Questionnaires 

Please start with the Free Consultation first.

The Questionnaire has been broken down to small sections. Any question skipped will be asked once again - so please save time by entering all information the first time. Once I review it, I immediately let you know the next step.

If an attorney has reviewed your case and referred you, you are welcome to pay. If not, please wait to pay until I have reviewed your entries. Please text or call 757-932-7422 for the fastest response. I cannot legally tell you your answers.

Once you pay and notify me you have paid and completed the questionnaires, I will prepare the first draft for your review within 2 business days. 

QUESTIONNAIRE 1 of 4 - Introduction

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in
Family Law Questionnaire Introduction
Hello! Please provide as much information as you would like for a prompt and complete search. Thank-you, Rica
First Name*
Last Name*
Email Address*
*
*
*
*
	CountryUnited StatesCanada----------------AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntiguaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribadiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoFederated States of MicronesiaMoldovaMonacoMongoliaMontserratMoroccoMontenegroMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaS. Georgia and S. Sandwich Isls.Saint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSt. HelenaSt. Pierre and MiquelonSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamUS Virgin IslandsWallis and Futuna IslandsWestern SaharaYemenYugoslavia (former)ZaireZambiaZimbabwe
Address
City State AND Zip Code
County
Other Parties' name
Do you have case file?	---Select---YES NO Unknown
If yes, What county? Case Number, if known.
Date Married, if married
Date Separated, if married
What type of Case are you asking for?	Dissolution of Marriage Dissolution of Domestic Parnership Legal Separation of Marriage Legal Separation of Domestic Partnership Nullity of Marriage Nullity of Domestic Partnership Never married - Establish Parental Rigths
Grounds for Dissolution of Marraige	Irreconcilable Differences Incurable Insanity
Ground for Nullity	Incest Bigamy Underage Prior Existing Unsound Mind Fraud Force Incapacity
Legal Relationship	We are married. We are domestic partners and our domestic partnership was established in California. We are domestic partners and our domestic partnership was NOT established in California.
Residential Requirements	Petitioner has been a resident of this state for at least six months and of this county for at least three months immediately preceding the filing of this Petition. Respondent has been a resident of this state for at least six months and of this county for at least three months immediately preceding the filing of this Petition. Our domestic partnership was established in California. Neither of us has to be a resident or have a domicile in California to dissolve our partnership here. We are the same sex, were married in California, but currently live in a jurisdiction that does not recognize, and will not dissolve, our marriage. This Petition is filed in the county where we married.
Minor Children ENTER ALL DATA Name, Birthdate, Age
Petitioner and Respondent signed a voluntary declaration of parentage or paternity.	Yes No
CHILD CUSTODY	Legal custody to PETITIONER Legal custody to RESPONDENT Legal custody JOINT Physical custody to PETITIONER Physical custody to RESPONDENT Physical custody JOINT
CHILD VISITATION	Form FL-311 Form FL-312 Form FL-341(C) Form FL-341(D) Form FL-341(E) Attachment 6c(1)
CHILD SUPPORT	See emailed notes Only what is on the Petition
SPOUSAL / DP SUPPORT	Spousal or domestic partner support payable to PETITIONER Spousal or domestic partner support payable to RESPONDENT Spousal or domestic partner support payable to BOTH Terminate (end) the court's ability to award support to PETITIONER Terminate (end) the court's ability to award support to RESPONDENT Terminate (end) the court's ability to award support to BOTH Reserve for future determination the issue of support payable to PETITIONER Reserve for future determination the issue of support payable to RESPONDENT Reserve for future determination the issue of support payable to BOTH
SEPARATE PROPERTY	NONE Will provide a Property Declaration FL-160 Will provide an Attachment 9b
COMMUNITY PROPERTY	NONE Will provide a Property Declaration FL-160 Will provide an Attachment 10b
PETITIONER'S NAME RESTORED TO

QUESTIONNAIRE 2 of 4 - Questionnaire Declaration for Uniform Child Custody Jurisdiction Enforcement Act 

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in
Declaration UCCJEA (one per child)
Hello! Please provide as much information as you would like for a prompt and complete search. Thank-you, Rica
First Name*
Last Name*
Email Address
*
Number of Children
Child	This questionnaire is for Child 1. This questionnaire is for Child 2. This questionnaire is for Child 3. This questionnaire is for Child 4. This questionnaire is for Child 5. This questionnaire is for Child 6.
Child's Name
Relationship to Filer
City, State of Birth
Date of Birth
Sex	Male Female
Child's Current Primary Address
THIS ADDRESS IS CONFIDENTIAL	Yes. No. The other parent already has this.
Your previous five years complete addresses with move in & out dates
Other Proceedings	There has never been a proceeding with this child. I will carefully read line 4 & 5 of the FL-105 A guardianship case is on file A restraining order case is on file. A juvenile delinquency case is on file. An adoption file is on file. A criminal case is on file. I have information regarding another case. case to provide.
Other Parties	Someone else has physical custody. Someone else has custody rights. Someone else has visitation rights. I will carefully read line 6 and provide information.

QUESTIONNAIRE 3 of 4 - Participant Enrollment Form 

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in
FL Participant Enrollment Form
Hello! Please provide as much information as you would like for a prompt and complete search. Thank-you, Rica
First Name*
Last Name*
Email Address
*
Email for the court to create an account

QUESTIONNAIRE 4 of 4 - Income & Expense Declaration

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in
Income & Expense Declaration Questionnaire (2of2)
Hello! Please provide as much information as you would like for a prompt and complete search. Thank-you, Rica
First Name*
Last Name*
Email Address
Phone*
*
Required Union Dues
Employer
Employer's Address
Employer's Phone
Occupation
Date Started
If unemployed, date job ended
Hours Worked Per Week
Gross Pay (before taxes) each check
Age
Pay Checks	Daily Every 7 days Every 14 days Twice A Month (such as 1st & 15th) Monthly Other (I will supplement)
My highest education completed
College Degree obtained, if any
Graduate Degree obtained, if any
Professional or Occupational License(s), if any
Last Year I filed taxes
Filing Status Last Used	Single Married Filing Joint Married Filing Separate Head of Household
I filed a state tax return	Yes No
Total Exemptions Claimed including myself
Other Party's estimated gross taxes and source
Vocational Training, if any
Required retirement payments (not taxes)
Medical, hospital, dental, & other health insurance premium
Child support that I receive for children (not this relationship)
Spousal support from a different marriage
Partner support thatI received from a different domestic partnership
Necessary job-related expenses - what for and how much monthly
How much money in deposit accounts do you hold?
How much in stocks, bonds, and other assets
Total value of Real Estate and Personal property less the amount you owe
1. Name, age, and relationship of dependents and Gross Income
#1 Expenses	They pay household expenses They do not pay household expense
2. Name, age, and relationship of dependents and Gross Income
#2 Expenses	They pay household expenses They do not pay household expenses
3. Name, age, and relationship of dependents and Gross Income
#3 Expenses	They pay household expenses They do not pay household expenses
4. Name, age, and relationship of dependents and Gross Income
#4 Expenses	They pay household expenses They do not pay household expenses
5. Name, age, and relationship of dependents and Gross Income
#5 Expensees	They pay household expenses They do not pay household expenses
How did you calculate your expenses	Estimated Expenses Actual Expenses Proposed Expenses
Rent
Mortgage
Real Estate Taxes if not included in payment
Home owner's or Renter's Insurance
Utilities (gas, electric, water, trash)
Health-care costs not paid by insurance
Telephone, cell phone, and e-mail
Child Care
Groceries and household supplies
Eating out
Laundry and cleaning
Clothes
Education
Entertainment, gifts, and vacation
Auto expenses & transportation (ins, gas, repairs, bus, etc)
Insurance (life, accident, etc - NOT auto, home, health)
Savings and Investments
Charitable Contributions
Any other payments - to whom and how much
Any other payments - to whom and how much
Number of Children under 18 in my car
Percentage of time with me
Percentage of time with other party
(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)
Health Care	I do have health insurance through my job I do NOT have health insurance through my job
Name of insurance company
Address of insurance company
The monthly cost for the children's health insurance is or would be (specify): $
Childcare so I can work or get job training
. Children's health care not covered by insurance
20. Other information I want the court to know concerning support in my case

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Rica J. Gilmore, Broker, Realtor® 

• Virginia License VA #0225235314 
• Rica Jo Ann Gilmore,​ ​Realtor®​ ​ ​
• Graduate, REALTOR® Institute
• ​​Rica Realty​​​ ​​​VA #0225235314​
• ​Accredited Buyer's Agent
• ​Seller Representative Specialist​ 
• ​REALTORS® Commitment to Excellence​
• ​Military Relocation Professional
• Seniors Real Estate Specialist®
• Short Sales and Foreclosure Resource
• Pricing Strategy Advisor
• Home Measurement Specialist
• ​Real Estate Negotiation Expert​
• ​Certified Team Specialist​

Rica Jo Ann Gilmore, Broker  Realtor®144 Shoe Lane, Newport News, VA 23606 1-757-932-7422  

North Carolina License NC 305512:  Rica J. Gilmore, Broker The Virtual Realty Group - Independent Firm Main office: 8116 Arlington Blvd, Ste 115, Falls Church, VA 22042 Telephone 1-888-407-2410 

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