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Uniform Settlement Pretrial Conference Memorandum Form. This is a Illinois form and can be use in Cook Local County.
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Tags: Uniform Settlement Pretrial Conference Memorandum, CCDR 0043, Illinois Local County, Cook
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3400 - Pre-Trial Memorandum Filed
Uniform Settlement Pretrial Conference Memorandum
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(Rev. 7/30/12) CCDR 0043
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION
IN RE THE MARRIAGE/CIVIL UNION
____________________________________________________
No. __________________________________
PETITIONER
AND
____________________________________________________
Calendar: ____________________________
RESPONDENT
UNIFORM SETTLEMENT PRETRIAL CONFERENCE MEMORANDUM
PREPARED BY: ______________________________________ (Petitioner or Respondent)
(Add Addendum if more space is required.)
Date of Civil Union/Marriage: _________________________
Date of Separation: ______________________________
Petitioner’s Age D/O/B: ______________________________
Respondent’s Age D/O/B: _______________________
Petitioner’s Occupation: ______________________________
Respondent’s Occupation: _____________________
Income from all sources to date (as calculated for child support purposes):
Last year’s gross:
Petitioner: ________________
Respondent: ________________
Last year’s net:
Petitioner: ________________
Respondent: ________________
Assets: (from Schedules A & C)
Civil Union/
P Non-Civil Union/ R Non-Civil Union/
Marital Value1 Non-MaritalValue Non-Marital Value
(1) Equity in real estate
(2) Cash/cash equivalents
$ ____________
$ ____________
(3) Investment accounts/securities
(4) Business interests (including Partnerships, Corporations,
LLCs)
(5) Stock Options/ESOs (other employment benefits)
$ ____________
(6) Cash value of life insurance
(7) Equity in motor vehicles, RVs, boats, aircraft
$ ____________
$ ____________
(8) Personal property
(9) IRA accounts, deferred compensation, annuities, 401(k),
profit-sharing
$ ____________
$ ____________
(10) Pension plans
(11) Other property
TOTAL ASSETS:
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
$ ____________
$ ____________
0.00
$ ____________
____________
____________
____________
0.00
____________
____________
____________
____________
0.00
____________
LESS LIABILITIES (from Schedules B & C):
(excluding liens on real estate, motor vehicles, RVs, boats, aircraft) $ ____________
Assets Less Liabilities:
$ ____________
Reimbursement Claim (from Schedule D):
$ ____________
Dissipation Claim(s) (from Schedule E):
$ ____________
____________
____________
____________
____________
____________
____________
____________
____________
$ ____________
$ ____________
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
1
Value listed should reflect most current value of asset
(Page 1 of 10)
Child(ren)’s Information:
Name(s) ___________________________________ School Child Attending: _________________________________
Birthdate(s) ________________________________School Expenses/Tuition: ___________________________________
Health/Education Issues:______________________________________________________________________________
Name(s) ___________________________________ School Child Attending: _________________________________
Birthdate(s) ________________________________School Expenses/Tuition: ___________________________________
Health/Education Issues:______________________________________________________________________________
Name(s) ___________________________________ School Child Attending: _________________________________
Birthdate(s) ________________________________School Expenses/Tuition: ___________________________________
Health/Education Issues:______________________________________________________________________________
Name(s) ___________________________________ School Child Attending: _________________________________
Birthdate(s) ________________________________School Expenses/Tuition: ___________________________________
Health/Education Issues:______________________________________________________________________________
Other Issues Pertaining to Parties;
Petitioner
Health: ________________________________________
_______________________________________________
_______________________________________________
Respondent
______________________________________________
_______________________________________________
_______________________________________________
Current Income Disputes and Basis:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Educational History
(Highest degree attained)
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
GROUNDS: (Specify party alleging grounds);
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
*See Schedule H if there are Custody or Visitation Issues
(Rev. 7/30/12) CCDR 0043
(Page 2 of 10)
SCHEDULE A
CIVIL UNION/MARITAL ASSETS (Add Addendum if more space is required.)
1.
Real Estate
Address
Title in
P/R
Date
Value
Value
Liens
Net Equity
___________________________
___________________________
___________________________
___________________________
_____________
_____________
_____________
_____________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
0.00
Total Equity in Real Estate: ____________________________________________________________________________
2.
Cash/Cash Equivalents
If Institutions/Account No.
(Use last 3 digits of account no.)
Title
Date Valued
__________________________
__________________________
__________________________
__________________________
________________________
________________________
________________________
________________________
______________
______________
______________
______________
Value
______________
______________
______________
______________
0.00
Total Value of Cash/Cash Equivalents: ____________________________________________________
3.
Investment Accounts/Stock/BondsMutual Funds/Secured/Unsecured Receivables/Other Institutions/Account No.
(Use last 3 digits of account no.)
Title
in P/R
Date Valued
Value
__________________________
__________________________
__________________________
__________________________
_______________________
_______________________
_______________________
_______________________
______________
______________
______________
______________
______________
______________
______________
______________
Total Value of Investment Accounts/Stock/Bonds/Mutual Funds/Secured/Unsecured/Receivables/Other:
____________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
(Rev. 7/30/12) CCDR 0043
(Page 3 of 10)
4.
Business Interests (including Partnerships, Corporations and LLCs)
Name of Business
Form of
Ownership
% of P/R
Ownership
Date Valued
Value
___________________________
___________________________
___________________________
___________________________
___________________
___________________
___________________
___________________
____________
____________
____________
____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
5.
Stock Options/ESOPS/Other Employee Benefits
Name of plan
P/R
Date Valued
Value
_________________________________
_________________________________
_________________________________
_________________________________
___________
___________
___________
___________
____________
____________
____________
____________
_____________
_____________
_____________
_____________
6.
Life and Disability Insurance Policies
Name of
Company
Policy
Number
Name
of Insured
Description
of Benefit
1.
2.
3.
4.
_______________
_______________
_______________
_______________
_____________________
_____________________
_____________________
_____________________
______________________
______________________
______________________
______________________
Owner
Cash Value
Date Valued
1.
2.
3.
4.
_______________________________
_______________________________
_______________________________
_______________________________
_______________
_______________
_______________
_______________
____________
____________
____________
____________
7.
Motor Vehicles/RVs/Boats/Aircraft
_______________________________
_______________________________
_______________________________
_______________________________
Year/Make/Model
Title in
P/R
Date
Valued
Value
Liens
Net Equity
________________________
________________________
________________________
________________________
____________
____________
____________
____________
__________
__________
__________
__________
_________
_________
_________
_________
__________
__________
__________
__________
__________
__________
__________
__________
(Rev. 7/30/12) CCDR 0043
(Page 4 of 10)
8.
Personal Property (including coins, stamps, art, antiques, etc.)
Description
Value
Date Valued
Title in P/R
_________________________________
_________________________________
_________________________________
_________________________________
___________
___________
___________
___________
____________
____________
____________
____________
______________________________
______________________________
______________________________
______________________________
9.
IRA Accounts/Deferred Compensation/Annuities/401(k) Profit-Sharing
Institutions/Account No.
(Use last 3 digits of account no.)
P/R
Date Valued
Value or Benefit
1.
2.
3.
4.
______________
______________
______________
______________
____________
____________
____________
____________
________________________
________________________
________________________
________________________
_______________________
_______________________
_______________________
_______________________
Type of plan
1.
2.
3.
4.
___________________________
___________________________
___________________________
___________________________
10. Pension Plans
Name of Plan
P/R
Date Valued
Value or Benefit
_____________________________
_____________________________
_____________________________
_____________________________
______________
______________
______________
______________
____________
____________
____________
____________
________________________
________________________
________________________
________________________
11. All Other Property Not Elsewhere Provided (including choses in action):
Description
Value
Date Valued
Value or Benefit
_____________________________
_____________________________
_____________________________
______________
______________
______________
____________
____________
____________
________________________
________________________
________________________
_____________________________
______________
____________
________________________
(Rev. 7/30/12) CCDR 0043
(Page 5 of 10)
SCHEDULE B
DEBTS/LIABILITIES
(Exclude liens on Real Estate, Autos, RVs, Boats, Aircraft)
Creditor Name/Last
4 Digits of any Acct. No.
Debtor/Name(s) on
Acct. if Applicable
Total Balance
Owed
Monthly
Payment
_________________
_________________
_________________
_________________
________________
________________
________________
________________
____________
____________
____________
____________
____________
____________
____________
____________
SCHEDULE C
NON-CIVIL UNION/NON-MARITAL PROPERTY, DEBT AND EQUITY
(for Real Estate, Autos, RVs, Boats and Aircraft)
Provide same details as required of assets in Schedule A.
Petitioner Non-Civil Union/Non-Marital
Asset
Title
Value
Non-Marital/
Non-Civil Union Debt
Date of Value
1. _______________
______________________
______________________
______________________
______________________
____________
____________
____________
____________
______________
______________
______________
______________
______________
______________
______________
______________
2. _______________
3. _______________
4. _______________
Basis of Non-Civil Union/Non-Marital Claim (for above):
1. _____________________________________________________
2. _____________________________________________________
3. _____________________________________________________
Respondent Non-Civil Union/Non-Marital
Asset
Title
Value
Non-Marital/
Non-Civil Union Debt
Date of Value
1. _______________
______________________
______________________
______________________
______________________
____________
____________
____________
____________
______________
______________
______________
______________
______________
______________
______________
______________
2. _______________
3. _______________
4. _______________
Basis of Non-Civil Union/Non-Marital Claim (for above):
1. _____________________________________________________
2. _____________________________________________________
3. _____________________________________________________
(Rev. 7/30/12) CCDR 0043
(Page 6 of 10)
SCHEDULE D
CLAIMS FOR REIMBURSEMENT FROM ONE ESTATE TO ANOTHER
Amount and Estate from which Reimbursement Claimed and to which Estate it is Due
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
Basis for Claims for Reimbursement
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
SCHEDULE E
ALLEGED DISSIPATION
State the amount/basis/time frame of each dissipation:
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
SCHEDULE F
STATEMENT OF LITIGATION EXPENSES PAID AND OWED
Petitioner’s litigation expenses paid: $ ____________; Owed _____________ As of Date: _____ /_____ /_____
Respondent’s litigation expenses paid: $ ____________; Owed _____________ As of Date: _____ /_____ /_____
Child Representative’s litigation expenses paid: $ ____________; Owed _____________ As of Date: _____ /_____ /_____
SCHEDULE G
MEDICAL INSURANCE
Describe current insurance available and any claims with regards to insurance
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
Name of party to carry medical insurance
____________________________________________________
Outstanding medical obligations and responsibilities
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
(Rev. 7/30/12) CCDR 0043
(Page 7 of 10)
SCHEDULE H
CUSTODY
Current order or status in effect relating to custody, visitation and child support (Describe):
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
1.) If no custody disclosure statement has been served please state the following:
a.
The basis for seeking custody:
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
b.
Child Support Proposal: (If deviation from child support guidelines is requested, state reasons)
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
c.
Are there any other court proceedings having a bearing on custody, visitation and support (Name of case, type of
action and last court order)
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
d.
A Custody Disclosure Form
HAS HAS NOT been served.
*If a Custody Disclosure Form HAS been served please attach a copy.
(Rev. 7/30/12) CCDR 0043
(Page 8 of 10)
SETTLEMENT PROPOSAL
1.) Maintenance Proposal (Amount, Duration and Reason(s) for Duration or Denial):
____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________
2.) Allocation of Civil Union/Marital Assets:
ASSET
NET VALUE
PETITIONER
RESPONDENT
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
Adjustment for dissipation or reimbursement:
_____________
__________________
__________________
TOTAL:
0.00
_____________
0.00
__________________
0.00
__________________
3.) Assignment of Non-Civil Union/Non-Marital Property:
ASSET
NET VALUE
PETITIONER
RESPONDENT
________________________________________
________________________________________
________________________________________
________________________________________
_____________
_____________
_____________
_____________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
TOTAL:
0.00
_____________
0.00
__________________
0.00
__________________
CREDITOR
AMOUNT
PETITIONER
RESPONDENT
________________________________________
________________________________________
________________________________________
________________________________________
_____________
_____________
_____________
_____________
0.00
_____________
__________________
__________________
__________________
__________________
0.00
__________________
__________________
__________________
__________________
__________________
0.00
__________________
4.) Assignment of Civil Union/Marital Debt:
TOTAL:
(Rev. 7/30/12) CCDR 0043
(Page 9 of 10)
5.) Assignment of Non-Civil Union/Non-Marital Debt:
CREDITOR
AMOUNT
PETITIONER
RESPONDENT
________________________________________
________________________________________
________________________________________
________________________________________
_____________
_____________
_____________
_____________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
__________________
TOTAL:
0.00
_____________
0.00
__________________
0.00
__________________
6.) School Expenses:
LIST EXPENSES
PARTY OBLIGATED TO PAY
_______________________________________
_______________________________________
_______________________________________
____________________________
____________________________
____________________________
7.) Attorneys, Other Litigation Fees and Costs, Proposal
ATTORNEY
FEES
OTHER LITIGATION FEES
AND COSTS
PROPOSAL
______________
______________
______________
______________
_________________________
_________________________
_________________________
_________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
Submitted by: _______________________________________
Petitioner/Respondent
Date Submitted: ______________________, __________
Signed: _______________________________________
Petitioner/Respondent
Atty. No.: ______________
Name: __________________________________________
Atty for: ________________________________________
Address: ________________________________________
City/State/Zip: _____________________________________
Telephone: _______________________________________
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
(Rev. 7/30/12) CCDR 0043
(Page 10 of 10)