James E.Smith, ESQ.

Name, address, phone number, e-mail and date of birth for husband

Name *

Address *

Phone Number *

Email Address *

Date of Birth for husband *

Name, address, phone number, e-mail and date of birth for wife

Name *

Address *

Phone Number *

Email Address *

Date of Birth for wife *

Name and address of your resident witness?

Name *

Address *

Name and birthdates of any children between husband and wife

Name *

Date of Birth for children *

Name

Date of Birth for children

Are you requesting child support, if so how much?

Are you requesting alimony, if so, now much?

Date and place of marriage

Date *

Place *

How long have husband or wife have lived in Nevada?

6 weeks

6 months

More than 6 weeks

Has your resident agent seen you in Nevada every week for the last 6 weeks?

Yes

Do you have a pre or post-nuptial or separation agreement?

Yes

Have you filed bankruptcy in the last 3 years?

Yes

What name wife wants after marriage

Name *

Is wife pregnant?

Yes

Who gets custody and what is the proposed visitation

Name *

Proposed visitation *

Who pays what community debts

Name *

what community debts *

Who gets what community property

Name *

what community property *

Note: I will need the social security number of husband and wife and this can be given to me by phone.

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