JARRETTE & WALMSLEY

120 El Paseo, Santa Barbara, CA 93101 (805) 338-2155 fax (805) 845-7705 Marlea F. Jarrette Robert R. Walmsley

CONFIDENTIAL CLIENT QUESTIONNAIRE Husband:___________________________________________________________________________

(Last) (First) (Middle)

Wife:

___________________________________________________________________________
(Last) (First) (Middle)

Address: ___________________________________________________________________________
(Number and Street) (Apt. No.) (City) (State & Zip)

____________________ Home Phone: _____________________ Home Fax: ______________________

(County of Residence) Email Address: (his)____________________________________ Email Address: (hers)___________________________________ Cell Phone: (his) ________________________ Cell Phone: (hers) _____________________________

BUSINESS Husband
(Company Name) (Address) (City, State, Zip) (Area Code - Phone) (Fax Number) (Company Name) (Address) (City, State, Zip) (Area Code - Phone) (Fax Number)

Wife

EMERGENCY CONTACT
(someone who will always know where you are/how to reach you) Name: Address: Relation: Phone.:

PERSONAL DATA Husband Age: Birth date: Birthplace: Hair: Eyes: Weight: Height: SSN: Drivers Lic. No: Complexion: Religion: Occupation: National Ancestry: Hobbies: Age: Birth date: Birthplace: Hair: Eyes: Weight: Height: SSN: Drivers Lic. No: Complexion: Religion: Occupation: National Ancestry: Hobbies: Wife

City/Count of Marriage: __________________________ Date of Marriage: ______________________ EDUCATION

Husband High School College Other Wife High School College Other Name of School No. of Years Degrees and Dates Name of School No. of Years Degrees and Dates

GENERAL FINANCIAL
Husband Wife

Average Annual Gross Income:

Average Annual Gross Income:

OTHER CHILDREN
(Please "star" Name of any adopted children) Name Age Birth date

PRIOR MARRIAGES
(If more than one prior marriage, provide additional info. below or on reverse.) Husband Name of Prior Spouse: Marriage Date/Place No. of Children: How Marr. Terminated: Date/County of Termination: Wife Name of Prior Spouse: Marriage Date/Place No. of Children: How Marr. Terminated: Date/County of Termination:

CRIMINAL HISTORY
(Please indicate, even if matter was dismissed or expunged. Explain all "yes" answers where provided) Husband Have you ever been arrested? If yes, provide: Date of arrest: Reason for arrest: City/County of arrest: Have you ever been convicted of a crime? If yes, provide: Date of crime: Conviction for: City/County of conviction: Has there been any child abuse registry reports/complaints made against you? Wife Have you ever been arrested? If yes, provide: Date of arrest: Reason for arrest: City/County of arrest: Have you ever been convicted of a crime? If yes, provide: Date of crime: Conviction for: City/County of conviction: Has there been any child abuse registry reports/complaints made against you?

ADDITIONAL PERSONAL HISTORY

Husband Been in bankruptcy? Been in a mental hospital? Had psychotherapy? Received other than an honorable discharge from military service? Been turned down by an adoption agency? Placed a child for adoption? Are you past due on any court ordered installment of child support? Wife Been in bankruptcy? Been in a mental hospital? Had psychotherapy? Received other than an honorable discharge from military service? Been turned down by an adoption agency? Placed a child for adoption? Are you past due on any court ordered installment of child support?

Describe the reason you are seeking legal counsel: 3

_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ I/We understand the importance of fully and accurately completing the above information as this information may be material in the matter for which we have consulted the Law Office of Jarrette & Walmsley. Therefore, we state that the foregoing is true and correct. Should any of the foregoing information change I/we will immediately advise the Law Office of Jarrette & Walmsley of such change.

Dated: ______________________________

Husband

Wife