Arizona | Negotiation Questionnaire

We do not directly share this form with anyone. We are using it to find the best hardship scenario so we can to assist you in obtaining a lower settlement.

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It is assumed that you intend this information for review by your anticipated counsel, as such, this communication will be privileged and confidential

Page 1 of 6 - About You

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Name Name First Last
Social Security Number

Format XXX-XX-XXXX
Date of Birth Date of Birth / MM / DD YYYY
Email
Do you consider yourself to be head of household?

Do you consider yourself to be head of household? Yes No

Head of Household is usually the person that brings in the most income into the houshold.
Marital Status
Date of your current Marriage

We are needing this to determine liability in the marital estate.
What was the date of your spouse's death?
How many dependents do you have?
Do you pay child support?

Do you pay child support? Yes No
How much do you pay in Child Support every month? $ Dollars . Cents
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.

Arizona | Negotiation Questionnaire

Arizona | Negotiation Questionnaire

Page 1 of 6 - About You