YOLO SUPERIOR COURT INSTRUCTIONS FOR FAMILY LAW SETTLEMENT CONFERENCE (FLSC) STATEMENT The following is required of all family law litigants who have been assigned settlement conference and trial dates: 1. Complete all sections of the FLSC Statement 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 need to use to answer the questions on the form. 4. Make two copies of the statement and any attachments. 5. Have another adult serve one copy on the other party by mail. If DCSS has appeared in this case, DCSS must be served by mail also. 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 FLSC Statement). 7. Take the original and the remaining copy of the FLSC Statement (with Proof of Service completed and attached) to Civil Legal Process in Room 103 of the main Courthouse. Civil Legal Process will put the original in the file and return a lodged copy for your records. 8. DEADLINE: both parties must complete all of this no later than 5 days before the FLSC 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 “Declaration Regarding Service of Declaration of Disclosure and Income & Expense Declaration” by the same deadline. 10. If you need to subpoena a witness for trial, you need to have your subpoenas issued by the clerk by the settlement conference date. Family Law Settlement Conference Statement 12/10 American LegalNet, Inc. www.FormsWorkFlow.com Name: ___________________________________________________________ Address: __________________________________________________________ Telephone: _______________________________ In Pro Per THE SUPERIOR COURT OF CALIFORNIA IN AND FOR THE COUNTY OF YOLO In Re Matter/Marriage of: Petitioner: ________________________ and Respondent: ______________________ ) ) ) ) ) ) ) ) ) ) ) ) ) Case No. __________________ □ PETITIONER’S □ RESPONDENT’S FAMILY LAW SETTLEMENT CONFERENCE STATEMENT Settlement Conference Date: _____________ Trial Date: ______________ PRELIMINARY INFORMATION 1.) Petitioner: Name ___________________________________ Age __________ Present Employer ________________________________________________ Gross Monthly Income $ ___________________________________ 2.) Respondent: Name _________________________________ Age _________ Present Employer _________________________________________________ Gross Monthly Income $____________________________________________ 3.) Date of Marriage: ___________________________________________________ Date of Separation: __________________________________________________ Length of Marriage: _________________________________________________ Page 1 of 7 Family Law Settlement Conference Statement 12/10 American LegalNet, Inc. www.FormsWorkFlow.com 4.) List all other court cases involving the parties: (Case # and Court) ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 5.) Issues to be considered by the Court (check those that apply): □ □ □ □ □ □ □ Dissolution of Marriage Child Custody Child Support Spousal Support Property Division and Equalization Assignment of Debts Other ___________________________________________________________ (Specify) DISSOLUTION OF MARRIAGE (Complete if you are requesting dissolution of marriage) 6.) When was the other party (Respondent) served with the Summons and Petition for Dissolution? (Date) __________________________________________________ CHILDREN OF THE RELATIONSHIP 7.) Provide the following information regarding minor children of the relationship: (When listing present custody, use the terms Mother, Father, or Other, and fill in name.) Name Date of Birth Age Present Custody ________________________ ___________ _______ _____________ ________________________ ___________ _______ ______________ ________________________ ___________ _______ ______________ ________________________ ___________ _______ ______________ ________________________ ___________ _______ ______________ ________________________ ___________ _______ _______________ Page 2 of 7 Family Law Settlement Conference Statement 12/10 American LegalNet, Inc. www.FormsWorkFlow.com EXISTING ORDERS 8.) Attach all court orders for custody, support, and control of property and list the date of the order. ___________________________________________________________________________ ___________________________________________________________________________ ISSUES SETTLED 9.) Please provide copies of settlement agreements for issues that are settled. If you believe there is an oral settlement on any issues, please state the agreement. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 10.) Attach all agreements reached in mediation and recommendations issued by the mediator. Comments? _________________________________________________________________________ _________________________________________________________________________ 11.) Describe the custody arrangement you want the court to order and provide the reasons you want this custody arrangement. __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Page 3 of 7 Family Law Settlement Conference Statement 12/10 American LegalNet, Inc. www.FormsWorkFlow.com __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ PROPERTY ISSUES (Complete if Property Division is an issue) 12.) State your proposed division of the property and debts of the marriage. Show how the community property and debts are being divided equally. __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Page 4 of 7 Family Law Settlement Conference Statement 12/10 American LegalNet, Inc. www.FormsWorkFlow.com 13.) If either party is a participant in a retirement plan, has the plan been joined to this legal action? ______________ If so, list plan and who is a participant. PARTICIPANT PLAN ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ CURRENT INCOME AND EXPENSE (Complete in all cases) 14.) Attach a completed Income and Expense Declaration which has current income and expense information for you, and includes copies of recent paycheck stubs and/or documentation of self-employment or other income (e.g., Schedule C, unemployment benefit award amounts, etc.) SPOUSAL SUPPORT (Complete if Spousal Support is an issue) 15.) Is there presently an order for payment of spousal support? a.) □ Yes □ No b.) Payable by which party? ______________________ to which party? ______________________ c.) How much per month? _______________________ (amount) d.) Date the order was issued: ______________________ (date) 16.) Future Spousal Support: If you are requesting future spousal support, please state the amount you are requesting, why this amount is appropriate, and for how long the other party should have to pay. __________________________________________________________________________ __________________________________________________________________________ Page 5 of 7 Family Law Settlement Conference Statement 12/10 American LegalNet, Inc. www.FormsWorkFlow.com __________________________________________________________________________ CHILD SUPPORT (Complete in all cases where child custody or child support is in issue) 17.) Is there presently an order for payment of child support? □ Yes a.) □ No b.) Payable by which party? ________________________________________ To whom? ____________________________________________________ (party name, or local child support agency) c.) How much per month? _______________________ (amount) 18.) d.) Date the order was issued: __________________________ (date) Are the children presently covered by health insurance? a.) □ Yes □ No b.) If yes, what is the monthly premium? $ ________________________ 19.) Does either party presently pay for day care for work? a.) □ Yes □ No b.) If yes, what is the monthly cost of day care? $ ________________________ 20.) Provide your proposal for future child support and attach a Guideline calculation. Amount: $______________________________ 21.) Has the Department of Child Support Services (DCSS) been contacted by either party in this case? a.) □ Yes □ No b.) If yes, is there currently a DCSS case open or has DCSS appeared in this case? DCSS Case # ________________________ Page 6 of 7 Family Law Settlement Conference Statement 12/10 American LegalNet, Inc. www.FormsWorkFlow.com c.) Has DCSS been notified about the settlement conference date? __________ OTHER ISSUES (Complete if there are additional issues before the court) 22.) If there are other issues the Court is to consider, identify each and describe the circumstances: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Date: _________________________________ _________________________________ □ □ Petitioner Respondent ATTACH COMPLETED PROOF OF SERVICE BY MAIL Page 7 of 7 Family Law Settlement Conference Statement 12/10 American LegalNet, Inc. www.FormsWorkFlow.com