Case Name (Petitioner's last name vs. Respondent's last name): Case Number 1 2 Attachment 19 to Declaration for Default or Uncontested Dissolution or Legal Separation (Form FL-170) 1. STATUS OF CASE 3 a. The parties were married on __________________ and separated on __________________. 4 5 6 7 8 The Petitioner requests his/her former name be restored to 9 10 11 12 13 14 15 ________________________________. b. This is a marriage of ________ year(s) and _______ month(s). c. Respondent was served with a Summons and Petition on _____________________. d. Respondent has not filed a Response and default has been submitted or entered. e. There is/are ______ minor child(ren) of this marriage. 2. NAME CHANGE (Only if you checked Item 7(1) of the Petition for Dissolution) 3. SPOUSAL SUPPORT (Only if you checked Item 7(f), 7(g) or both in the Petition for Dissolution) Petitioner requests that the Court find that Petitioner has WAIVED spousal support and that Respondent has not requested spousal support. Accordingly, spousal support is denied to both parties and the Courts jurisdiction to award spousal support is terminated. Petitioner requests that the Court find the issue of spousal support as to both parties is RESERVED effective forthwith upon entry of Judgment. Petitioner requests that the Court order permanent spousal support based on the facts set forth in the attached Spousal Support Questionnaire, pursuant to Family Code Section 4320. 4. PROPERTY DIVISION (Only if you checked Item 4, 5(a or b) or 7(h) of the Petition for Dissolution) 16 17 18 19 20 21 22 23 24 25 Petitioner requests that the Court find that there are no community assets and or debts to divide. Petitioner requests that the Court order the community assets and debts to be divided as set forth in the attached COMMUNITY PROPERTY DECLARATION (FL-160). Petitioner requests that the Court confirm the separate property assets and/or debts as set forth in the attached SEPARATE PROPERTYATTACHMENT. 5. OTHER ORDERS (Optional) Petitioner requests that the Court make other orders as set forth on OTHER ORDERS attachment. I declare under penalty of perjury under the laws of the State of California that the above stated facts are true and correct. Dated: ____________________________________________(Sign) __________________________________(Print name), Petitioner Attachment 19 to Declaration for Default or Uncontested Dissolution or Legal Separation (Form FL-170) Local Form FL-019 Rev. 6/2012 Page ___ of ___ American LegalNet, Inc. www.FormsWorkFlow.com Case Name (Petitioner's last name vs. Respondent's last name): Case Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 SPOUSAL SUPPORT QUESTIONNAIRE (Complete if requesting a permanent spousal support order) The Petitioner requests spousal support commencing (date) ________________, in the amount TO BE DETERMINED by court based upon the following facts: EARNING CAPACITY/MARITAL STANDARD OF LIVING: Marketable skills: I have the following job skills: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Job market for those skills: I am currently employed with (employer's name) __________________________________________ _______________________________________ and have been since (date) ________________. My position there is as a (position title) ________________________________ earning $______________ per hour/week/month. I am currently unemployed. I am making the following attempts to seek employment: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ I have been unable to find employment that utilizes my marketable job skills for the following reasons: 17 18 19 20 CONTRIBUTIONS TO SUPPORTING SPOUSE: 21 22 23 24 25 During the marriage I contributed to the education, training, career, or license of my spouse or partner as follows: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ /// (Describe the possible need for retraining or education to get more marketable skills or employment, the time and expense to get education/training to develop skills, and if your earning ability was impaired by periods of unemployment during the marriage devoted to domestic duties.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Attachment 19 to Declaration for Default or Uncontested Dissolution or Legal Separation (Form FL-170) Local Form FL-019 Rev. 6/2012 Page ___ of ___ American LegalNet, Inc. www.FormsWorkFlow.com Case Name (Petitioner's last name vs. Respondent's last name): Case Number ABILITY TO PAY/EARNING CAPACITY: 1 The other party has the ability to pay spousal support because: (Describe current employment and earning 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 GAINFUL EMPLOYMENT/INTERESTS OF CHILDREN: 21 22 23 24 25 My ability to work will will not unduly interfere with the interests of the dependent children in my custody because: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ DURATION OF MARRIAGE: We were married on _________________, and separated on ___________________, which is _______ year(s) and _______ month(s) of marriage. The other party has the following assets and obligations: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ capacity, all other sources of income other than employment and their current standard of living.) __________________________________________________