STATE OF INDIANA COUNTY OF (Select One) ) IN THE (Select One) ) SS: ) CASE NO. SUPERIOR/CIRCUIT COURT IN RE THE MARRIAGE OF: Petitioner, V. Respondent. TEMPORARY ORDER Petitioner appears/does not appear, and Respondent appears/does not appear for provisional hearing on ______________________, 20___. The court having been duly advised in this matter, now finds the following: ______ Petitioner/Respondent is awarded temporary custody of the minor child(ren); ______ Petitioner/Respondent shall pay temporary child support for the minor child(ren) in the amount of $__________________ per week, payable through the ______________ County Clerk, or by income withholding order if available from the employer, beginning on ________________________, 20____. ______ Petitioner/Respondent shall be responsible for the first $__________________ of uninsured medical expenses for the minor child(ren). Thereafter, Petitioner shall be responsible for ________% and Respondent for ________% of uninsured medical expenses for the minor child(ren). ______ Petitioner/Respondent shall have temporary parenting time (visitation) with the minor child(ren) as the parties agree or according to the Indiana Parenting Time (Visitation) guidelines; ______ Petitioner/respondent shall have temporary possession of the marital residence; ______ Petitioner/Respondent shall temporarily maintain medical, dental, and optical insurance as available through employment for the following persons: __________________________________________ __________________________________________ __________________________________________ Form #PS-31152-2 Approved by State Court Administration 02/10 Page 8 of 19 American LegalNet, Inc. www.FormsWorkFlow.com ______ There shall be a temporary division of debts, as follows: a. Petitioner shall be solely responsible for the following debts: ________________________________________________ ________________________________________________ ________________________________________________ b. Respondent shall be solely responsible for the following debts: _________________________________________________ _________________________________________________ _________________________________________________ _______ There shall be a temporary division of property, as follows: a. Petitioner shall have sole possession of the following items of property: __________________________________________________ __________________________________________________ __________________________________________________ b. Respondent shall have sole possession of the following items of property: __________________________________________________ __________________________________________________ __________________________________________________ _______ There shall be a temporary division of motor vehicles, as follows: a. Petitioner shall have temporary possession of the following vehicles: __________________________________________________ (Vehicle #1, Make, Model, and Year) __________________________________________________ (Vehicle #2, Make, Model and Year) b. Respondent shall have temporary possession of the following vehicles: __________________________________________________ (Vehicle #1, Make, Model, and Year) __________________________________________________ (Vehicle #2, Make, Model and Year) _______ There shall be a temporary restraining order in effect during these proceedings: ______ Restraining the parties from removing the child(ren) from the state without the permission of the court or all parties; Form #PS-31152-2 Approved by State Court Administration 02/10 Page 9 of 19 American LegalNet, Inc. www.FormsWorkFlow.com ______ Restraining the parties from transferring, encumbering, or concealing, or in any way disposing of any of the property of the parties; ______ Other: _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ ALL OF WHICH IS SO ORDERED THIS______ DAY OF __________________, 20____. ________________________ Date _____________________________ Judge Distribution: Form #PS-31152-2 Approved by State Court Administration 02/10 Page 10 of 19 American LegalNet, Inc. www.FormsWorkFlow.com