Superior Court of California, County of Amador Self Help Center INSTRUCTIONS FOR STATEMENTS OF ISSUES The following is required before your settlement conference and trial dates: 1. 2. 3. 4. 5. 6. Complete all sections of the Statement of Issues that apply to you. Insert your Settlement Conference and Trial dates on the first page of the form. Attach any additional sheets you used to answer the questions on the form. Make three (3) copies of the statement and any attachments. Have another adult serve one copy on the other party by mail. Ask the person serving the other party to complete a Proof of Service by Mail (one may be attached to the end of your Statement of Issues). File the original and the remaining two (2) copies of the Statement of Issues (with Proof of Service completed and attached) in the clerks office. Deadline: Where a matter is set for contested trial, either short or long cause, both parties shall file with the Court and serve a "Statement of Issues, Contentions and Proposed Disposition of the Case" at least 20 days prior to 7. 8. the trial date, and if there is a settlement conference, at least five (5) court days before the settlement conference. (Pursuant to Local Rule 13.03 and 13.15(f) www.amadorcourt.org)If both parties fail to timely file a Statement the matter shall not be permitted to proceed to trial; however, a court assisted settlement conference shall remain available. Failure by one party to file a Statement pursuant to this rule will allow the complying party to continue or drop the trial date and may result in the imposition of sanctions. The imposition of sanctions pursuant to this rule shall be heard upon noticed motion. 9 Note: If you are obtaining a divorce or legal separation, be sure to also complete your financial disclosures and file your form entitled "Declaration Regarding Service of Declaration of Disclosure and Income & Expense Declaration" by the same deadline. Note: If there is not enough space provided in any question for all the information you want to present, use additional sheets and attach them to this completed form. 1 Statement of Issues Packet FCS-92 ­ 03/2017 American LegalNet, Inc. www.FormsWorkFlow.com Name: Address: Telephone: ( ) E-mail address: In Pro Per THE SUPERIOR COURT OF CALIFORNIA IN AND FOR THE COUNTY OF AMADOR In Re Matter/Marriage of: Petitioner: and Respondent: ) ) ) ) ) ) ) ) ) ) ) Case No. PETITIONER'S RESPONDENT'S STATEMENT OF ISSUES Settlement Conference Date: Trial or Long Cause Date: PRELIMINARY INFORMATION 1.) Petitioner: Name D.O.B. Present Employer Employer's Address Gross Monthly Income $ 2.) Respondent: Name D.O.B. Present Employer Employer's Address Gross Monthly Income $ 2 American LegalNet, Inc. www.FormsWorkFlow.com 3.) Date of Marriage Date of Separation Length of Marriage 4.) When was the Respondent served with the Summons and Petition? (Date) 5.) Issues to be considered by the Court (check those that apply): [ ] Dissolution of the Marriage [ ] Child Custody [ ] Child Support [ ] Spousal Support [ ] Property Division and Equalization [ ] Assignment of Debts [ ] Other (specify) CHILDREN OF THE RELATIONSHIP 6.) Provide the following information regarding minor children of the relationship: Name Date of Birth Age 7.) In Present Custody of (Petitioner / Respondent / Other) 3 American LegalNet, Inc. www.FormsWorkFlow.com HISTORY OF DOMESTIC VIOLENCE (Complete in all cases) 8.) [ ] There has been no history of domestic violence between the parties. [ ] There has been a history of domestic violence, but neither party has a Domestic Violence Restraining Order in place at this time. [ ] There is a Domestic Violence Restraining Order in place against [ ] Petitioner [ ] Respondent. (Attach a copy) CHILD CUSTODY (Complete if child custody or child support is in issue) 9.) Is there presently an order for child custody in effect? a.) [ ] Yes [ ] No 10.) If yes, list existing child custody orders: Name of Child Date of Order Party Having Custody Party Having Visitation 11.) Describe the child custody/visitation arrangements presently being followed by you and the other parent: 12.) Have parties attended mediation? [ ] Yes [ ] No 13.) Describe the custody arrangement you want the court to order at the present time (check the appropriate box): a.) b.) [ ] Remain the same. [ ] Other (describe): 4 Statement of Issues Packet FCS-92 ­ 03/2017 American LegalNet, Inc. www.FormsWorkFlow.com CHILD SUPPORT (Complete in all cases where child custody or child support is in issue) 14.) Is there presently an order for payment of child support? a.) [ ] Yes (complete b., c. and d.) [ ] No (go on to #36) b.) Payable by which party? Payable to which party? (party name, or child support agency) c.) d.) 15.) How much per month? (amount) Date the order was issued: Does either party presently pay for day care for work? a.) [ ] Yes [ ] No b.) If yes, what is the monthly cost of day care? $ 16.) Future Child Support: a.) Should one Party continue to pay Child Support to the other Party? [ ] Yes [ ] No b.) If no, why not? c.) Amount of time the child(ren) spend with each parent: Father percent Mother percent 17.) Is the Department of Child Support Services involved in collecting your child support? [] Yes [] No SPOUSAL SUPPORT (Complete if Spousal Support is in issue) 18.) Is there presently an order for payment of spousal support? a.) [ ] Yes (complete b., c. and d.) [ ] No (go on to #34) b.) Payable by which party? Payable to which party? American LegalNet, Inc. www.FormsWorkFlow.com 5 c.) How much per month? (amount) d.) Date the order was issued: (date) 19.) Future Spousal Support: a.) Should one Party pay Spousal Support to the other Party? [ ] Yes [ ] No b.) Why / why not? CURRENT INCOME AND EXPENSES (Complete in all cases) 20.) A completed Income and Expense Declaration (FL-150) which has current income and expense information is: [ ] attached [ ] was filed on (date) [ ] was served with the financial disclosures on (date) SEPARATE PROPERTY AND DEBTS (Complete if Property Division is an issue) 21.) Does either party presently have property or debts which are the party's separate property? [ ] Yes [ ] No If yes, list each item of property and debt, and the party that property or debt belongs to: Description of Item/Debt 1. 2. 3. 4. 5. 6 American LegalNet, Inc. www.FormsWorkFlow.com . 22.) Party to Whom it Belongs (H or W) COMMUNITY PROPERTY AND DEBTS (Complete if Property Division is an issue) 23.) Property owned by