Family Law Intake | Joseph A. McMillen, Attorney at Law

Your Information

First Name *

Middle Name

Last Name *

Other Names Used (maiden, prior married)

Do you wish to change your name? If so, to what?

Date of Birth (YYYY-MM-DD) *

Social Security Number

Phone (Mobile) *

Email Address *

Other Phone Number

Current Address (Street, City, State, ZIP, County) *

Years of Missouri Residency

Place of Birth (City, State)

Highest Education Completed

Employer Name & Address

Occupation & Work Phone

Spouse / Other Parent Information

Full Legal Name *

Other Names Used

Date of Birth

SSN (if known)

Phone (if known)

Current Address (if known)

Email Address (if known)

Employer & Address (if known)

Occupation & Work Phone (if known)

Place of Birth (if known)

Years of Missouri Residency (if known)

Marriage & Relationship Information

Date of Marriage (if applicable)

Place of Marriage (City, County, State)

Date of Separation

How many times have you been married (including this one)?

How many times has your spouse been married (including this one)?

If you were married before — how and when did it end?

If spouse was married before — how and when did it end?

Is wife currently pregnant?

Yes No

Children of This Relationship

Complete one block per child. Provide information for each child of this relationship only.

Child 1

Full Name

Date of Birth

Gender

SSN (last 4 OK)

City & State Born

Address where child presently lives

Missouri residency ≥ 6 months?

Yes No

Prior custody orders or cases?

Yes No

If yes, briefly explain

Child 2 (if applicable)

Full Name

Date of Birth

Gender

SSN (last 4 OK)

City & State Born

Address where child presently lives

Child 3 (if applicable)

Full Name

Date of Birth

Gender

Additional children — names, DOBs, and any relevant details

Parenting & Custody Information

Your proposed custody arrangement

Spouse/other parent's proposed arrangement (if known)

Any concerns about the other parent's ability to care for the children?

Yes No

Any history of domestic violence, abuse, or neglect?

Yes No

Describe each parent's involvement with the children (school, medical, extracurricular, daily routines)

Property & Financial Information

Note: We only need detailed financial documents if you anticipate a contested case involving property disputes. If you are in agreement on division of property and debts, a brief overview is sufficient.

Marital residence address & approximate value / mortgage balance

Other real estate (address / value / loan balance / whose name)

Vehicles (year / make / model / titled to / value / amount owed)

Retirement accounts (type / whose name / approximate value)

Bank accounts (bank name / type / whose name / balance)

Debts (credit cards / loans / medical / etc., with approximate balances)

Business ownership (name / type / value / ownership interest)

Other significant assets or items that need to be divided

Support & Maintenance

Do you wish to request child support?

Yes No

Do you wish to request maintenance (spousal support)?

Yes No

Do you have health insurance for the children?

Yes No

Provider and cost per month (if yes)

Do you wish for your spouse to maintain health insurance for the children?

Yes No

Attorney Fees & Additional Information

Are you requesting that your spouse pay any portion of your attorney fees?

Yes No

Any pending or prior court cases involving you, your spouse, or children? (divorce, custody, juvenile, protection orders)

Yes No

Any current safety concerns?

Yes No

Any other information you believe is relevant to your case

Certification & Submission

By typing your name below and clicking Submit, you certify that the information provided is true and correct to the best of your knowledge. This form does not create an attorney-client relationship.

I certify that the information provided in this intake form is true and correct to the best of my knowledge.

Electronic Signature (type your full legal name) *

Today's Date *

⚠ Your information will be sent securely to Joe McMillen (joe@bolivarlawoffice.com) and Tiffany Rowell (tiffany@bolivarlawoffice.com). Do not include information you do not want transmitted electronically — you may also bring a completed printed copy to your appointment. This form does not create an attorney-client relationship.

✓ Intake Form Submitted

Thank you. Your family law intake has been sent to Joe and Tiffany. They will be in touch within one business day. If you have an urgent matter, please call (417) 298-9661 directly.

Family Law IntakeDissolution, Custody & Support

Your Information

Spouse / Other Parent Information

Marriage & Relationship Information

Children of This Relationship

Child 1

Child 2 (if applicable)

Child 3 (if applicable)

Parenting & Custody Information

Property & Financial Information

Support & Maintenance

Attorney Fees & Additional Information

Certification & Submission

✓ Intake Form Submitted

Family Law Intake
Dissolution, Custody & Support