Online Form * Required Fields Nature of Case (Select One) Divorce Separation Annulment Other Your Full Legal Name* Your Birth or Maiden Name Your Address* Your Cell Phone No.* Your Home Phone No. Your Email* Your Last 4-digits of Social Security Number Your Year of Birth Your Place of Birth Your Race Your Highest Grade Completed You have lived in the State of Hawaii since You have lived on the island of Oahu since Your Primary Employer Your Job Title Your Work Schedule Your Length of Service Your Gross Monthly Income (Primary) Your Gross Monthly Income (Secondary) Your Gross Monthly Income (Welfare) Were you previously married? NoYes Your Prior Marriage Start Date Your Prior Marriage End Date State where your prior marriage occurred Your Prior Marriage Terminated By (Select One) Divorce Annulment Death Any other prior marriages? NoYes Your Other Prior Marriage Start Date Your Other Prior Marriage End Date State where your other prior marriage occurred Your Other Prior Marriage Terminated By (Select One) Divorce Annulment Death Any previous civil unions? NoYes Your Prior Civil Union Start Date Your Prior Civil Union End Date State where your prior civil union occurred Your Prior Civil Union Terminated By (Select One) Divorce Annulment Death Any other prior civil unions? NoYes Your Other Prior Civil Union Start Date Your Other Prior Civil Union End Date State where your other prior marriage occurred Your Other Prior Civil Union Terminated By (Select One) Divorce Annulment Death Are you pregnant? NoYes Expected Delivery Date Spouse's Full Legal Name* Spouse's Birth or Maiden Name Spouse's Address* Spouse's Cell Phone No.* Spouse's Home Phone No. Spouse's Email* Spouse's Last 4-digits of Social Security Number Spouse's Year of Birth Spouse's Place of Birth Spouse's Race Spouse's Highest Grade Completed Spouse's has lived in the State of Hawaii since Spouse's lived on the island of Oahu since Spouse's Primary Employer Spouse's Job Title Spouse's Work Schedule Spouse's Length of Service Spouse's Gross Monthly Income (Primary) Spouse's Gross Monthly Income (Secondary) Spouse's Gross Monthly Income (Welfare) Was your spouse previously married? NoYes Spouse's Prior Marriage Start Date Spouse's Prior Marriage End Date State where your spouse's prior marriage occurred Spouse's Prior Marriage Terminated By (Select One) Divorce Annulment Death Any other prior marriages for your spouse? NoYes Spouse's Other Prior Marriage Start Date Spouse's Other Prior Marriage End Date State where your spouse's other prior marriage occurred Spouse's Other Prior Marriage Terminated By (Select One) Divorce Annulment Death Does your spouse have any previous civil unions? NoYes Spouse's Prior Civil Union Start Date Spouse's Prior Civil Union End Date State where spouse's prior civil union occurred Spouse's Prior Civil Union Terminated By (Select One) Divorce Annulment Death Any other prior civil unions for your spouse? NoYes Spouse's Other Prior Civil Union Start Date Spouse's Other Prior Civil Union End Date State where your spouse's other prior marriage occurred Spouse's Other Prior Civil Union Terminated By (Select One) Divorce Annulment Death Is your spouse pregnant? NoYes Expected Delivery Date Date of this Marriage Location of this Marriage Are you living separately? NoYes Date of Separation Place you last lived together Do either you or your spouse have any children? NoYes Enter child(ren)'s info from youngest to oldest Full Name of child(ren) Gender of child(ren)(Enter M or F) Birthdate of child(ren)(MM/DD/YYYY) Legal Parent of child(ren) Who does your child(ren) currently live with? School & Grade of child(ren) Present Address of child(ren) Has your child(ren) lived with any other caretaker or at any other address within the last 5 years? NoYes Previous Address of child(ren) Previous Caretaker of child(ren) Date From Date To Any other caretaker or address within the last 5 years? NoYes Previous Address of child(ren) Previous Caretaker of child(ren) Date From Date To Any other caretaker or address within the last 5 years? NoYes Previous Address of child(ren) Previous Caretaker of child(ren) Date From Date To
