Custody & Child Support Intake Form

Your full legal name *

First

Last

Mailing address (street, city, state, ZIP) *

Phone number *

Email address *

What do you need? *

Existing case number (if any)

Other parent's full legal name *

First

Last

Other parent's mailing address (or last known address) *

Do both parents agree on custody, the schedule and child support? *

Children: full names, dates of birth, current address, and every state they lived in during the last 5 years *

Has paternity been established? *

Through marriage, a signed Voluntary Acknowledgment of Paternity, or a court order.

Legal custody requested (major decisions) *

Physical custody requested (where the children live) *

Proposed parenting time schedule, holidays and transportation

Your employer and gross monthly income (before taxes)

Other parent's employer and gross monthly income (if known)

Child support

Who will provide health insurance for the children?

Clark County custody cases generally require both parents to complete the COPE parenting class. Have you completed it?

Is there any history of domestic violence or a protection order involving either parent?

This helps make sure the right forms are used. You may discuss it by phone instead.

How would you like to sign and notarize? *

Anything else we should know?

Acknowledgment *

I understand Yuri Notary is not an attorney, cannot give legal advice, and will prepare documents at my direction based on the information I provide. Nothing is filed or recorded until I review and sign my documents.

Custody and Child Support Intake Form