Harley Law Firm Intake Form

Much of the information collected in this form is needed for the preparation of your actual divorce papers. Some of it, however (such as how many marriages you’ve had, your race, and how far you went in school), is collected so that we can submit to the Court the required Vital Records Divorce Report.

Your legal papers cannot be created until the Law Firm receives this completed form.

If you have any questions about how to answer any of these questions, please call or email Larry Harley at The Harley Law firm: lharley@harleylawfirm.com; or 276.477.3105.


1. Your Information

Is it safe to leave messages at this number? *

Can you receive and send documents by email? *

May we communicate by email? *

Lived in Virginia last six months? *

Sex: *

2. Your Spouse's Information

Lived in Virginia last six months? *

Sex *

3. Marriage Information

Do you have a separation agreement? *

Please email a copy of the separation agreement to lharley@harleylawfirm.com.

4. Service of Process

We must give your spouse a copy of the Complaint for Divorce. The easiest way is for you, or for your lawyer, to send them a copy and let them sign a paper saying that they "accept service." Do you think your spouse would like to accept service of the divorce papers rather than being served by the Sheriff? *

Do you think your spouse would be more likely to cooperate witht he divorce if you give them the copy of the Complaint, or if the lawyer mails or emails it to them? *

5. Your Witness

Both you and your witness who is at least 18 years old must sign affidavits swearing to the facts of your case; essentially, you will swear that you are a Virginia resident, that you and your spouse were married on such-and-such a date, and that you and your spouse have been separated without interruption since such-and-such a date.

Is the person who will be your witness a close friend, or a relative of yours? *

6. Maiden Name

Would you like to resume the use of your maiden name or a former married name? *

7. Children

Custody has been resolved by:

Full names and birthdates of your minor children of marriage (by birth or adoption):

8. Payment Information