Client Information Card
 Our Family, Divorce & Custody Attorneys near Albany and Schenectady, New York
Divorce, Child Support & Family Law - Attorneys in Glenville, New York
Family Law, Divorce, Child Support, and Custody in the Albany, Saratoga Area
Contact Gordon, Tepper, DeCoursey - Family Law Attorneys
Family Law & Divorce Attorneys in the Albany, Saratoga, New York Area

 

Client Information

* indicates a required field

 
Last name:
*First Name, MI:
Address:
D.O.B.:
State of Birth:
Maiden Name ( if applicable):
Date of marriage:
SS#:
Home Phone:
Work Phone:
*Email Address:
Employer Name:
Employer Address:
Gross Earnings (specify by week, month, year):
Other gross income (specify source and amount by week, month, year):
Number of this marriage (if applicable):
Highest grade level completed:
Are you in the military:

 

Spouse (or other party ) Information

Last name:
First Name, MI:
Address:
D.O.B.:
State of Birth:
Maiden Name ( if applicable):
Number of this marriage (if applicable):
SS#:
Home Phone:
Work Phone:
Employer Name:
Employer Address:
Work Phone:
Gross Earnings (specify by week, month, year):
Other gross income (specify by source and amount by week, month, year):
Highest grade level completed:
Is this party in the military:

 

Your Nearest Relative Information

Name:
Address:
Relationship:
Home Phone:

 

Child(ren) Information

Names
Social Security
Date of Birth

Addresses of the children for the last (5) years, and all other places where child has lived, and with whom they have resided.

Child(ren) name(s)
Present Address

 

Child(ren) name(s)
Other addresses within last 5 years:

 

Medical Plan(s) Information

Client:
Group Health Plan:
Address:
Identification No.:
Plan Administrator:
Type of coverage:
 
Spouse (ex-spouse) or other party:
Group Health Plan:
Address:
Identification No.:
Plan Administrator:
Type of Coverage:

Turn to our family law and divorce attorneys in the Albany and Saratoga, New York area, for dependable consideration of your situation. Gordon, Tepper & DeCoursey has earned the highest possible peer rating ("AV") by Martindale Hubbell. Prior results do not guarantee a similar outcome.

Home | Our Attorneys | Divorce & Family Law | Areas of Practice | Contact Us | Site Map

Socha Plaza South | 113 Saratoga Road, Route 50 | Glenville, NY 12302 | 866.791.0122
Website developed by Einstein Law