Superior Court of California, County of Sacramento Self Help Center INSTRUCTIONSFORSTATEMENTSOF The following is required before your settlement conference and trial dates: 1. Complete all sections of the Statement of Issues that apply to you. 2. Insert your Settlement Conference and Trial dates on the first page of the form. 3. Attach any additional sheets you used to answer the questions on the form. 4. Make four (4) copies of the statement and any attachments. 5. Have another adult serve one copy on the other party by mail. 6. 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). 7. File the original and the remaining three (3) copies of the Statement of Issues (with Proof of Service completed and attached) in Room 215. 8. Deadline: All of this must be completed and served by both parties at least 20 days before the settlement conference. If the statement of issues is served by mail, an additional five calendar days is required for service. If neither party complies with this requirement, the settlement conference will take place but the trial date will be dropped. If only one party complies, the settlement conference will take place, but the complying party has the option to proceed with the trial, or change or drop the trial date. 9. Note: If you are obtaining a divorce or legal separation, be sure to also complete your financial disclosures and file your form entitled 223Declaration Regarding Service of Declaration of Disclosure and Income & Expense Declaration224 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. Revised 2-4-19 American LegalNet, Inc. www.FormsWorkFlow.com -1 Name: Address: Telephone: ( ) E-mail address: In Pro Per THE SUPERIOR COURT OF CALIFORNIA IN AND FOR THE COUNTY OF SACRAMENTO In Re Matter/Marriage of: ) Case No. ) ) PETITIONER222S Petitioner: ) RESPONDENT222S ) STATEMENT OF ISSUES and ) ) Settlement Conference Respondent: ) Date: ) ) Trial or Long Cause ) Date: 1.) Petitioner: PRELIMINARY INFORMATION Name D.O.B. Present Employer Employer222s Address Gross Monthly Income $ 2.) Respondent: Name D.O.B. Present Employer Employer222s Address Gross Monthly Income $ American LegalNet, Inc. www.FormsWorkFlow.com -2 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) American LegalNet, Inc. www.FormsWorkFlow.com -3 HISTORY OF DOMESTIC VIOLENCE (Complete in all cases) 20.) A completed Income and Expense Declaration which has current income and expense information is: [ ] 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) 8.) Is there presently an order for child custody in effect? a.) [ ] Yes [ ] No 9.) If yes, list existing child custody orders: Name of Child Date of Order Party Having Custody Party Having Visitation 10.) Describe the child custody/visitation arrangements presently being followed by you and the other parent: 11.) Has custody been mediated at Family Court Services? [ ] Yes [ ] No 12.) If yes, has the report been completed? [ ] Yes [ ] No If the report has not been completed, when do you think it will be completed? (date) American LegalNet, Inc. www.FormsWorkFlow.com -4 What is the date of the completed report and recommendation? (date) What custody/visitation arrangement is recommended by the Family Court Services Report? (Briefly describe): 13.) Describe the custody arrangement you want the court to order at the present time (check the appropriate box): a.) [ ] Remain the same. b.) [ ] Adopt Family Court Services report dated: c.) [ ] Other (describe): 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 district attorney) c.) How much per month? (amount) d.) Date the order was issued: 15.) 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? American LegalNet, Inc. www.FormsWorkFlow.com -5 [ ] 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? 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 which has current income and expense information is: American LegalNet, Inc. www.FormsWorkFlow.com -6[ ] 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 party222s separate property? [ ] Yes [ ] No 22.) If yes, list each item of property and debt, and the party that property or debt belongs to: Description of Item/Debt Party to Whom it Belongs (H or W) 1. 2. 3. 4. 5. COMMUNITY PROPERTY AND DEBTS (Complete if Property Division is an issue) 23.) Property owned by the Parties: (List the property owned by you and the other party) Description of Item Present Value Who Has It (H or W) 1. 2. 3. 4. 5. 24.) Shared Debts of the Parties: (List the debts for which you and the other party are liable) American LegalNet, Inc. www.FormsWorkFlow.com -7 Creditor Name 226 Purpose of Debt Amount Owing 1. $ 2. $ 3. $ 4. $ 5. $ 25.) Has either party made payments after your separation on debts shared by the parties? [ ] Yes [ ] No 26.) If yes, list all payments on shared Debts of the Parties: Creditor Name 226 Date of Payment Amount Paid 1. $ 2. $ 3. $ 4. $ 5. $ FUNDS HELD BY OTHERS (Complete if Property Division is an issue) 27.) Does any firm, business, or other entity have money or property in which either party presently has an interest (e.g., life insurance policies, brokerage accounts, deposit accounts)? [ ] Yes [ ] No 28.) If yes, list each item of property and the party who presently has the property, and describe each party222s interest in the property: 29.) Does either party have an interest in a retirement plan, profit sharing or pension plan? American LegalNet, Inc. www.FormsWorkFlow.com -8 [ ] Yes [ ] No 30.) If yes, list the business, agency or employer who maintains the plan, and describe the party222s interest in the plan (e.g., party222s employer, party is receiving benefits from plan): TRACING (Complete if Property Division is an issue) 31.) Was an item of property acquired by you and the other party using money or other property which was the sole property of just one of you? [ ] Yes [ ] No 32.) If yes, list each item of property and describe how th