The Law Office of Jack E. Brackney

Attorney and Counselor at Law

(877) 679-5225
jack@brackneylawoffice.com

39-20 59th Street, Suite 2
Woodside, New York 11377

815 Superior Avenue East, Suite 1618

Cleveland, Ohio 44114

Thank you so much for contacting our law office! Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Your Social Security Number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Security Numbers are most often used to positively identify parties. Most courts require Social Security Numbers of all parties in a case. Some other examples of how this information may be used include:

initial service
in court orders
in required reports or other documents filed with the State

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!

Contact information: Contact 1

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

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Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

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Phone numbers

Phone number

Type

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Social Security Number

Employer Name

Employer Address

Employer Phone Number

What is your highest level of education?

Contact information: Spouse Information

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

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Spouse's Social Security Number

Spouse's Attorney (if applicable)

Spouse's Employer Name

Spouse's Employer Address

Spouse's Employer Phone Number

What is your spouse's highest level of education?

Has either spouse previously been married?

Yes

Jurisdiction & Residency Requirements

Date of Marriage

City, State, & Country of Marriage

Was the ceremony a civil ceremony or religious ceremony?

Civil

Religious

Does either party have a birth name if different from their married name?

Yes

Did you live as a married couple in New York State?

Yes

Do you have any children?

Yes

Are you paying or receiving any support?

Yes

Is custody/visitation an issue?

Yes

Is child support an issue?

Yes

Do you and your spouse own any real estate, antiques, or collectibles?

Yes

Do you and/or your spouse own a business?

Yes

Did either you or your spouse earn a degree or license during the marriage?

Yes

Do either you or your spouse have a pension plan, Keough, annuity, Social Security payments, trust fund, etc.?

Yes

Do you and/or your spouse have a savings account, certificate of deposit, or safety deposit box?

Yes

Spousal Support

Are you paying or receiving financial support from your spouse?

Yes

Domestic Violence

Are you or have you ever been the petitioner or respondent in a family offense proceeding?

Yes

Are you seeking an order of protection?

Yes

Are you seeking exclusive occupancy of the marital residence?

Yes

Other

Are you living separate and apart from your spouse?

Yes

Do you have a signed and notarized prenuptial and/or separation agreement?

Yes

Are the spouses covered under a health insurance plan?

Yes

Please attach any other documents you feel are important or relevant to our initial discussion. (i.e. court documents, custody petitions or agreements, letters or other correspondence, etc.)

Add attachment

Thank You!

If you have any written documents or witness statements regarding any of the above, please email this fact sheet, together with those documents to jack@brackneylawoffice.com.

Thank you for contacting The Law Office of Jack E. Brackney regarding your divorce concerns. Family separation is never easy, and we will do what we can to make the process as painless as possible.

We value each potential client who contacts us and will make arrangements to meet or speak with you when convenient, including Saturdays. Please be advised, however, that The Law Office of Jack E. Brackney is not your legal counsel until there is a signed fee agreement in place between you and the firm. By submitting this form, you are requesting that we evaluate whether you have a valid claim. We have not agreed to act as your legal counsel.