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Current Marital Status:

Single Married Divorced Widowed

Spouse/Partners Name:

Age:

Sex:

Date of Birth:

Number of previous marriages:

Number of non-marital relationships resulting in children:

Number of spouse/partner’s previous marriages:

Number of spouse/partner’s previous non-marital relationships resulting in children:

Length of first marriage/relationship:

Length of first non-marital relationship resulting in children:

Reason for termination of first marriage/relationship:

Age at time of marriage:

Age at time of divorce/termination of relationship:

Number of children from first marriage/relationship:

Length of second marriage/relationship:

Length of second non-marital relationship resulting in children:

Reason for termination of second marriage/relationship:

Age at time of second marriage:

Age at time of divorce/termination of marriage/relationship:

Number of children from second marriage/relationship:

Length of third marriage/relationship:

Length of third non-marital relationship resulting in children:

Reason for termination of third marriage/relationship:

Age at time of third marriage/relationship:

Age at time of divorce/termination of marriage/relationship:

Number of children from third marriage/relationship: