Secure Information Form

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Florida Divorce Service ℠ Secure Information Form
Your Full Legal Name:
Your Street Address:
Your City, State & Zip:
Your Telephone No.:
Your E-mail:
Your Date of Birth:
Spouse's Full Legal Name:
Spouse's Street Address:
Spouse's City, State & Zip:
Spouse's Telephone:
Spouse's E-mail:
Spouse's Date of Birth:
Date of Marriage:
Place of Marriage:
Date of Separation:
Y=Yes or N=No
	Has the wife lived in Florida for at least 6 months?
	Has the husband lived in Florida for at least 6 months?
	Is the wife a member of the military service?
	Is the husband a member of the military service?
	Are there marital debts or property that need to be divided?
	Does the wife want to restore her maiden name?
If yes, maiden name:
The minor child(ren) common to both parties:
Full Legal Name	Date of Birth	Place of Birth (city & state)





Which parent will maintain health insurance for the minor child(ren)?
	Father
	Mother
Which parent will maintain dental insurance for the minor child(ren)?
	Father
	Mother

	$145 - The husband and wife will both sign.
	$135 - I don't know where my spouse is located OR my spouse will not sign.


Satisfactionn Guaranteed!		Reliability Report

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