WASHTENAW COUNTY TRIAL COURT DOMESTIC PRETRIAL STATEMENT The following shall be completed and exchanged between the parties at the time of the pretrial conference. MCR 2.401, et.seq. Case No: DV-W: Case Title: Attorney Name: Address: Telephone No.: Fax No: E-mail: CASE INFORMATION Date of Filing Complaint: Date of Filing Answer: Ex-Parte Orders Signed? Type of Order(s): PPO Requested? yes no MARRIAGE INFORMATION Date of Marriage: Date of Separation: MINOR CHILDREN INFORMATION NAME BIRTHDATE Age GRADE HEALTH/OTHER NOTES date signed yes no date signed versus For Plaintiff For Defendant Other at issue minors: INFORMATION PURSUANT TO MCR 2.401 Time Requested to Complete Discovery: Has Alternative Dispute Resolution been discussed with your client? If no, why not? Are you requesting a referral to FOC? Issues to be referred: Custody Child Support yes yes Parenting Time no no Spousal Support Property Are there allegations of Domestic Violence? Effective 6/1/97 Revised 3/14/02 i American LegalNet, Inc. www.FormsWorkFlow.com Are there unusual facts or issues related to this case? List of Issues: Controlling Case Law: Expert and Non-expert Witnesses: Effective 6/1/97 Revised 3/14/02 ii American LegalNet, Inc. www.FormsWorkFlow.com