Questionnaires

Please start with the Free Consultation first.

The Questionnaire has been broken down to small sections. Any question skipped will be asked once again - so please save time by entering all information the first time. Once I review it, I immediately let you know the next step.

If an attorney has reviewed your case and referred you, you are welcome to pay. If not, please wait to pay until I have reviewed your entries. Please text or call 757-932-7422 for the fastest response. I cannot legally tell you your answers.

Once you pay and notify me you have paid and completed the questionnaires, I will prepare the first draft for your review within 2 business days.

QUESTIONNAIRE 1 of 4 - Introduction

Family Law Questionnaire Introduction

Name*

Phone*

Email Address*

Address

City State AND Zip Code

County

Other Parties' name

Do you have case file?

If yes, What county? Case Number, if known.

Date Married, if married

Date Separated, if married

What type of Case are you asking for?

	Dissolution of Marriage
	Dissolution of Domestic Parnership
	Legal Separation of Marriage
	Legal Separation of Domestic Partnership
	Nullity of Marriage
	Nullity of Domestic Partnership
	Never married - Establish Parental Rigths

Grounds for Dissolution of Marraige

	Irreconcilable Differences
	Incurable Insanity

Ground for Nullity

	Incest
	Bigamy
	Underage
	Prior Existing
	Unsound Mind
	Fraud
	Force
	Incapacity

Legal Relationship

	We are married.
	We are domestic partners and our domestic partnership was established in California.
	We are domestic partners and our domestic partnership was NOT established in California.

Residential Requirements

	Petitioner has been a resident of this state for at least six months and of this county for at least three months immediately preceding the filing of this Petition.
	Respondent has been a resident of this state for at least six months and of this county for at least three months immediately preceding the filing of this Petition.
	Our domestic partnership was established in California. Neither of us has to be a resident or have a domicile in California to dissolve our partnership here.
	We are the same sex, were married in California, but currently live in a jurisdiction that does not recognize, and will not dissolve, our marriage. This Petition is filed in the county where we married.

Minor Children ENTER ALL DATA Name, Birthdate, Age

Petitioner and Respondent signed a voluntary declaration of parentage or paternity.

	Yes
	No

CHILD CUSTODY

	Legal custody to PETITIONER
	Legal custody to RESPONDENT
	Legal custody JOINT
	Physical custody to PETITIONER
	Physical custody to RESPONDENT
	Physical custody JOINT

CHILD VISITATION

	Form FL-311
	Form FL-312
	Form FL-341(C)
	Form FL-341(D)
	Form FL-341(E)
	Attachment 6c(1)

CHILD SUPPORT

	See emailed notes
	Only what is on the Petition

SPOUSAL / DP SUPPORT

	Spousal or domestic partner support payable to PETITIONER
	Spousal or domestic partner support payable to RESPONDENT
	Spousal or domestic partner support payable to BOTH
	Terminate (end) the court's ability to award support to PETITIONER
	Terminate (end) the court's ability to award support to RESPONDENT
	Terminate (end) the court's ability to award support to BOTH
	Reserve for future determination the issue of support payable to PETITIONER
	Reserve for future determination the issue of support payable to RESPONDENT
	Reserve for future determination the issue of support payable to BOTH

SEPARATE PROPERTY

	NONE
	Will provide a Property Declaration FL-160
	Will provide an Attachment 9b

COMMUNITY PROPERTY

	NONE
	Will provide a Property Declaration FL-160
	Will provide an Attachment 10b

PETITIONER'S NAME RESTORED TO

QUESTIONNAIRE 2 of 4 - Questionnaire Declaration for Uniform Child Custody Jurisdiction Enforcement Act

Declaration UCCJEA (one per child)

Name*

Phone*

Email Address

Number of Children

Child

	This questionnaire is for Child 1.
	This questionnaire is for Child 2.
	This questionnaire is for Child 3.
	This questionnaire is for Child 4.
	This questionnaire is for Child 5.
	This questionnaire is for Child 6.

Child's Name

Relationship to Filer

City, State of Birth

Date of Birth

Sex

	Male
	Female

Child's Current Primary Address

THIS ADDRESS IS CONFIDENTIAL

	Yes.
	No. The other parent already has this.

Your previous five years complete addresses with move in & out dates

Other Proceedings

	There has never been a proceeding with this child.
	I will carefully read line 4 & 5 of the FL-105
	A guardianship case is on file
	A restraining order case is on file.
	A juvenile delinquency case is on file.
	An adoption file is on file.
	A criminal case is on file.
	I have information regarding another case. case to provide.

Other Parties

	Someone else has physical custody.
	Someone else has custody rights.
	Someone else has visitation rights.
	I will carefully read line 6 and provide information.

QUESTIONNAIRE 3 of 4 - Participant Enrollment Form

QUESTIONNAIRE 4 of 4 - Income & Expense Declaration

Income & Expense Declaration Questionnaire (2of2)

Name*

Phone*

Email Address

Required Union Dues

Employer

Employer's Address

Employer's Phone

Occupation

Date Started

If unemployed, date job ended

Hours Worked Per Week

Gross Pay (before taxes) each check

Age

Pay Checks

	Daily
	Every 7 days
	Every 14 days
	Twice A Month (such as 1st & 15th)
	Monthly
	Other (I will supplement)

My highest education completed

College Degree obtained, if any

Graduate Degree obtained, if any

Professional or Occupational License(s), if any

Last Year I filed taxes

Filing Status Last Used

	Single
	Married Filing Joint
	Married Filing Separate
	Head of Household

I filed a state tax return

	Yes
	No

Total Exemptions Claimed including myself

Other Party's estimated gross taxes and source

Vocational Training, if any

Required retirement payments (not taxes)

Medical, hospital, dental, & other health insurance premium

Child support that I receive for children (not this relationship)

Spousal support from a different marriage

Partner support thatI received from a different domestic partnership

Necessary job-related expenses - what for and how much monthly

How much money in deposit accounts do you hold?

How much in stocks, bonds, and other assets

Total value of Real Estate and Personal property less the amount you owe

1. Name, age, and relationship of dependents and Gross Income

#1 Expenses

	They pay household expenses
	They do not pay household expense

2. Name, age, and relationship of dependents and Gross Income

#2 Expenses

	They pay household expenses
	They do not pay household expenses

3. Name, age, and relationship of dependents and Gross Income

#3 Expenses

	They pay household expenses
	They do not pay household expenses

4. Name, age, and relationship of dependents and Gross Income

#4 Expenses

	They pay household expenses
	They do not pay household expenses

5. Name, age, and relationship of dependents and Gross Income

#5 Expensees

	They pay household expenses
	They do not pay household expenses

How did you calculate your expenses

	Estimated Expenses
	Actual Expenses
	Proposed Expenses

Rent

Mortgage

Real Estate Taxes if not included in payment

Home owner's or Renter's Insurance

Utilities (gas, electric, water, trash)

Health-care costs not paid by insurance

Telephone, cell phone, and e-mail

Child Care

Groceries and household supplies

Eating out

Laundry and cleaning

Clothes

Education

Entertainment, gifts, and vacation

Auto expenses & transportation (ins, gas, repairs, bus, etc)

Insurance (life, accident, etc - NOT auto, home, health)

Savings and Investments

Charitable Contributions

Any other payments - to whom and how much

Number of Children under 18 in my car

Percentage of time with me

Percentage of time with other party

(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)

Health Care

	I do have health insurance through my job
	I do NOT have health insurance through my job

Name of insurance company

Address of insurance company

The monthly cost for the children's health insurance is or would be (specify): $

Childcare so I can work or get job training

. Children's health care not covered by insurance

20. Other information I want the court to know concerning support in my case

Home
- Contact Us
- Resources
Reviews
Buyer's Information
Sellers Information
- What's Your Home Worth?
Specialties
Business Verification Resources
RSS/Blog

Rica Gilmore, 757-932-RICA, VA #0225235314 GA #401322 NC #305512

Lance Mason, 478-744-1257 GA Real Estate Agent #428771

Sean Gilmore, VA Real Estate Agent #0225246258

Laurinda Mason, Project Manager and Transaction Coordinator

FIRM - Rica Realty VA #0226034555

FIRM - Rica Gilmore Realty GA #81053

FIRM - Rica Realty #305512

144 Shoe Lane, Newport News, VA 23606 - 1 (757) 932-RICA

Current Affiliates Business Arrangements and Family Businesses

Rica Gilmore is a Morty Loan Originator and Real Estate Broker (VA, NC, GA)

NMLS ID# 2549170 Morty's NMLS ID# 1429243

Rica Realty is a family business and agents are related. Lance Mason is Rica Gilmore's son-in-law. Laurinda Mason is Rica Gilmore's Daughter. Lance and Laurinda Mason are married.

This website contains information related to law and is NOT LEGAL advice. It contents is for information only. If you need legal advice, please consult an attorney or act as your own.

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in
FL Participant Enrollment Form

Name*
Phone*
Email Address
*
Email for the court to create an account

Questionnaires

Family Law Questionnaire Introduction

Declaration UCCJEA (one per child)

FL Participant Enrollment Form

Income & Expense Declaration Questionnaire (2of2)