Legal Aid of Manasota
Divorce Clinic Application

Pro Se Dom Clinic

Please complete the form below to apply.

Personal Information
First Name
Middle Name/Initial
Last Name
Address
City/State/Zip
,
County
Home Phone
Work Phone
E-Mail

Case Information
Income Eligible?
Yes, I am income eligible.
No, I am not income eligible.

Has there been Domestic Violence?
Yes, there has been Domestic Violence.
No, there has not been Domestic Violence.

If yes, is there any documentation?
Yes, I do have documentation.
No, I do not have documentation.

Have you been served with divorce papers?
Yes, I have been served with divorce papers.
No, I have not been served with divorce papers.

Have you lived in the State of Florida for at least the last 6 months?
Yes, I have lived in Florida for at least 6 Years.
No, I have not lived in Florida for at least 6 Years.

Opposing Party
First Name
Middle Name/Initial
Last Name

Do you know the address where your spouse currently lives?
Yes, I know his/her address.
No, I do not know his/her address.

If yes, does he/she live in the same county as you?
Yes, he/she does live in the same county.
No, he/she does not live in the same county.

In what County did you last live together?

Is your spouse in the Military?
Yes, he/she is in the Military.
No, he/she is not in the Military.

Children
Are there any minor children from this marriage?
Yes, there are children from this marriage.
No, there are not children from this marriage.

Note: If you are pregnant or have children born during the marriage, whether they are your husband's or not, you must select "Yes".

Assets & Debts
Do you and your spouse own a home?
Yes, we do own a home.
No, we do not own a home.

Are there any assets (property) from this marriage?
Yes, we do have assets.
No, we do not have assets.

Are there any debts from this marriage?
Yes, we do have debt.
No, we do not have debt.

Misc.
Have you and your spouse already settled any or all the issues in the divorce?
Yes, we have settled.
No, we have not settled.

I hereby certify that the above information is correct.
Signature

Date (ie. 01-01-2010)