Application to Open a Get File

Why are you opening this file? (Please choose one of the following):

Both spouses are ready to arrange a Get, and we wish to schedule a Get at this time.I am opening a file to send a hazmana (summons) to my spouse for a Get.I am opening a file to send a hazmana (summons) to my spouse for a Get and to resolve all other divorce issues in a din torah arbitration.I want the Beth Din to help me mediate divorce issues between us.I am unsure of the answer to this question, and I wish to speak with someone about my options.

Have you already spoken with someone in the office recently about your case? (Please choose one of the following):

YesNo

Who is submitting this application?WifeHusband

Title:

First Name

Maiden Name

Preferred Last Name

Home or Office Number

Mobile Number

Street Address

City

State

Zip Code

Country (if not U.S.A.)

Email Address

Year of Birth

Place of Birth

Title:

First Name

Last Name

Email Address

Home or Office Number

Mobile Number

Street Address

City

State

Zip Code

Country (if not U.S.A.)

Year of Birth

Place of Birth

Year of Marriage

Number of children from this marriage

Age of youngest child from this marriage

Approximately how long have you been separated?
(If you are still living in the same residence, please indicate that you are still residing together; please note that a Get cannot be arranged if the couple still lives together)

Was a halachic prenup signed? YesNoOther

Was wife previously married to anyone else? If so, how did that marriage end?

Is wife a convert? YesNo

Was wife adopted as a child? YesNo

Was husband previously married to anyone else? If so, how did that marriage end?

Civil divorce status

Is husband a convert? YesNo

Was husband adopted as a child? YesNo

Wife's Information:

Husband's Information:

Additional Information: