ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) : FOR COURT USE ONLY TELEPHONE NO: ATTORNEY FOR (Name): FAX NO: SUPERIOR COURT OF CALIFORNIAl COUNTY OF FRESNO 1100 Van Ness Avenue Fresno, California 93724-0002 PETITIONER: RESPONDENT: CLAIMANT: CASE NUMBER: SETTLEMENT CONFERENCE STATEMENT Hearing Date: Time: Department Number: I am the Petitioner Respondent Claimant in this case and submit this Settlement Conference Statement. The following list shows the issues that are in dispute and those upon which we agree: ISSUE Community Property Separate Property Community Debt Separate Debt Child Support Spousal Support Child Custody Visitation Attached are the mandatory Income and Expense Declaration, my last three months pay stubs, and my past two years tax returns. I understand that if I fail to provide these mandatory documents this Settlement Conference will not be heard. 1. REAL PROPERTY We own a house located at The Fair Market Value is $ I propose: the house be sold I buy out Other: and the amount owed is $ Petitioner Petitioner's , leaving a net value of $ DISPUTED AGREED TO Respondent buy out my interest in the house. Respondent's interest in the house. The reason(s) for my request is/are: FFL-05 E08-01 SETTLEMENT CONFERENCE STATEMENT Page 1 of 5 2002 © American LegalNet, Inc. CASE TITLE CASE NUMBER: 2. COMMUNITY ASSETS/DEBTS Property Declaration SEPARATE ASSETS/DEBTS Schedule of Assets and Debts. I have filed with the court a I propose the following division of assets: Property To Go To Petitioner Property To Go To Respondent Debts To Go To Petitioner Debts To Go To Respondent 3. RETIREMENT PLAN Petitioner has a retirement plan. Respondent has a retirement plan. Petitioner has a retirement plan of employment with retirement plan be awarded to Petitioner Respondent has a retirement plan of employment with Respondent's retirement plan be awarded to Other: 401K that is currently worth approximately $ Respondent as a result . I am requesting Petitioner's divided between the parties. as a result . I am requesting divided between the parties. 401K that is currently worth approximately $ Petitioner Respondent FFL-05 E08-01 SETTLEMENT CONFERENCE STATEMENT Page 2 of 5 2002 © American LegalNet, Inc. CASE TITLE CASE NUMBER: 4. CHILD SUPPORT There is no current child support order. There is a Family Support Division case from The current child support order filed on Although there is no current child support order, per month as and for child support. I have Other: paid I have been paying County, Case Number is attached. I have been receiving $ since the date of separation. received a total of $ 5. I ASK THE COURT TO CHANGE THE CURRENT ORDER BECAUSE: The amount of time the children are with me has increased. My income has decreased. Petitioner's I have Respondent's income has increased. children from a separate relationship that are mine and reside with me. There is an order for me to pay child support for other children from separate relationships in the amount of $ per month. Other: 6. CHILDCARE EXPENSES The current child support orders include childcare in the amount of $ I currently pay $ per month. per month for childcare while Petitioner per month. Respondent is paying $ 7. HEALTH INSURANCE There is a health insurance order that Petitioner Respondent provides health insurance. Petitioner Respondent. The children currently have a health care plan provided by Other: 8. OTHER ISSUES RELATED TO CHILD SUPPORT I would like the court to consider the following factors in determining the amount of child support: FFL-05 E08-01 SETTLEMENT CONFERENCE STATEMENT Page 3 of 5 2002 © American LegalNet, Inc. CASE TITLE CASE NUMBER: 9. SPOUSAL SUPPORT Date of Separation: years, I request Petitioner months of marriage. Respondent pay receive spousal support in the sum of $ per month. Date of Marriage: Total: I request the court to stop the spousal support order. There is no current spousal support order. The current spousal support order filed on The County of order. Although there is no current spousal support order, month in spousal support. I have paid I have been paying received a total of $ I have been receiving $ since the date of separation. per month. per , Case Number is attached. , is currently enforcing the spousal support There is an order for me to pay spousal support from a previous relationship in the amount of $ I request the following spousal support order: 10. I ASK THE COURT TO CHANGE THE CURRENT ORDER BECAUSE: My income has decreased. Petitioner's Petitioner Other: Respondent's income has increased. Respondent is co-habitating with another. 11. CHILDREN We have NAME children. The children's names and dates of birth are listed below: DATE OF BIRTH NAME DATE OF BIRTH I have attached a Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act. 12. CURRENT CHILD CUSTODY AND VISITATION ORDERS There is/are no current The current FFL-05 E08-01 child custody child visitation order(s). is/are attached. Page 4 of 5 2002 © American LegalNet, Inc. child custody child visitation order(s), filed on SETTLEMENT CONFERENCE STATEMENT CASE TITLE CASE NUMBER: 13. PROPOSED CHILD CUSTODY I propose the current order(s) continue without change. I propose the following changes: The reason for the proposal is: 14. PROPOSED CHILD VISITATION I propose the current order continue without change. I propose the following visitation: The reason for the proposal is: Visitation should be supervised. The exchange should be supervised. Supervision should be provided by a mutually agreed upon third party equally by the parties a professional service. by Petitioner by Respondent. Costs for the professional service should be paid Other: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dated: (TYPE OR PRINT NAME) (SIGNATURE) FFL-05 E08-01 SETTLEMENT CONFERENCE STATEMENT Page 5 of 5 2002 © American LegalNet, Inc.