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<br />n ATTOi1Ni.:,:V i OAT;: OPt-"-':NL:U 1 FrU"~ fj";
<br />Ii ! !
<br />n----II-REFEffR''''6-TO---~t 'OA Yt-CLO' ""'Ol-CA'''''': "")
<br />
<br />I" ,,_. i __,~_, .., _
<br />
<br />I PHON~ iL:~P_~~~~,~:~_~~~. FEE ! CROSS ""v€^
<br />rl OPPOSING PAR l Y
<br />TOTAL 11
<br />Ii A-ODf.fES'S
<br />II
<br />II
<br />\1 STUDENT
<br />I
<br />
<br />Ii
<br />I
<br />I!
<br />II
<br />II
<br />I,
<br />II Asset:;
<br />II 800k aa:t.;
<br />I R.c,llty
<br />I Molor'i'~hicle
<br />!I Ol"&r
<br />!i
<br />III' Li.~;:;~;i~bIS $
<br />Tolal uebl'
<br />I. R<curring ol1!ir..tio".
<br />
<br />
<br />II
<br />il
<br />\
<br />I
<br />'I
<br />Ir ..
<br />
<br />11 f~rc;'l.ses m.ukcd "G'. above; oro oHiF.es .ansWI!'rthis. -"'".
<br />_ qucstioi'l: Will. client ob"jcctive atta.illed? 1. ,Yes 2_ nO'
<br />
<br />Nota: for cascs mark-ed-!!.7l+.or',"'S"above, OEO oHlces Ii:~'_.lJt"
<br />II ,"",_." ,;,po,;,~ .....
<br />
<br />
<br />
<br />II
<br />
<br />r-~
<br />
<br />'\.",\'\j,
<br />
<br />. i, ,_ ~~_.:..
<br />
<br />1-
<br />
<br />::_,_' ';;-O\;~7S
<br />
<br />OTHER
<br />
<br />,...,:: :::.~"'l.-\M::---
<br />
<br />iEi'f?LOYE-07
<br />
<br />; ~_~,~s
<br />
<br />~=-I='-'
<br />
<br />.
<br />
<br />.-
<br />
<br />-,__". J=:::'_,
<br />1 RE.O?ENi-NGS
<br />I . ' . ,
<br />
<br />:",,',;;'::;)~ .\D.
<br />
<br />I PHo-N~E.
<br />
<br />000000
<br />123456.
<br />
<br />o
<br />
<br />EnUre fOimily incom~
<br />By week; mo. $,
<br />Family mftlnOOr Employe!
<br />
<br />.: ;~::i S\-J~u.s-
<br />;\,;,,'cr jl,lJ,
<br />
<br />3. Sop,
<br />
<br />4. Oiv.
<br />
<br />5, Wid.
<br />
<br />L. Md.
<br />
<br />,'.~\:t:: .:' 1
<br />
<br />: :104.
<br />
<br />3. .5,.4
<br />
<br />4. 6J or over
<br />
<br />: .:;'-.J~ CJS~ ~020:orm 6.2.1.. Gn. 3}
<br />5, Pubiicily
<br />6.So.ciJI "3genq4
<br />7. Employe, /
<br />8, Olh<<
<br />
<br />
<br />o
<br />10
<br />
<br />'7
<br />
<br />
<br />o
<br /><3
<br />
<br />o
<br />9
<br />
<br />Main sour.:c o~ inco.m.o ,,'
<br />I.OllJI~JYili€f~
<br />2. SOGia! Sr.f.ulity WASil}
<br />3. U,1cmplQYIU't C04.lp.
<br />
<br />',h:;Hll: .cmjJluy~u.? (OEO qn. ~fA)
<br />3. NrJ, but other member of
<br />huuschold is employed
<br />
<br />o
<br />II
<br />
<br />:t:;;
<br />
<br />2 ~~J
<br />
<br />o
<br />lZ
<br />
<br />r~-'~
<br />L....,;
<br />
<br />:_' i:ilC first time applicant has
<br />"': 1"u;i;2da lawyer? (OEO Go.48)
<br />
<br />QualHic;ition 01 a~f)U~
<br />1. Accepied
<br />Z. Rejected. fin.,nciai eHg.:"
<br />3. .f\clected type- at c.a~
<br />
<br />4. np'j~cted~ ~ut
<br />o~ 'Juri".IJlctirJII,
<br />5. ReJtOled, oU..,
<br />
<br />PR03 1 PROS, Z PR08, 3
<br />'''''Ie.so ,DO 0 0 DO
<br />13 15 17
<br />;: . ~'" cfiifll'L I fami.ly
<br />"< c' I 31. Oivo".,& a_1m'!
<br />'~'~>,. $~;~:\' ~~ ~n~dun't .n. SeparatIon
<br />,I ;;~~~ C:.J;r;t 33. N()nsup~o.rt
<br />::""001'1 34, c."lody & g~
<br />,>, ',i'", 35, Pat.mily
<br />..,,,j'iil.;t;\:'J,~i~:,1~'lj wclfJre ~~:~ri~i"
<br />" u '''OASEll Miscell.neo..s
<br />{'c\:;',~;;'~~~i~~' ',. ~i: j~;;"i~" ,
<br />
<br />IJ\;:'-:1.~;G:rm,;!,ii~ In'i'. 43-. Schooh:'::ts-e-
<br />',\:1\". 44.. Misdemeanor
<br />45, otlle( cdmtnal
<br />46, Commiht1ent procedure. .
<br />47. OiOtir
<br />
<br />
<br />I. '.,:,1;,
<br />',: ':1l i,li1~i0rJ.lt!(\Jot
<br />. ~\1;: ,,::c,k '.'iol,)lion.
<br />.,: i"i;)USlng
<br />,-,.(",
<br />
<br />"""';0 c,eses (0[0 q~s, 4C. 4D. 4El
<br />[,15i?? L YC5 2. No
<br />,)(ct't1tiJd? 1. Yes 2. No
<br />."j'l', ]f) ,:rOl;~._
<br />
<br />
<br />PROS, 4
<br />DO
<br />19
<br />
<br />
<br />Sorvic'~ rC;ldcicu.\
<br />-'Cons1.iltatiol1 & 'cf~(r~ IOEO'qn..-11U
<br />1. Lawy~ reteteace . 3. Sad<il ase.nq'
<br />2, ?overty progl<Jm agenq IL QUiet
<br />5. Mvic~ only <OEO qn. lilI ' , "
<br />6. Negol~t~R- -and/Ol p'e"3fatiefl,otd~ete;:
<br />-but"" lilig3!ioo or ,tlmiA.oct....toroqn. It,I" '
<br />'7. COII'I,ctionrOEiI"".IOI, ,,'
<br />8, Admio. '?,ortCyproco'dinf,tOEOqw.16
<br />9, Cos. withdrawnlclosed alto'p:>tt.."'iceliOEO qn. 29
<br />
<br />2~
<br />
<br />
<br />o
<br />zo
<br />o
<br />Zl
<br />
<br />Mtv. time in hr5. (OEO qn. lGI
<br />tEstim.l1c jf necessary).
<br />Interviewing client
<br />III COlllt
<br />Olhertime on case
<br />
<br />) '.: I-I t ~
<br />
<br />13'.
<br />
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