2019-October Information from Brooklyn Clients

This form is for clients of Marsh Law Firm / Pfau Cochran Vertetis Amala PLLC to provide necessary information for the case. If you are not a client of our law firms, please do not fill out this form; instead contact us through our contact form.

Thank you again for providing the following information. Please remember we will provide this information to the defendants as part of your case, subject to a court order, so it is important that you provide as much information as you can.

ID Number
If you were provided an ID number, please enter it exactly as provided here. E.g. 41026.999
What is your current full name?*
Prefix First Middle Last Suffix
Do you have a maiden name or previously used name?*
- Yes
- No
What are your maiden names or previously used names?
Please click the “plus” to add more if you have more than one.
First Middle Last
What is your date of birth?*
What is your social security number?*
This will be kept strictly confidential by the parties.
What are the full names of all your biological parents, adoptive parents, other parents, or legal guardians?
First Middle Last Suffix
What is your current address?*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please list each address where you lived at the time of the abuse.

It is OK if you do not recall the exact address, but please provide as much information as possible. If it is easier, you can also describe the location. Please click the “plus” to add more addresses if you have more than one.

Address	City	State	Zip

If you do not recall the specific addresses, please describe each location where you lived during the abuse.
(e.g., across from the parish, a few blocks from a school, on the corner of __ and __ streets, on ___ street near the parish)

Save and Continue Later

First	Middle	Last

First	Middle	Last	Suffix