ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): TELEPHONE NO: FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF LASSEN Hall of Justice 2610 Riverside Drive Susanville, CA 96130 (530) 251-8205 PETITIONER/PLAINTIFF(S): RESPONDENT/DEFENDANT(S): FAMILY LAW CASE MANAGEMENT: SETTLEMENT CONFERENCE STATEMENT CASE NUMBER: SETTLEMENT CONFERENCE DATE: _______________ TIME: _______________ DEPT: _______________ NOTICE: You must file this document at least five (5) calendar days before the hearing date listed above. (a) [ ] attorney for (b) [ ] self-represented petitioner or [ ] self-represented respondent [ ] petitioner or [ ] respondent represented by an attorney. 1. I am: Opposing attorney or self-represented party's name, address, and telephone number is: Name: _____________________________________ Representative: _________________________ Address: __________________________________________________________________________ [ ] Additional parties and representative information attached. Phone: _____________________________________________________________ The other party [ ] is [ ] is not (c) [ ] other (explain): __________________________________________________________ 2. NATURE OF CASE a. Have the parties reconciled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [ ] Yes [ ] No b. Has the Respondent been served with the Summons and Petition . . . . . . . [ ] Yes [ ] No c. Do the parties expect to make an agreement . . . . . . . . . . . . . . . . . . . . . . . . . [ ] Yes [ ] No d. Has this case settled . . . . . . . . . . . . . . . [ ] Yes [ ] No Judgment will be filed on/before: ______ e. Parties working on an agreement and request the CMC be continued . . . . . . [ ] Yes [ ] No LSC Form 1B Page 1 of 4 Mandatory Form, Effective 01/01/2013 American LegalNet, Inc. www.FormsWorkFlow.com f. Has the Petitioner served Respondent with Disclosure Documents . . . . . . . . [ ] Yes [ ] No g. Has the Respondent served Petitioner with Disclosure Documents . . . . . . . . [ ] Yes [ ] No h. Have the parties had a meeting to try and settle all issues . . . . . . . . . . . . . . [ ] Yes [ ] No i. Are the parties involved in any private mediation . . . . . . . . . . . . . . . . . . . . . 3. ISSUES. This case involves the following issues (check all that apply): a. CHILD CUSTODY/VISITATION has been [ ] resolved by agreement [ ] resolved by Court Order [ ] still pending and the next hearing date is _____________ [ ] still pending and there is no hearing date set. 1. Party's proposed disposition for Child Custody/Visitation (Form FL-341) is attached. b. CHILD SUPPORT has been [ ] resolved by agreement [ ] resolved by Court Order [ ] still pending and the next hearing date is _____________ [ ] still pending and there is no hearing date set. 1. Is Department of Child Support Services a party to this action? 2. If yes, has Department of Child Support Services been notified? [ ] Yes [ ] Yes [ ] No [ ] No [ ] Yes [ ] No 3. Attach a completed Income and Expense Declaration (Form FL-150) with the requisite pay stubs attached and/or the immediate prior two years state and federal income tax returns. 4. Attach a completed Dissomaster Calculation. c. SPOUSAL SUPPORT has been [ ] resolved by agreement [ ] resolved by Court Order [ ] still pending and the next hearing date is _____________ [ ] still pending and there is no hearing date set. Attach on a separate sheet of paper the following: 1. Party's proposed disposition for spousal support including an analysis pursuant to Family Law Code section 4320. d. DIVISION OF ASSETS has been [ ] resolved by agreement [ ] resolved by Court Order [ ] still pending and the next hearing date is _____________ [ ] still pending and there is no hearing date set. Attach on a separate sheet of paper the following: 1. Party's claims for separate property and facts in support of said claims. 2. Tracing ­ if it is contended a single asset is part community and part separate in nature, then describe the asset, the date of acquisition, its value, the dates and amounts of payments upon its purchase or the transaction which resulted in its acquisition and a statement regarding the total value of the asset as to its community and separate property values. 3. Dates of acquisition of the assets. 4. Describe the encumbrances on each asset including the nature and extent of the terms of payments. LSC Form 1B Page 2 of 4 Mandatory Form, Effective 01/01/2013 American LegalNet, Inc. www.FormsWorkFlow.com 5. Describe the manner in which title is currently vested in the asset and the record of the title data. 6. Attach any appraisals for any assets. 7. Describe any funds held by others whether the fund is community or separate property such as insurance policies, pensions, profit sharing or other trust of retirement funds and list any loans that exist as against any of said funds. e. DIVISION OF DEBTS has been [ ] resolved by agreement [ ] resolved by Court Order [ ] still pending and the next hearing date is _____________ [ ] still pending and there is no hearing date set. Attach on a separate sheet of paper the following: 1. Party's claims for separate property and facts in support of said claims. 2. Dates debt was incurred. 3. Describe the terms and payments of the debts and any security held by a creditor. 4. Describe the manner in which title is currently vested in the debt. f. CREDITS Attach on a separate sheet of paper the following: 1. Describe in detail any credits and/or reimbursement due from the other party. g. ATTORNEY'S FEES & COSTS have been [ ] resolved by agreement [ ] resolved by Court Order [ ] still pending and the next hearing date is _____________ [ ] still pending and there is no hearing date set. 1. My position on attorney's fees is as follows: ___________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 4. TRIAL READINESS. I [ ] am [ ] am not ready for trial. [ ] hours a. If not ready for trial, when will you be ready (date): __________________________ to complete. b. If ready for trial, this case will take _____ [ ] days c. If ready for trial, what dates are you unavailable for trial: __________________________________________ _______________________________________________