II. MARITAL INFORMATION Marital status: Married Widowed Divorced Separated Single Spouse’s Immigration Status:_________________ Spouse’s Name: (Last), (First), (Middle) Other names used: Sex: Male Female (Includes Maiden, Religious, Professional, Aliases, etc.) Date of birth: Place of birth: (Mo/Day/Yr) (City), (Country) Citizenship: U.S. Social Security No. Date of marriage: Place of marriage: Country of Date of Spouse’s former spouse name citizenship divorce/death Is your spouse currently working in the U.S.? Yes No If yes, does he or she have authorization to work full-time? Yes No If no, does he or she wish to work in the U.S.? Yes No Were you previously married? Yes No Your first former spouse’s name: (Last), (First), (Middle) Date of birth: Place of birth: (Mo/Day/Yr) (City), (State), (Country) Citizenship: Date of divorce/death: Place of divorce: Your second former spouse’s name: (Last), (First), (Middle) Date of birth: Place of birth: (Mo/Day/Yr) (City), (State), (Country) Citizenship: Date of Place of divorce: Will this case type require the attorney to represent the spouse? Yes No Unknown at this time__________ Note to Intake Attorney—If you are going to represent the spouse, please sent up a separate meeting with the applicant and spouse in person, and let Ann or
II. MARITAL INFORMATION Marital status: Married Widowed Divorced Separated Single Spouse’s Immigration Status:_________________ Spouse’s Name: (Last), (First), (Middle) Other names used: Sex: Male Female (Includes Maiden, Religious, Professional, Aliases, etc.) Date of birth: Place of birth: (Mo/Day/Yr) (City), (Country) Citizenship: U.S. Social Security No. Date of marriage: Place of marriage: Spouse’s former spouse name Country of citizenship Date of divorce/death Is your spouse currently working in the U.S.? Yes No If yes, does he or she have authorization to work full-time? Yes No If no, does he or she wish to work in the U.S.? Yes No Were you previously married? Yes No Your first former spouse’s name: (Last), (First), (Middle) Date of birth: Place of birth: (Mo/Day/Yr) (City), (State), (Country) Citizenship: Date of divorce/death: Place of divorce: Your second former spouse’s name: (Last), (First), (Middle) Date of birth: Place of birth: (Mo/Day/Yr) (City), (State), (Country) Citizenship: Date of Place of divorce: Will this case type require the attorney to represent the spouse? Yes No Unknown at this time__________ Note to Intake Attorney—If you are going to represent the spouse, please sent up a separate meeting with the applicant and spouse in person, and let Ann or