SEPARATION AGREEMENT WORKSHEETSeparation Agreement • October 11th, 2013
Contract Type FiledOctober 11th, 2013FOR OFFICE USE ONLY Clients Name: Clients Phone No. Attorney: Date: PRIVACY ACT STATEMENT AUTHORITY: 5 U.S.C. § 301; 44 U.S.C. § 3101 (E.0. 9397)PRINCIPAL PURPOSE: Obtain personal information to prepare legal document(s).ROUTINE USE(S): Information provided will be used by legal assistance personnel (attorneys and staff) to prepare a Separation Agreement requested by individual providing the information.DISCLOSURE: Voluntary; however, failure to provide the requested information may prevent furnishing of requested legal assistance services.