Intake Form - Cohabitation Agreement / Marriage Contract - Lauraverdin Notary Public

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55 Main Street West
Huntsville, ON
P1H 1W9
Telephone: (705) 787-0077
Fax: (705)787-0577
Email: laura@verdinlaw.ca
Intake Form – Cohabitation Agreement/ Marriage Contract
NOTE: THIS DOCUMENT IS STRICTLY CONFIDENTIAL AND WILL ONLY BE SEEN BY THIS
OFFICE. While some of the information that I request may seem irrelevant, it is necessary
in order to help me develop a complete and accurate picture of your current situation so
that I can fully advise you.
PERSONAL INFORMATION:
Name:
____________________________________________________________
Current address:
Street/Apt. No.
City
Postal Code
Home Phone:
Work Phone:
Where would you like mail to be sent?
Same as above
Or:
E-mail address:
Can confidential information be sent to this e-mail address?
Yes
No
Your occupation:
____________________________________________________________
Name and address of your employer: ___________________________________________________________
Your approximate income:
55 Main Street West
Huntsville, ON
P1H 1W9
Telephone: (705) 787-0077
Fax: (705)787-0577
Email: laura@verdinlaw.ca
Intake Form – Cohabitation Agreement/ Marriage Contract
NOTE: THIS DOCUMENT IS STRICTLY CONFIDENTIAL AND WILL ONLY BE SEEN BY THIS
OFFICE. While some of the information that I request may seem irrelevant, it is necessary
in order to help me develop a complete and accurate picture of your current situation so
that I can fully advise you.
PERSONAL INFORMATION:
Name:
____________________________________________________________
Current address:
Street/Apt. No.
City
Postal Code
Home Phone:
Work Phone:
Where would you like mail to be sent?
Same as above
Or:
E-mail address:
Can confidential information be sent to this e-mail address?
Yes
No
Your occupation:
____________________________________________________________
Name and address of your employer: ___________________________________________________________
Your approximate income:
From employment:
From other sources:
Your birth date:
___________________________________________________________
Your birthplace:
__________________________________________________________
When did you begin to reside in Ontario? _____________________________________________________
YOUR SPOUSE / PARTNER:
Spouse/ partner’s full name:
Spouse/ partner’s address:
Your spouse/ partner’s occupation:
Name and address of spouse/ partner’s employer:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Spouse/ partner’s approximate income:
From employment:
From other sources:
Spouse/ partner’s birth date:
Spouse/ partner’s birthplace:
When did your spouse/ partner begin
to reside in Ontario?
Does your spouse/ partner have a lawyer?
Yes
No
Lawyer’s Name:
Lawyer’s Telephone Number:
DETAILS OF RELATIONSHIP:
Date you began living together:
______________________Place:_______________________
Date of Marriage, if applicable: _______________________________________ Place:_______________________
Have you been married before?
If yes:
Date of previous divorce:
Place of previous divorce:
Do you have a copy of the Certificate
of Divorce or the Divorce Judgment?
Yes
No
What was your surname
during that marriage?
Has your spouse/ partner been married before?
Yes
No
If yes:
What was your spouse/ partner’s surname
during that marriage?
___________________________________________________________________
Date of previous divorce:
Place of previous divorce:
Do you have a copy of the Certificate
of Divorce or the Divorce Judgment?
Yes
No
CHILDREN:
Name(s)
Age
Birth date
Now living with
CURRENT LIVING ARRANGEMENTS:
Address of the home you are both living in or intend to live in:
Whose names is on title to the home: ____________________________________________________________________
How is title to the home held?:
Joint Tenants
Tenants in Common
Sole
Approximate value: ___________________________________________________________________________________________
Amount owing on any Mortgages:____________________________________________________________________________
OTHER MAJOR ASSETS:
Description
Owned by
Approximate Value
you/spouse?
DEBTS:
Description
Owned by
Approximate Value
you/spouse?
Please make note of any other details you would like to provide:
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________

Download Intake Form - Cohabitation Agreement / Marriage Contract - Lauraverdin Notary Public

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