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Florida Divorce Service ℠
Secure Information Form

 

Visa, MasterCard, Discover and American Express.

 

 

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
   $95 - The husband and wife will both sign.
   $135 - I don't know where my spouse is located OR my spouse will not sign.

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