IN THE CIRCUIT COURT, FOURTH JUDICIAL CIRCUIT, IN AND FOR CLAY COUNTY, FLORIDA CASE NO.: DIVISION: In re: The marriage of , Husband, and , Wife. / PRETRIAL STATEMENT I. Parties and Counsel: A. B. C. D. II. Husband: Husband's Attorney: Wife: Wife's Attorney: Type of proceedings: Original Dissolution of Marriage Original Paternity Post-Dissolution Modification of Custody, Visitation and Support Post-Paternity Final Judgment Modification of Custody, Visitation and Support Other: Pleading to be heard at trial: Party filing Pleading III. Full Title of Pleading Date Served Preliminary Data: 1 American LegalNet, Inc. www.USCourtForms.com A. Marriage 1. 2. B. Date: Place (City/State): Separation and filing: 1. 2. Date of separation: Date of filing petition: C. Mediation completed? D. Residences of parties: 1. E. No Husband resides at: 2. Yes Wife resides at: Residency of party for subject matter jurisdiction. Original Dissolution of Marriage Action This is not an Original Dissolution of Marriage Action. If this is a dissolution of marriage action, the party who is alleged to have been a resident of the State of Florida for the six months immediately preceding the filing of this action must provide corroboration of residency. If not previously filed, a copy of such party=s Florida driver=s license (with an issue date of at least six months prior to the date of filing) or an affidavit of a residency witness should be furnished to the court. Corroboration of residency furnished. 2 American LegalNet, Inc. www.USCourtForms.com IV. Children: A. Identification of children: Name B. Date of Birth Age (as of trial date) Children currently reside with: Wife/Mother Husband/Father Other: C. Completion certificate for Parenting Education and Family Stabilization Course (CFID/PDR) was filed by: Husband: Wife: D. Yes Yes No No UCCJEA Affidavit (or sworn allegations in pleading) filed by: Husband Wife 3 American LegalNet, Inc. www.USCourtForms.com V. Prior orders/judgments: Name and date of any order previously entered in this case regarding temporary custody, visitation or support; or if this a modification proceeding, the name and date of entry of the judgment sought to be modified and all prior modification order(s): Date of Entry Name of Judgment/Order VI. Related Clay County Cases: List any other related case which has been filed in Clay County, Florida. If either party contends any other case is related, it should be listed. Be certain to include any child support actions filed by the Department of Revenue, or any dependency actions filed by the Department of Children and Families. Also include any criminal, mental health, or other proceedings which either party contends is relevant. Case No. Type of action VII. Related Cases Filed in Other Counties or Jurisdictions: List any other related case which has been filed in any court outside of Clay County, Florida. If either party contends any other case is related, it should be listed. Be certain to include any child support actions filed by the Dept. of Revenue, or any dependency actions filed by the Dept. of Children and Families filed outside Clay County. Similar actions filed in any other state should also be included as well as any criminal, mental health, or other proceedings which either party contends is relevant. Type of action County/Jurisdiction Where Filed Case No. 4 American LegalNet, Inc. www.USCourtForms.com VIII. Summary of Issues: Indicate whether issue is involved in this case. Yes Check appropriate column to indicate which issues have been resolved. Description of issue Completely Resolved No Partially Resolved Disputed Parental Responsibility Custody Visitation Child Support Child(ren) Health Ins. & Health Expenses Alimony Equitable Distribution of Marital Assets and Liabilities Attorney Fees Describe any other issue involved in this case, even if resolved: State any agreements on issues resolved or not contested: 5 American LegalNet, Inc. www.USCourtForms.com IX. Specific Issues - Complete only for contested issues: A. Alimony: 1. Alimony is: Sought by the Wife. Sought by the Husband. Sought by each party. 2. The party seeking alimony is: requesting permanent, periodic alimony of $_____ per month. requesting rehabilitative alimony of $____ per month for __________ months/years. (If rehabilitative alimony is being sought, the party seeking should provide a brief written summary of their rehabilitation plan with this pretrial statement.) requesting another type of alimony: which is to be in the lump sum amount of $_________; or to be paid at the rate of $______ per month for _______ months. 3. B. The position of the party against whom alimony is sought is: Custody and visitation: If issues of custody and visitation have not been resolved, has a child custody evaluation been completed? Yes No. If either party is requesting or proposing a visitation schedule other than Fourth Judicial Circuit Visitation Guidelines, his or her proposed schedule should be submitted with this statement. 6 American LegalNet, Inc. www.USCourtForms.com C. Real estate: If the issues of real estate are not resolved prior to the pretrial conference, then each party shall submit with this pretrial statement a list of all real estate owned by the parties. For each parcel of real estate, the party should state: (1) Street address of property; (2) Legal description (or provide deed); (3) Name(s) of all owners of record (or provide deed); (4) Name of all mortgage holders, with the monthly payment and balance of each mortgage; (5) Name of all occupants or tenants, and if rental property, the amount of rental income with a copy of any written rental or lease agreements; and (6) Any fact or basis for asserting a claim that the party is entitled to an interest other than one-half. Although providing more detailed information, the list submitted by each party must be consistent with his or her Financial Affidavit. D. Tangible Personal Property: If the parties have not agreed upon a full and complete distribution of all tangible personal property, then each party shall submit with this pretrial statement a detailed list of all tangible personal property. Each item should be described with particularity. For each item, the party should state: (1) Description of item; (2) Location of item; (3) Fair market value; (4) Whether there is any debt for such item, and if so, the amount of the existing debt and the name of the creditor. Although providing more detailed information, the list submitted by each party must be consistent with his or her Financial Affidavit. E. Intangible Personal Property: List any Intangible Personal Property for which an equitable distribution needs to be made: . F. Liabilities. All liabilities should be listed on the parties= Financial Affidavits. Each party should submit a proposed distribution of the martial liabilities at the pretrial conference. G. Attorney fees and costs. Sought by: Husband Wife Issue to be reserved for consideration subsequent to final hearing. Issue to be heard at trial. 7 American LegalNet, Inc. www.USCourtForms.com H. Other issues. 1. X. Describe any other issues to be heard by the court: Pretrial Notice Requirements: A. Central Governmental Depository Memorandum: If this involves a request for alimony or child support, has a Central Governmental Depository Party Information Questionnaire been completed? Yes B. No Not applicable Witnesses and exhibits: Has a witness list been prepared and furnished to the opposing party/counsel? By the Husband? By the Wife? Yes Yes No No Have the exhibits been copied, indexed and furnished to the opposing counsel and the court? By the Husband? By the Wife? Dated this ____ day of Yes Yes No No , 20 . Husband, if pro se, or Husband's Counsel Wife, if pro se, or Wife's Counsel 8 American LegalNet, Inc. www.USCourtForms.com