DOMESTIC INTAKE WORKSHEET Style of Case: _ Case Number: Date of Filing: Judge Assigned to Case: _ _ Part A Information About the Parties Petitioner: Name(s) NOTE: "If you are a victim 0/ domestic violence and do not wish to include your address please make a notation. Address: Street Address Count City State Zip Telephone: Home Work Birth Year: Petitioner's Attorney: Email: Name Attorney's Address: Street Address Count City State Zip Attorney's Telephone Number: Respondent: Name(s) NOTE: "Ifyou are a victim of domestic violence and do not wish 10 Email: include your address please make a notation. Address: Street Address Count City Stare Zip Telephone: Home Work Birth Year: Respondent's Attorney: Email: Name Attorney's Address: Street Address Count City State Zip Attorney's Telephone Number: Email: If your case is assigned to the Family Division, It is malldatorv tlrat you complete and. return this worksheet at your 30day Scheduling Conference. Last Revised 04114 American LegalNet, Inc. www.FormsWorkFlow.com Information About the Current Case and Related Cases Number of Children: Names of Children: _ Current Claim(s); Issue(s); Allegation(s): 0 0 0 0 0 Divorce Child Custody Visitation Child Support Paternity 0 0 0 0 0 Legitimation Family Violence Child Abuse URE;SA 0 0 0 0 Adoption Guardianship Substance Abuse Other Issues: DHR Is there currently pending in any Fulton County Court a case or cases involving the petitioner, respondent, or any minor children of the relationship? 0 Yes 0 No If yes, please list the Court, Case number, and style of case below. Court Case Number Style of Case Last Revised 04/14 American LegalNet, Inc. www.FormsWorkFlow.com