IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS IN RE THE MARRIAGE SUPPORT CIVIL UNION PARENTAGE ) ALLOCATION OF PARENTAL ) RESPONSIBILITIES ) ) ) ) ) ) ) ) Case No. ________________________ ____________________________________________________ vs. ___________________________________________________ JUDGMENT OF DISSOLUTION This matter coming on to be heard on the Petition for Dissolution filed on ______________________________________ , proper notice having been given, the following persons present in open court ___________________________________ _________________________________________________________________________________________________ the court being fully advised, FINDS as follows: 1. This Court has personal and subject matter jurisdiction. This Court also has jurisdiction under the Uniform Child-Custody Jurisdiction and Enforcement Act (UCCJEA). 2. The Petitioner was a resident of the State of Illinois at the time the Petition for Dissolution was commenced and maintained his/her residence in the State of Illinois for ninety (90) days prior to either the filing date of the petition or the date of these proceedings . 3. The Petitioner and Respondent were married/entered into a civil union on __________________________________ . (mm/dd/yyyy) 4. The service took place in __________________________________ and is registered in that state and county. City/County and State 5. Children (Check all that apply): a. The following child(ren) were born to or adopted by the Petitioner and Respondent: Name Date of Birth (mm/dd/yyyy) Currently Living With (Attach additional pages as needed) b The Petitioner and Respondent have no children together. or c. That the Petitioner is / is not currently pregnant. or d. That the Respondent is / is not currently pregnant. e. That the allocation of parental responsibilities of the parties minor child(ren) as set forth herein is in the best interest of the minor child(ren) the Court having considered the statutory factors. 6. Grounds for Dissolution Irreconcilable differences have caused the irretrievable breakdown of the marriage and efforts at reconciliation have failed or future attempts at reconciliation would be impracticable and not in the best interest of the family. 7. Petitioner is unemployed / employed and has an approximate take-home pay of $ ________________________ Payable weekly, bi-weekly, semi-monthly, monthly / status of employment is unknown. Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com 171-411 (Rev. 8/16) 8. Respondent is unemployed / employed and has an approximate take-home pay of $ ______________________ Payable weekly, bi-weekly, semi-monthly, monthly / status of employment is unknown. 9. The Petitioner has proven the material allegations of the Petition for Dissolution by substantial competent and relevant evidence and a Judgment for Dissolution should be granted. IT IS THEREFORE ORDERED: (Check all that apply) A. The parties are awarded a Judgment of Dissolution, and the bonds existing between the Petitioner and the Respondent are hereby dissolved. B. Allocation of Parental Responsibilities 1. Significant Decision Making Responsibilities a. That sole parental decision-making responsibilities for the minor child(ren) is awarded to the Petitioner / Respondent. b. The Petitioner and Respondent are awarded joint parental decision-making responsibilities of the minor child(ren), with the Petitioner / Respondent to be the residential custodian pursuant to the terms of the attached Parenting Plan (#171-480) which is incorporated into this Judgment by reference herein. 2. Parenting Time a. The Petitioner / Respondent shall have specific parenting time with the minor children(ren) as specified in the attached Parenting Plan (#171-480) Order for Parenting Time (#171-412) which document is incorporated into this Judgment by reference herein. b. The issue of parenting time is reserved _____________________________________________ C. Child Support and other Support Issues 1. The Petitioner / Respondent shall pay child support in the amount of $______________ payable weekly, bi-weekly, semi-monthly or monthly. A Uniform Order for Support (#171-195) to be entered concurrently with this Order. a. This sum is in compliance with the statutory guidelines. b. This sum is a deviation upward downward from the statutory guidelines because _____________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ c. This is a minimum amount since the current income of the payor is unknown. mm/dd/yyyy 2. Child support shall commence on ______________________________. a. A Notice to Withhold Income for Support (#171-60a) shall issue immediately upon request and shall be served on the employer at the address listed in the Notice. Payments shall be made payable to the State Disbursement Unit and sent to the STATE DISBURSEMENT UNIT at P.O. BOX 5400, CAROL STREAM, IL 60197. (Payments must be sent to the STATE DISBURSEMENT UNIT if this box is checked.) or b. The parties have agreed to payment of child support directly to the recipient by money order, cashier's check, or personal check. ___________________________________________ Petitioner Date __________________________________________ Respondent Date 3. The Petitioner / Respondent shall provide major medical insurance coverage for the minor child(ren). The Petitioner / Respondent shall contribute $____________________ towards this expense. The parties shall share uninsured medical expenses of the minor child(ren) as follows: _______________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com 171-411 (Rev. 8/16)  4. The Petitioner / Respondent shall contribute to the following child related expenses (including childcare) in the following manner: _________________________________________________________________________ ___________________________________________________________