Proposed Client Intake Sheet-General

PROPOSED CLIENT INTAKE SHEET

DATE:

PERSONAL INFORMATION

FULL NAME:________________________________________________

SOCIAL SECURITY NUMBER: BIRTH DATE:________________________

CITIZENSHIP: MARITAL STATUS:______________________________

HOME ADDRESS: ___________________________________________

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COUNTY OF RESIDENCE:____________________________________

HOME TELEPHONE:   ____________________

HOME FACSIMILE:    ____________________

OTHER CONTACT#:   ____________________

HOME E-MAIL: ____________________________________________

OCCUPATION: _____________________________________________

EMPLOYER: _______________________________________________

BUSINESS ADDRESS:_________________________________________ _________________________________________________________

 

BUS TELEPHONE:       ____________________

BUS FACSIMILE:        ____________________

OTHER CONTACT#:   ____________________

BUSINESS E-MAIL: __________________________________________

SPOUSE’S INFORMATION

FULL NAME:_______________________________________________

SOCIAL SECURITY NUMBER: ____________ BIRTH DATE:___________

NATURE OF LEGAL MATTER

Please describe the reason for you need for legal assistance.  Facts should include who, what where, when information.  Please attach additional sheets if necessary.

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WITNESSES – OTHER PARTIES

Please list all witnesses and other persons having knowledge of facts relevant to you legal matter.

NAME                     RELATION                  ADDRESS                     WITNESS?

________              __________                   ______________        ___________

________              __________                   ______________        ___________

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PROPOSED DEFENDANTS

If you legal matter involves a potential defendant, please provide name and address.

NAME

__________________

ADDRESS

____________________________

 

 

 

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WORK ADDRESS

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OTHER MATTERS

Please state any other matters relevant to your case that you would like to state.

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Please bring this Intake sheet with you to your appointment.


Inside Proposed Client Intake Sheet-General