FORM MUST BE FILLED OUT COMPLETELY

Have you read Required Information:  Uncontested Divorces?  Yes No

Client is WIFE HUSBAND

Contact Information:

Please provide the following information for WIFE: (Required under Tennessee Law)

Full Name
Maiden Name
Restore Maiden Name?	Yes No
Social Security No.
Race
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Length of Residence in TN
Number of Previous Marriages
Previous Marriage Ended By	Divorce/Annulment  Death
Ever member of Armed Services	Yes  No
Highest Educational Level
Current Employer

Please provide the following information for HUSBAND: (Required pursuant to Tennessee Law)

Full Name
Social Security No.
Race
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Length of Residence in TN
Number of Previous Marriages
Previous Marriage Ended By	Divorce/Annulment  Death
Ever member of Armed Services	Yes  No
Highest Educational Level
Current Employer

General Information:

Children of this Marriage:  Full Names, Dates of Birth and Social Security Numbers

Last five (5) addresses for the minor child(ren):

Debts That WIFE Will Be Responsible For (Creditor, Account Number, Balance):

Debts That HUSBAND Will Be Responsible For (Creditor, Account Number, Balance):

Vehicle WIFE will Receive (Year, Make, Model, How Vehicle is Titled): i.e. 1999 Toyota 4Runner, Both

Vehicle HUSBAND Will Receive (Year, Make, Model, How Vehicle is Titled): i.e. 1999 Toyota 4Runner, Both