VLS Clinic Form 02

Case Information

In the Matter of the Marriage of
ex. Smith-Jones (do not use a \)
Login Information




Information Regarding Petitioner

The Petitioner is the person who is initiating the lawsuit.



Petitioner's Address





Additional Contact Information for Petitioner

Please provide the following additional contact information for Petitioner, if known:


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(
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(
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For example: I can be reached on my cell phone most evenings between 5 p.m. and 9 p.m.
Information Regarding Petitioner's Age

Information Regarding Respondent

The Respondent is the person who is being sued in the lawsuit.



Respondent's Address

Respondent's Address





Respondent's City of Residence


List the State in which Respondent resides or, if Respondent resides outside of the United States, list the Country in which Respondent Resides.

That is, to the extent that it is known to you, provide any helpful information such as 1) Respondent's last known address and an approximate date when Respondent last lived there - as well as any other information helpful in locating the Respondent.
Additional Contact Information for Respondent

Please provide the following additional contact information for Respondent, if known:


(
)
-

(
)
-

(
)
-


For example: I can be reached on my cell phone most evenings between 5 p.m. and 9 p.m.
Waiver of Citation

Note:  

A Waiver of Citation is a document that the Respondent would sign and have notarized indicating their agreement to waive formal service of the lawsuit.  

Indicate 'Yes' below ONLY IF:

1) you are willing to take the Waiver of Citation or mail the Waiver of Citation to the Respondent AND

2) you believe the Respondent would be willing to sign the document, take it to a notary so that person can notarize the document, and return it to you. 


Service on Respondent (THIS SECTION TO BE COMPLETED BY THE ATTORNEY ONLY)

Information Regarding Respondent's Age



Respondent is approximately
years old
Respondent's Military Status


Court Information

County



Judicial District
Ex. 250th

County Court at Law #

#

Select the first option if more than one of the statements are true.
Information Regarding the Marriage




Date of Marriage:
Date of Separation:





If you are seeking a Protective Order, you may be assigned to a different clinic and/or the County Attorney's Office.

If you are seeking a Protective Order, you may be assigned to a different clinic and/or the County Attorney's Office.
Minor Children


A Court may determine that a child with a serious disability may remain unemancipated past the date the child would otherwise be an adult. Consult an attorney for specific advice.
Children of Both of the Parties

Indicate yes if the both of the parties are the biological or adopted parents of the child/ren.

Name of the Child
Date of Birth
Sex of the Child

Are you asking that the child/ren above live primarily with you?

Children of the Wife Only

Indicate yes if the both of the parties are the biological or adopted parents of the child/ren.

Name of the Child
Date of Birth
Sex of the Child
Children of the Husband Only

Indicate yes if the both of the parties are the biological or adopted parents of the child/ren.

Name of the Child
Date of Birth
Sex of the Child
STOP!

STOP HERE!  The information below should be completed at the second clinic.

Marital Property
Personal Property and Vehicles
Personal Property

Personal Property Awarded to Wife


e.g. Kenmore Refrigerator (currently in possession of the husband) e.g. Coin collection
Personal Property Awarded to Husband


e.g. Maytag washer and dryer (currently in possession of the husband) e.g. Grill and electric tools
Motor Vehicles

Motor Vehicles Awarded to Wife


e.g. 2003 Ford Mustang e.g. 2007 Honda Accord
Motor Vehicles Awarded to Husband


e.g. 2002 Ford F-150 e.g. 2007 Toyota Camry
Financial Accounts
Bank Accounts

Bank Accounts Awarded to Wife


e.g. Bank of America Account ending #1010 in wife's name e.g. Joint Wells Fargo checking account ending #2345
Bank Accounts Awarded to Husband


e.g. Bank of America Account ending #1010 in wife's name e.g. Joint Wells Fargo checking account ending #2345
Investment Accounts

Investment Accounts Awarded to Wife


e.g. Fidelity Account ending #9999 in wife's name e.g. Joint Vanguard mutual fund account ending #7890
Investment Accounts Awarded to Husband


e.g. Fidelity Account ending #1111 in husband's name e.g. Joint Vanguard mutual fund account ending #2345
Retirement Accounts

Retirement Accounts Awarded to Wife


e.g. 401K Account ending #3232 in wife's name e.g. TRS Pension account ending #7890 in wife's name
Retirement Accounts Awarded to Husband


e.g. 401K Account ending #9292 in husband's name e.g. ERS Pension account ending #8484 in husband's name
Real Estate

Real Estate Awarded to Wife


e.g. House and Lot at 1410 Hummingbird, Austin, TX e.g. 1604 Willow Way, Buda, TX
Real Estate Awarded to Husband


e.g. 97 Main Street, Pflugerville, TX e.g. 1010 14th St., Austin, TX
Other Specified Assets

Other Specified Assets Awarded to Wife


e.g. Business known as Cookie Cutters e.g. Henry the Dog
Other Specified Assets Awarded to Husband


e.g. 10 Bales of Hay located at Danny's barn e.g. Landscaping business known as Manny's Landscaping
Separate Property

Separate property refers to 1) property items that belonged to either the wife or the husband prior to the date of marriage and 2) property items were gifted only to the wife or the husband during the marriage.   

Wife's Separate Property


Husband's Separate Property


Marital Debt
Listed Debts
Listed Debts Awarded to Wife

Listed Debts Awarded to Husband

Credit Card Debt

Credit Card Awarded to Wife


e.g. UFCU Visa in wife's name (approx. $3,000.00) e.g. Joint Discover Card/ending #4567
Credit Card Awarded to Husband


e.g. Chase Mastercard in husband's name e.g. Joint AMEX/ending #4111 (approx. $1,200.00 - account to be paid off and closed)
Other Miscellaneous Debt

Miscellaneous Debt Awarded to Wife


e.g. Wife's Sallie Mae student loan debt(approx. $10,000.00) e.g. Outstanding Time Warner Bill (approx. $300.00)
Miscellaneous Debt Awarded to Husband


e.g. Bill owed to Dr. Smith (approx. 400.00) e.g. Outstanding AT&T Bill (approx. $200.00 - account to be paid off and closed)


Miscellaneous Information
Name Change




Verification

Please read and indicate your agreement to the following:

By submitting this form, I am authorizing Volunteer Legal Services and/or Mark W. Sims to file this lawsuit on my behalf. I understand and authorize that pleadings based on the answers provided in this form will be created and filed at a later date and I authorize Volunteer Legal Services to file those documents with the Court.  I understand that the documents and/or pleadings based on the information I provide in this form will either be personally signed by me or that my signature may be attached electronically to those documents and/or pleadings.  I authorize the use of my electronic signature for that purpose. 

I understand that I am filing this lawsuit as a Pro Se Petitioner, meaning that I am representing myself and that I'm not represented by Volunteer Legal Services and/or Mark W. Sims. 


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