Where do the child/ren live now?
With whom do they live: __________________________________________________
Address: _______________________________________________________________
How long have they lived there: _____________________________________________
Where did the children live before: ___________________________________________
How long did they live there: ________________________________________________
Where and with whom do you think the children should live: ______________________
________________________________________________________________________
________________________________________________________________________
Is there someone other than the Mother or Father who the child/ren lives with?
No Yes (if yes, please provide name(s) and relationship).
Name: _________________________ Relationship: _____________________________
Name: _________________________ Relationship: _____________________________
Names of other extended family with significant ties to the child:
Name: _________________________Relationship:______________________________
Name: _________________________Relationship:______________________________
Name: _________________________Relationship:______________________________
Name: _________________________Relationship:______________________________
Name: _________________________Relationship:______________________________
Name: _________________________Relationship:______________________________
Name: _________________________Relationship:______________________________
Custody Plan:
Have the parties already agreed on a child-custody plan?
No Yes (If yes, please explain):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Marriage Information:
Date of Marriage: ________________________________________________________
Location of Marriage: _____________________________________________________
Date of Separation: _______________________________________________________