Name: Mailing Address: City, State, Zip Code: Daytime Phone Number: Evening Phone Number: Representing: [ ] Self [ ] Petitioner [ ] Respondent State Bar Number: For Clerk's Use Only ARIZONA SUPERIOR COURT, COUNTY OF YAVAPAI Case No. Petitioner ATLAS No. Respondent PROPOSED RESOLUTION STATEMENT OF: [ ] HUSBAND [ ] WIFE Date of Marriage: 1300DO The undersigned party provides the following position on each of the issues in this case. BE SPECIFIC. 1. IV-D Case: [ ] I receive or have received public assistance which may include AFDC, TANF, or AHCCCS for my child(ren) or me. [ ] I have a case with the Division of Child Support Services. Legal Decision-Making: The parties have the following natural or adopted child(ren) in common. (If there are no minor or disabled child(ren) common to the parties, skip to paragraph 3) Child(ren)'s Name(s) Date(s) of Birth Age(s) 2. The child(ren) should live primarily with [ ] Mother [ ] Father and have parenting time with [ ] Mother [ ] Father as follows (check all that apply): [ ] Generally in accordance with County Guidelines for reasonable parenting time. [ ] Model Parenting Time Plans (describe plan) . [ ] Every other weekend from at a.m./p.m. to at a.m./p.m. [ ] One-half of the holidays on an alternating basis. [ ] For weeks in the summer from ____________ to ____________ (inclusive). [ ] Spring Break from school. Superior Court of Arizona in Yavapai County July 2013 Page 1 of 5 PropResoStmt American LegalNet, Inc. www.FormsWorkFlow.com Case No. 1300DO [ ] Other: [ ] Mother or [ ] Father should have sole legal decision-making, OR [ ] Mother and Father should have joint legal decision-making. 3. Child Support: (If there are no minor or disabled children common to the parties and were no minor or disabled children from the date the parties separated, skip to paragraph 5.) The financial factors necessary to calculate child support under the Arizona Child Support Guidelines are as follows (complete in full): Father's gross monthly income: $ Mother's gross monthly income: $ [ ] Father has other child(ren) not listed above who he is supporting who live(s) in his household. [ ] Father has other child(ren) not listed above for whom he pays courtordered child support in the amount of $ per month. [ ] Mother has other child(ren) not listed above who she is supporting live(s) in her household. [ ] Mother has other child(ren) not listed above for whom she pays courtper month. ordered child support in the amount of $ [ ] Medical/insurance should be paid by [ ] Mother [ ] Father. Monthly cost for the child(ren) in this case is $ [ ] Dental insurance should be paid by [ ] Mother [ ] Father. Monthly cost for the child(ren) in this case is $ [ ] Vision insurance should be paid by [ ] Mother [ ] Father. Monthly cost for the child(ren) in this case is $ [ ] Neither parent has insurance which is accessible and available at a reasonable cost. [ ] Mother [ ] Father should pay cash medical support in the amount of $______ per month. [ ] Monthly child care costs for child(ren) in this case are $ . [ ] Extra education expenses or extraordinary child adjustments - I believe the court should add the following to the child support calculation (leave blank if none claimed): Description of expense Monthly Amount [ ] Uninsured medical/dental/vision expenses should be paid: [ ] Pro rata based upon each party's income, as provided in the Guidelines; or [ ] Other: % paid by Father and % paid by Mother. [ ] Tax exemptions for the child(ren) should be divided: [ ] Pro rata based upon each party's income, as provided in the Guidelines; or [ ] Other: Superior Court of Arizona in Yavapai County July 2013 Page 2 of 5 PropResoStmt American LegalNet, Inc. www.FormsWorkFlow.com Case No. 1300DO 4. 5. Past support should be paid by [ ] Mother [ ] Father for the period of through in the amount of $ . Spousal Maintenance: My position on spousal maintenance is: [ ] No spousal maintenance need be paid by either me or my spouse. [ ] I should pay my spouse $ per month for months. [ ] I should receive from my spouse $ per month for months. 6. Separate Property: I believe the following property is my sole and separate property (describe): 7. Community Liens on Separate Property: I believe I have a community interest in the following sole and separate property of my spouse: 8. Community Property. I want to divide all of the community property (except tangible personal property) as follows: Directions: Column 1: List short description of each item or real and personal property. Column 2: List your estimate of the fair market value of each item of property. List the loan or encumbrance amount(s) on the line directly below its value. Column 3: List the amount of net value of each item you propose for Husband. Column 4: List the amount of net value of each item you propose for Wife. 2. Fair Market Value (encumbrances) $ 3. Proposed for Husband $ 4. Proposed for Wife $ 1. Description Real Property Personal Property (e.g. stocks, bonds, life insurance, etc.) Superior Court of Arizona in Yavapai County July 2013 Page 3 of 5 PropResoStmt American LegalNet, Inc. www.FormsWorkFlow.com Case No. 1300DO IRAs, 401(k)s, Pensions (including survivor benefits) Vehicle(s) Boat(s) 9. Tangible Personal Property. I believe that the value of the tangible personal property (household furniture, furnishings, jewelry etc.) in the possession of each party is as follows: Husband has tangible personal property in his possession valued at approximately $ . Wife has tangible personal property in her possession valued at approximately $ . My preference to divide the tangible personal property is to (list your order of preference 1 ­ 4 with 1 being most important and 4 being the least): Each party should keep the tangible personal property currently in his/her possession with the exception of the following items I want from my spouse: An equalization payment/credit should be made based upon the above values so each of us gets the same value. We should make a list of all the tangible personal property and alternately select items from the list until all the property is divided. One of us should make two (2) lists of tangible personal property both equal in value, and the other one be awarded all property on the list of his or her choice. Other: 10. Debts: The community debts should be divided as follows (complete in detail): [ ] All of the debt should be paid % by Husband and % by Wife; or [ ] Each of us should pay the followi