / Z# DATE FILED MUST BE TYPED AND COMPLETED IN FULL CHECK CAUSE: COURT USE ONLY Court of Common Pleas of Hamilton County Division of Domestic Relations DIVORCE DISSOLUTION LEGAL SEPARATION ANNULMENT ______ (A) PREVIOUS UNDISSOLVED MARRIAGE ______ (B) WILLFUL ABSENCE FOR 1 YEAR ______ (C) ADULTERY ______ (D) EXTREME CRUELTY ______ (E) FRAUDULENT CONTRACT ______ (F) GROSS NEGLECT OF DUTY ______ (G) HABITUAL DRUNKENNESS ______ (H) IMPRISONMENT IN PENITENTIARY ______ (I) DEFENDANT DIVORCED IN OTHER STATE ______ (J) LIVING APART FOR 1 YEAR ______ (K) INCOMPATIBILITY ______ (L) OTHER SH. PAR. (CIRCLE ONE) HUSBAND PLAINTIFF / DEFENDANT / PETITIONER NAME: ______________________________________________________________ LAST FIRST MIDDLE (CIRCLE ONE) WIFE PLAINTIFF / DEFENDANT / PETITIONER NAME: __________________________________________________________________ LAST FIRST MIDDLE ADDRESS ___________________________________________________________ ____________________________________________________________________ CITY STATE ZIP ADDRESS ________________________________________________________________ __________________________________________________________________________ CITY STATE ZIP PHONE:______________________________________________________________ HOME WORK PHONE: __________________________________________________________________ HOME WORK SS# __________________________ PRESENT AGE ___________ D.O.B._________________ SS# ___________________________ PRESENT AGE __________ D.O.B. ______________________ ATTORNEY'S NAME & PHONE ________________________________________________ ATTORNEY'S ADDRESS ______________________________________________________ ATTORNEY'S I.D. NUMBER ___________________________________________________ ATTORNEY'S NAME & PHONE ____________________________________________________ ATTORNEY'S ADDRESS __________________________________________________________ ATTORNEY'S I.D. NUMBER _______________________________________________________ HUSBAND RACE: Caucasian Native Am. African Am. Hispanic Asian Other SOCIAL HISTORY RACE: Caucasian Native Am. African Am. WIFE Hispanic Asian Other EDUCATION High School: College(s) ­ Tech. School Grade Completed: PRESENT OCCUPATION: EDUCATION High School: College(s) ­ Tech. School Grade Completed: PRESENT OCCUPATION: NAME OF EMPLOYER: ADDRESS: POSITION HELD: WEEKLY EARNINGS: Gross $ Net $ OTHER INCOME (Amount): $ PARENTS NAME: Mother: ______________________________________________________________ Father: _______________________________________________________________ Marriage Date _________________________ Place___________________________ Date of Separation ______________________________________________________ DR 1.1 (Revised 01/01/2015) NAME OF EMPLOYER ADDRESS: POSITION HELD: WEEKLY EARNINGS: Gross $ Net $ OTHER INCOME (Amount): $ PARENTS NAME: Mother: ___________________________________________________________________ Father: ____________________________________________________________________ Final Hearing Disposition_____________________________ Date____________________ Granted __________________________ To Whom________________________________ Page 1 American LegalNet, Inc. www.FormsWorkFlow.com MINOR CHILDREN OF PRESENT MARRIAGE NAME 1. 2. 3. 4. HUSBAND'S FORMER MARRIAGES / CHILDREN WIFE'S FORMER MARRIAGES / CHILDREN SEX DATE OF BIRTH SOC. SEC. NO. LIVING WITH REMARKS NAME DIVORCED DECEASED NAME DIVORCED DECEASED HUSBAND'S FORMER WIVES 1._______________________________ 2._______________________________ 3._______________________________ ________________ ________________ ________________ ______________ ______________ ______________ WIFE'S FORMER HUSBANDS 1.________________________________ 2.________________________________ 3.________________________________ ________________ ________________ ________________ _______________ _______________ _______________ NAME OTHER PARENT AGE NAME OTHER PARENT AGE CHILDREN OF HUSBAND 1._______________________________ 2._______________________________ 3._______________________________ ________________ ________________ ________________ ______________ ______________ ______________ CHILDREN OF WIFE 1._________________________________ 2._________________________________ 3._________________________________ ________________ ________________ ________________ _______________ _______________ _______________ DR 1.1 (Revised 01/01/2015) Page 2 American LegalNet, Inc. www.FormsWorkFlow.com