Law Office of A. Green: Confidential Child Custody/Child Support Involving 4 Children Under 18 y.o.

Law Office of A. Green: Confidential Child Custody/Child Support Involving 4 Children Under 18 y.o.

Name
N/A

Required First Required Middle Required Last
Junior, Senior, II, III, or Etc? *
N/A
Gender *
N/A
DOB *
N/A

dd-MMM-yyyy
Place of Birth *
N/A

City, State, Country
US Citizen *
N/A
Social Security Number *
N/A

This information is needed for court purposes. This information will be kept confidential. Please do not include any dashes or symbols. NUMBERS ONLY!
DL or ID Number *
N/A

This information is needed for court purposes. This information will be kept confidential. Please do not include any dashes or symbols. NUMBERS ONLY!
State for DL or ID
N/A
Home Address
N/A

Required
Street Address Required
Address Line 2 Required City Required State/Region/Province Required
Postal / Zip Code
How long have you lived at the above address? *
N/A
How long have you lived in your County? *
N/A
How long have you lived in Texas? *
N/A
Phone Number *
N/A
Best time of day to contact you by phone *
N/A
Email address *
N/A
How do you prefer to be contacted? *
N/A
Place of Employment *
N/A

Name of your Employer
Address of Employment
N/A

Street Address
Address Line 2 City State/Region/Province
Postal / Zip Code

Country
Work Number
N/A
Job Title
N/A
Gross Monthly Pay USD *
N/A

If the amount is unknown, please type 0
How often are you paid?
N/A
Other Party's Information
Other Party's Name
N/A

Required First Required Middle Required Last
Junior, Senior, II, III, or Etc? *
N/A
Other Party's Gender *
N/A
Other Party's DOB
N/A

dd-MMM-yyyy
Other Party's Place of Birth
N/A

City, State, Country
Other Party: US Citizen
N/A
Other Party's Social Security Number
N/A

This information is needed for court purposes. This information will be kept confidential. Please do not include any dashes or symbols. NUMBERS ONLY!
Other Party's DL or ID Number
N/A

This information is needed for court purposes. This information will be kept confidential. Please do not include any dashes or symbols. NUMBERS ONLY!
State for DL or ID *
N/A
Other Party's Home Address
N/A

Street Address
Address Line 2 City State/Region/Province
Postal / Zip Code

Country
How long has the other party lived in your County? *
N/A
How long has the other party lived at the above address? *
N/A
Other Party's Phone Number
N/A
Other Party's Email address
N/A
How does the other party prefer to be contacted? *
N/A
Other Party's Place of Employment
N/A

Name of your Employer
Other Party's Address of Employment
N/A

Street Address
Address Line 2 City State/Region/Province
Postal / Zip Code

Country
Other Party's Work Number
N/A
Other Party's Job Title
N/A
Other Party's Gross Monthly Pay USD *
N/A

If the amount is unknown, please type 0
How often is the other party paid?
N/A
Emergency Contact
Emergency Contact
N/A

Required First Required Middle Required Last
Relationship to Emergency Contact *
N/A
Address for Emergency Contact
N/A

Street Address
Address Line 2 City State/Region/Province
Postal / Zip Code
Phone Number for Emergency Contact *
N/A
Children Under the Age of 18
1. Child's Name
N/A

Required First Required Middle Required Last
Junior, Senior, II, III, or Etc? *
N/A
1. Child's DOB *
N/A

dd-MMM-yyyy
1. Child's Gender *
N/A
1. Child US Citzen *
N/A
1. Child's Place of Birth *
N/A

City, State, Country
1. Child's Social Security Number *
N/A

This information is needed for court purposes. This information will be kept confidential. Please do not include any dashes or symbols. NUMBERS ONLY!
1. Child's Age *
N/A
1. Child resides at the above address with whom? *
N/A
1. Address of where the child resides:
N/A

Required
Street Address Required
Address Line 2 Required City Required State/Region/Province Required
Postal / Zip Code
1. Child has resided at the above address for how long? *
N/A
1. How long has the child lived in the county? *
N/A
2. Child's Name
N/A

Required First Required Middle Required Last
Junior, Senior, II, III, or Etc? *
N/A
2. Child's Gender *
N/A
2. Child US Citzen *
N/A
2. Child's Place of Birth *
N/A

City, State, Country
2. Child's Social Security Number *
N/A

This information is needed for court purposes. This information will be kept confidential. Please do not include any dashes or symbols. NUMBERS ONLY!
2. Child's Place of Birth *
N/A

City, State, Country
2. Child's Age *
N/A
2. Address of where the child resides:
N/A

Street Address
Address Line 2 City State/Region/Province
Postal / Zip Code

Country

If the address for this child is the same as above, please check same address as above below.
Same address as above *
N/A
2. Child resides at the above address with whom? *
N/A
2. Child has resided at the above address for how long? *
N/A
2. How long has the child lived in the county? *
N/A
3. Child's Name
N/A

Required First Required Middle Required Last
Junior, Senior, II, III, or Etc? *
N/A
3. Child's DOB *
N/A

dd-MMM-yyyy
3. Child's Gender *
N/A
3. Child US Citizen? *
N/A
3. Child's Place of Birth *
N/A

City, State, Country
3. Child's Social Security Number *
N/A

This information is needed for court purposes. This information will be kept confidential. Please do not include any dashes or symbols. NUMBERS ONLY!
3. Child's Age
N/A
3. Address of where the child resides:
N/A

Street Address
Address Line 2 City State/Region/Province
Postal / Zip Code

Country

If the address for this child is the same as above, please check same address as above below.
Same address as above *
N/A
3. Child resides at the above address with whom? *
N/A
3. Child has resided at the above address for how long? *
N/A
3. How long has the child lived in the county? *
N/A
4. Child's Name
N/A

Required First Required Middle Required Last
Junior, Senior, II, III, or Etc? *
N/A
4. Child's DOB *
N/A

dd-MMM-yyyy
4. Child's Place of Birth *
N/A
4. Child's Gender *
N/A
4. Child US Citizen? *
N/A
4. Child's Social Security Number *
N/A

This information is needed for court purposes. This information will be kept confidential. Please do not include any dashes or symbols. NUMBERS ONLY!
4. Child US Citizen? *
N/A
4. Child's Age
N/A
4. Address of where the child resides:
N/A

Street Address
Address Line 2 City State/Region/Province
Postal / Zip Code

Country

If the address for this child is the same as above, please check same address as above below.
Same address as above *
N/A
4. Child resides at the above address with whom? *
N/A
4. Child has resided at the above address for how long? *
N/A
4. How long has the child lived in the county? *
N/A
Additional Information About the Children
Who currently provides health insurance for the children? *
N/A
What is the cost of insuring your children health insurance per month? USD *
N/A
Who currently provides dental insurance for the children? *
N/A
What is the cost of insuring your children dental insurance per month? USD *
N/A
Name of Health Insurance Policy/Company USD *
N/A

For Example Aetna Blue Cross Blue Shield, CHIPS, etc. or None.
Name of Dental Insurance Policy/Company USD *
N/A

For Example Aetna Blue Cross Blue Shield, CHIPS, etc. or None.
Upload a copy of the front of the health insurance card for the children *
N/A
Upload file
Upload a copy of the front of the dental insurance card for the children *
N/A
Upload file
Have the children EVER been on government assistance in Texas or any other state? *
N/A
Has there EVER been a Court Order involving this/these children? *
N/A
If YES, please list the Year, State, County, Cause Number, and Type of Case
N/A
Has the Texas Attorney General EVERY been involved with the children in this case? *
N/A
If YES, please list the Year, State, County, Cause Number, and Type of Case
N/A
Do the children own any property? *
N/A
if yes, explain what property the children own?
N/A
Do/does the children have any physical or mental disability? *
N/A
If the child(ren) do/does have a physical or mental disability, please explain:
N/A
Has the other party signed the children's birth certificate or an Acknowledgment of Paternity *
N/A
If YES, please explain:
N/A
Has a DNA test been performed? *
N/A
If YES, what were the results
N/A
Additional Information About Parties
Are you in the military? *
N/A
Is the other party in the military? *
N/A
Have you or any other person seeking custody of the child(ren) ever been accused of, or commited acts of family violence? *
N/A
If YES, please explain:
N/A
Have you or any other person that may be seeking custody/visitation with the child(ren) ever been accused of, or found guilty of neglect or abuse? *
N/A
If YES, please explain:
N/A
Have you ever been charged with any crime other than traffic tickets? *
N/A
If YES, please explain:
N/A
Has your spouse ever been charged with any crime other than traffic tickets? *
N/A
If YES, please explain:
N/A
Are there other circumstances, which may be a factor in your potential case? *
N/A
If YES, please explain:
N/A
Have you been served with papers/lawsuit? *
N/A
If YES, when is the court date?
N/A
Does your case involve any of the allegations below:
Physical Violence *
N/A
Has a Protective Order ever been issued? *
N/A
If YES, please explain:
N/A
Physiological or Mental Abuse *
N/A
Criminal Record *
N/A
Excessive Alcohol Use *
N/A
Use of Illegal Drugs *
N/A
Child Abuse *
N/A
Stalking
N/A
Have you or anyone asociated with this case every been the subject of any of the following below?
Protective Order *
N/A
Restraining Order *
N/A
Child Protective Services Investigation *
N/A
Mental Health Professional Treatment *
N/A
Questionable Paternity Status *
N/A
Gestational Agreement *
N/A
Self/at-home insemination *
N/A
Substance Abuse Treatment *
N/A
Welfare or Aid Families with Dependent Children *
N/A
Termination of Parental Rights *
N/A
If YES to any of the following above, please explain:
N/A
Please Uploaded Picture of Yourself for Your File *
N/A
Upload file
How Did You Hear About Us? *
N/A
Event: Let us know which one so we can honor any discounts.
N/A

List the event you attended.
Word of Mouth: Let us know who, so we can send a thank you note.
N/A

List the person's name.
Other: Let us know
N/A

Law Office of A. Green: Confidential Child Custody/Child Support Involving 4 Children Under 18 y.o.

Other Party's Information

Emergency Contact

Children Under the Age of 18

Additional Information About the Children

Additional Information About Parties

Does your case involve any of the allegations below:

Have you or anyone asociated with this case every been the subject of any of the following below?

Error Occurred

Link to resume this form later:

Turn on the camera permission in your browser to continue further