FAM104 State ENG Rev 07/15www.mncourts.gov/formsPage 1 of 5State of Minnesota District Court County of: Select County Judicial District: Court File Number: Case Type: Name of Petitioner (first, middle, last) Name of Respondent (first, middle, last) In Re the Marriage of: In Re the Custody of:Alternate Scheduling Statement (Use if one or both Parties do not have an Attorney) Minn. Gen. R. Prac. 304.021.This form is being filled out: Jointly (both parties together) SeparatelyCheck or complete the following if they apply. A Petition for an Order of Protection has been filed by one party against the other party at some time during the marriage or relationship An Order for Protection is in effect. is the court file number for the Order of Protection.2.Please identify any party or witness who will require interpreter services, and describe theservices (specifying language and, if know, particular dialect) needed. 3.CHILDRENa.Do you have joint children? Yes No4.CHILD SUPPORT AND SPOUSAL MAINTENANCEa.Do you agree on the amount of child support? If there are no joint children involved in thisaction, check the box "Not Applicable." Yes No Not Applicableb.Do you agree on the amount of spousal maintenance? (applies only to marriage dissolution matters) Yes No Not Applicable5.ASSET AND DEBT INFORMATION (applies only to marriage dissolution matters)a.Are you satisfied that you have sufficient information about your assets and debts to makean informed decision about how they should be divided? Yes No Not Applicable American LegalNet, Inc. www.FormsWorkFlow.com FAM104 State ENG Rev 07/15www.mncourts.gov/formsPage 2 of 56.FINAL HEARING BY DEFAULT (applies only to marriage dissolution matters)The parties are in agreement on all matters and this dissolution will proceed by default. Yes No Not Applicable7.ALTERNATE DISPUTE RESOLUTION (ADR)(NOTE: ATTORNEYS ANSWER QUESTIONS 9-12)a.Did you and the other party meet with a mediator or other person to help resolvedisagreement about your children or property? Yes Nob.Is this person you met with on the Supreme Court's roster of qualified neutrals? Yes Noc.MEETING: The parties (or their attorneys) met on to discuss case management issues.d.ADR PROCESS: (Check one) (descriptions can be obtained from the court administrator) You Both PartiesAgree that ADR is appropriate and choose the following: Mediation Arbitration (non-binding) Arbitration (binding) Mediation/Arbitration Early Neutral Evaluation Moderated Settlement Conference Mini-Trial Summary Jury Trial Consensual Special Magistrate Impartial Fact-Finder OtherIf Other, describe: You Both PartiesAgree that ADR is appropriate but request that the Court select the process. You Both PartiesAgree that ADR is NOT appropriate because: the case implicates the federal or state constitution domestic violence has occurred between the parties other (explain with particularity) American LegalNet, Inc. www.FormsWorkFlow.com FAM104 State ENG Rev 07/15www.mncourts.gov/formsPage 3 of 5If Other, describe: e.PROVIDER: (Check one) You Both Parties (date) Have selected the following ADR neutral: Cannot agree on an ADR neutral and request the Court to appoint one. Agree to select an ADR neutral on or before f.DEADLINE: (Check one) You Both PartiesRecommend that the ADR process be completed by (date)8.List any other information which may help the court schedule your dissolution, if necessary: Note: Both parties must submit this form, together on one form, or separately. Address: City, State, Zip: Telephone: E-mail address: Date: E-mail address: Telephone: Date: City, State, Zip: Address: Signature of Self-Represented Respondent Signature of Self-Represented Petitioner THE NEXT THREE PAGES ARE TO BE COMPLETED BY ATTORNEYS ONLY.9.It is estimated that the discovery specified can be completed within months from the date of this form. (check all that apply and supply estimates where indicated.)a.Interrogatories No Yesb.Document Requests No Yesc.Factual Depositions No Yesd.Medical/Vocational Evaluations No Yese.Experts No Yes10.The dates and deadlines specified below are suggested.a. Deadline for bringing motion regarding: (specify) American LegalNet, Inc. www.FormsWorkFlow.com FAM104 State ENG Rev 07/15www.mncourts.gov/formsPage 4 of 5b. Deadline for completion and review of property evaluation.c. Deadline for completion and review of custody/parenting time mediation.d. Deadline for completion and review of custody/parenting time evaluation.e. Deadline for submitting to the court. (specify)f. Deadline for pretrial conference.g. Deadline for trial or final hearing.11. Estimated trial or final trial hearing time: days hours(estimates less than a day must be stated in hours).12. a. MEETING: I met with the opposing pro se party on to discuss casemanagement issues. b. ADR PROCESS: (check one) The other party and I agree that ADR is appropriate and choose the following: Mediation Arbitration (non-binding) Arbitration (binding) Mediation/Arbitration Early Neutral Evaluation Moderated Settlement Conference Mini-Trial Summary Jury Trial Consensual Special Magistrate Impartial Fact-Finder OtherIf Other, describe: We agree that ADR is appropriate but request that the court select the process We agree that ADR is NOT appropriate because: the case implicates the federal or state constitution domestic violence has occurred between the parties other (explain with particularity)If Other, describe: c. PROVIDER: (Check one) American LegalNet, Inc. www.FormsWorkFlow.com FAM104 State ENG Rev 07/15www.mncourts.gov/formsPage 5 of 5 (date) Parties have selected the following ADR neutral: Parties cannot agree on an ADR neutral and request the Court to appoint one. Parties agree to select an ADR neutral on or before:d. DEADLINE: The parties recommended that the ADR process be completed by (date)13. Please list any additional information which might be helpful to the court when scheduling this matter, including any difficult or complex matters that will affect readiness for final hearing or trial and any issues that may significantly affect the welfare of the children: Signature of Lawyer Telephone: Date: City, State, Zip: Address: Firm: Respondent PetitionerLawyer for: Attorney Reg. # American LegalNet, Inc. www.FormsWorkFlow.com