Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Decree Of Divorce (With Children) Form. This is a Nevada form and can be use in District Court Statewide.
Loading PDF...
Tags: Decree Of Divorce (With Children), Nevada Statewide, District Court
1
2
3
4
5
6
Code No.
____________________________
Your Name: ____________________________
Address:
____________________________
____________________________
Telephone:
____________________________
In Proper Person
IN THE________ JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA
7
8
9
10
11
12
13
IN AND FOR THE COUNTY OF _________________
)
, )
Plaintiff(s),
)
vs
)
)
________________________________ , )
Defendant(s).
)
________________________________ )
14
17
DATE OF HEARING:_____________
TIME OF HEARING:______________
This cause coming before the Court by (Check either Summary Disposition or Hearing)
Summary Disposition (check one)
18
Both parties acting in Proper Person
19
Both parties represented by counsel
________________ represented by counsel and _________________ acting
(Plaintiff/Defendant)
(Plaintiff/Defendant)
20
21
in Proper Person
22
23
DEPT. NO.:______________________
DECREE OF DIVORCE
(With Children)
15
16
CASE NO.: ______________________
Hearing
24
Plaintiff appearing (check one)
not appearing
25
Defendant appearing (check one)
26
not appearing
27
28
in Proper Person /
in Proper Person /
through counsel/
through counsel/
1
American LegalNet, Inc.
www.USCourtForms.com
1
AND
2
(check one)
3
an affidavit of resident witness having been received
4
testimony of the resident witness having been received
5
AND
6
The parties having been duly served
7
AND
8
The Court, having (check all that apply)
9
reviewed the pleadings and papers on file
10
heard the testimony presented this date,
11
The Court finds as follows:
SERVICE
Check all that apply
12
13
1.
14
15
16
17
The Defendant was served the Summons and Complaint (check only one box)
personally
by publication and mailing.
The Plaintiff was served the Answer or Answer and Counterclaim (check only one
box)
personally
by mail
18
19
HOW CASE RESOLVED
Check only one box
20
21
2.
22
23
A Default has been filed against the Defendant on the Complaint
A Default has been filed against the Plaintiff on the Counterclaim
An agreement has been reached by the parties
A decision having been made by the Court
RESIDENCY REQUIREMENT
24
25
26
27
28
3.
The (check one)
Plaintiff/
Defendant is a resident of the State of Nevada,
2
American LegalNet, Inc.
www.USCourtForms.com
1
County of ________________________ and for a period of more than six weeks immediately
2
preceding the commencement of this action has resided in, been physically present in, and is a
3
resident of the State of Nevada, and intends to continue to make the State of Nevada his/her home
4
for an indefinite period of time.
5
6
MARRIAGE INFORMATION
7
8
9
10
4. That the parties were married on __________________ in ___________________
(date of marriage)
(city and state)
________________________;
(Check one)
The parties are incompatible in marriage and there is no hope for reconciliation;
11
12
The parties have lived separate and apart for more than one year without
cohabitation.
13
CHILDREN’S INFORMATION
14
15
16
5. That there are ________ minor child(ren) who are either the issue of this marriage
(number)
or have been adopted by the parties.
17
Wife (check one)
18
is/
is not currently pregnant.
(If wife is pregnant) Husband (check one)
19
is/
is not the father of the unborn
child. The unborn child is due to be born on __________________
(date of expected birth)
20
21
6. That the name(s), date(s) of birth, and state(s) of habitual residence of the
22
23
minor child(ren) are: (fill in child(ren)’s name(s), date(s) of birth, and state(s) where child(ren)
24
live):
25
Name
26
27
28
__________________________________
Date of Birth
State of habitual residence
_______________
_________________________
3
American LegalNet, Inc.
www.USCourtForms.com
1
__________________________________
_______________
_________________________
2
__________________________________
_______________
_________________________
3
__________________________________
_______________
_________________________
4
7. This Court has the initial and continuing jurisdiction under the UCCJA, UCCJEA and
5
PKPA to issue orders concerning the care, custody and control of the following minor children:
6
______________________________________________________________________
(children's names)
7
8
9
8. This Court (check one)
has /
does not have jurisdiction to enter orders concerning
child support of the minor children.
10
CHILD CUSTODY – LEGAL
Check only ONE box below
indicating legal custody
11
12
13
14
9.
The parties are fit and proper persons to be awarded joint legal custody of the minor
child(ren);
OR
15
(Check one)
16
17
18
19
20
Plaintiff/
Defendant is a fit and proper person to be awarded sole
legal custody of the minor child(ren). The other parent is not fit to have joint legal custody
because: ________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
21
CHILD CUSTODY – PHYSICAL
Check only ONE box below
22
23
24
25
26
27
10.
The parties are fit and proper persons to be awarded joint physical custody of the
minor child(ren). The parties should have visitation as set forth below;
OR
4
28
American LegalNet, Inc.
www.USCourtForms.com
1
(Check one)
Plaintiff/
Defendant is a fit and proper person to be awarded
2
primary physical custody of the minor child(ren). The parties should have visitation as set forth
3
below;
4
OR
5
6
(Check one)
9
10
11
12
13
14
15
16
17
18
19
20
Defendant is a fit and proper person to be
awarded sole physical custody of the minor child(ren);
7
8
Plaintiff/
11. That (check one)
CHILD SUPPORT
Plaintiff/ Defendant should pay child support in the amount
of $____________ per month per child, for a total monthly child support obligation of
(amount)
$________________;
(total monthly child support amount)
12. That (check one)
Plaintiff/
Defendant has a child support arrearage in the total
amount of $________________ from ___________________ through the present and a judgment
(date of separation or order)
should be entered for that amount against him/her.
13.
(CHECK ONLY ONE BOX)
That the amount of child support in paragraph 11 is in compliance with NRS
125B.070 and is either _______% of _________________ gross monthly income or the statutory
(18/25/29/31) (Plaintiff’s or Defendant's)
minimum;
OR
That under the statutory formula, (check one) Plaintiff/
Defendant
21
would be obligated to pay $________ per month for child support. That amount should be
(amount)
22
changed because (please see NRS 125B.080 for the only reasons that you can change the amount
23
from the formula amount) _________________________________________________________
24
______________________________________________________________________________
25
______________________________________________________________________________
26
______________________________________________________________________________.
27
5
28
American LegalNet, Inc.
www.USCourtForms.com
1
This amount of child support meets the child(ren)’s financial needs;
2
3
4
MEDICAL INSURANCE
14.
provisions for the children as set forth below. (check all that apply)
5
6
The children presently are not covered by a health insurance policy. The parties
do not intend to maintain health insurance on the children.
7
AND/OR
The children presently are not covered by health insurance. The parties intend
8
9
10
11
12
13
14
That the Court should order the parties to follow the medical and health insurance
to obtain coverage for the children. ___________________ will be responsible for obtaining and
(Husband/Wife/Both)
maintaining coverage. ___________________ will be responsible for the cost of the premiums.
(Husband/Wife/Both)
AND/OR
The children presently are covered by health insurance. ___________________
(Husband/Wife/Both)
will maintain the health insurance on the children. The children’s portion of the insurance
15
premium is $___________ per month.
16
pays $______________ of this amount.
17
Husband pays $__________ of this amount and Wife
AND/OR
18
The children presently (check one)
19
are/
are not on Medicaid
are/
are not on Nevada Check-up.
AND/OR
20
The children presently (check one)
21
22
DIVISION OF ASSETS AND DEBTS
23
24
25
26
27
16.
(CHECK ONLY ONE BOX)
That there is no community property to be adjudicated by the Court;
OR
6
28
American LegalNet, Inc.
www.USCourtForms.com
1
2
3
That the property division set forth below is, to the extent possible, an equal
distribution of the community property.
17.
4
(CHECK ONLY ONE BOX)
That there are no community debts to be adjudicated by the Court;
5
OR
6
7
That the division of community debts set forth below is, to the extent possible,
an equal distribution of the community debts;
8
9
SPOUSAL SUPORT
18.
10
(CHECK ALL THAT APPLY ONE BOX)
That neither party should be awarded spousal support.
11
12
13
14
15
AND/OR
That the Court should award spousal support as set forth below;
That pursuant to an order filed on ________________ (check one)
Husband/
(date)
Wife owes $_______________ in spousal support arrearages and that amount should be
reduced to judgment.
16
17
18
19
20
21
WIFE’S NAME
19.
(CHECK ONLY ONE BOX)
That Wife should not have her former or maiden name restored.
OR
That Wife should have her former or maiden name _______________________
22
__________________________ restored to her.
23
OR
24
That Wife never changed her name and therefore should retain her current name.
25
26
27
Therefore, IT IS ORDERED, ADJUDGED AND DECREED that the bonds of
7
28
American LegalNet, Inc.
www.USCourtForms.com
1
matrimony now and heretofore existing between the parties are hereby wholly dissolved, set aside
2
and forever held for naught, and an absolute Decree of Divorce is hereby granted to the parties,
3
and each of the parties are hereby restored to the status of a single, unmarried person.
4
5
IT IS FURTHER ORDERED, ADJUDGED AND DECREED (check only one box)
The parties are awarded joint legal custody of the minor child(ren).
6
7
8
9
10
11
OR
(Check one)
Plaintiff/
Defendant is awarded sole legal custody of the minor
child(ren).
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that (CHECK ONLY
ONE BOX)
The parties are awarded joint physical custody of the minor child(ren). Plaintiff shall
12
have visitation as follows: (must specify days and times) _________________________________
13
_______________________________________________________________________________
14
_______________________________________________________________________________
15
Defendant shall have visitation as follows: ____________________________________________
16
_______________________________________________________________________________
17
______________________________________________________________________________.
18
19
OR
That (check one)
Plaintiff/
Defendant is awarded primary physical custody of the
20
minor child(ren). (Check one that does not have primary custody)
21
have visitation as follows: (must specify days and times)__________________________________
22
_______________________________________________________________________________
23
______________________________________________________________________________.
24
25
26
27
Plaintiff/
Defendant shall
OR
That (check one)
Plaintiff/
Defendant is awarded sole physical custody of the
minor child(ren).
8
28
American LegalNet, Inc.
www.USCourtForms.com
1
2
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that holiday visitation,
when in conflict with the above, will take precedence.
3
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that the major holidays
4
will be handled in the following manner: (name each holiday such as Thanksgiving, Christmas,
5
Easter, Passover, Hanukkah and include exactly when the holiday visitation shall begin and who
6
will provide transportation to and from the visiting parent.)
7
_______________________________________________________________________________
8
_______________________________________________________________________________
9
_______________________________________________________________________________
10
_______________________________________________________________________________
11
_______________________________________________________________________________
12
_______________________________________________________________________________
13
_______________________________________________________________________________
14
_______________________________________________________________________________
15
_______________________________________________________________________________
16
_______________________________________________________________________________
17
_______________________________________________________________________________
18
_______________________________________________________________________________
19
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that should a holiday fall
20
on a three day weekend and it is the other parent's weekend to have the children the three day
21
holiday will be handled as follows: __________________________________________________
22
_______________________________________________________________________________
23
_______________________________________________________________________________
24
_______________________________________________________________________________
25
_______________________________________________________________________________
26
_______________________________________________________________________________
27
9
28
American LegalNet, Inc.
www.USCourtForms.com
1
_______________________________________________________________________________
2
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that on each of the
following holidays, visitation shall commence at _________ _____.m. on the day of the holiday
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
and end at __________ _____.m. ____________________________ will provide the
(Visiting parent or custodial parent)
transportation for the initial exchange and ____________________________ will provide the
(Visiting parent or custodial parent)
transportation for the return exchange.
New Year’s Day will be alternated with_____________________________ having
(Husband or Wife)
the child in the year _________ and each ______________year thereafter.
(odd or even)
Martin Luther King’s Birthday will be alternated with____________________ having the
(Husband or Wife)
child in the year _________ and each ______________year thereafter.
(odd or even)
President’s Day will be alternated with____________________________ having the
(Husband or Wife)
child in the year _________ and each ______________year thereafter.
(odd or even)
Memorial Day will be alternated with_____________________________ having the
(Husband or Wife)
child in the year _________ and each ______________year thereafter.
(odd or even)
Fourth of July will be alternated with_____________________________ having the
(Husband or Wife)
child in the year _________ and each ______________year thereafter.
(odd or even)
Labor Day will be alternated with _______________________having the child in
(Husband or Wife)
the year _________ and each ______________year thereafter.
(odd or even)
Nevada Day will be alternated with_________________________ having the child in
(Husband or Wife)
the year _________ and each ______________year thereafter.
(odd or even)
10
28
American LegalNet, Inc.
www.USCourtForms.com
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Halloween will be alternated with_________________________ having the child in
(Husband or Wife)
the year _________ and each ______________year thereafter.
(odd or even)
Veteran’s Day will be alternated with______________________ having the child in
(Husband or Wife)
the year _________ and each ______________year thereafter.
(odd or even)
Child’s birthday will be alternated with ____________________having the child in
(Husband or Wife)
the year _________ and each ______________year thereafter.
(odd or even)
________Wife shall have the child on Mother’s Day and Husband shall have the child on
(Yes or No)
Father’s Day.
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that (check one)
Plaintiff/
Defendant will pay $___________ per month per child for a total monthly child
(amount)
support obligation of $________________ for child support. The child support obligation for
(total monthly child support amount)
each child ceases when the child reaches 18 years of age if he/she is no longer enrolled in high
school, otherwise, when he reaches 19 years of age.
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that a wage assignment
for the child support (check one)
will/
will not be immediately put in place.
IT IS FURTHER ORDERED, ADJUDGED AND DECREED (check only one box)
There is already a child support action through the District Attorney’s Office and
payment of the child support shall continue to be handled through that office.
The children are receiving Welfare benefits and the Welfare Department has, or will
have, a child support case through the District Attorney’s Office and the District
Attorney’s Office shall continue to handle the child support payments.
No formal child support obligation has ever previously been established and this will be
the first Court Order for child support and the parent paying child support will pay the
support directly to the receiving parent.
Although this is the first Court Order for child support, the payments will be through the
District Attorney’s Office and the parent who will be collecting child support shall open
the case with the District Attorney’s Office.
11
28
American LegalNet, Inc.
www.USCourtForms.com
1
2
3
4
IT IS FURTHER ORDERED, ADJUDGED AND DECREED (check only one box)
that pursuant to the order filed on _______________ and/or NRS 125B.030 (check
(date of file-stamp)
one)
Husband/
Wife owes child support arrears of $___________ and that
5
amount is reduced to judgment. This amount is for arrears owed from
6
______________ through _______________.
(date)
(date)
OR
Neither party owes child support arrears.
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that
___________________________________ shall maintain health insurance on the child(ren). The
(Husband, Wife, both parents or neither parent)
parties shall each share equally any health expenses incurred on behalf of the child(ren) that are
not covered by insurance and each party shall be responsible for one half of the deductible and one
half of the medical insurance premium if the child(ren) are covered by medical insurance.
IT IS FURTHER ORDERED, ADJUDGED AND DECREED The community property
should be divided as follows: (Include retirement accounts, bank accounts, pension benefits and
vehicles. When listing accounts, use the last four digits of the account number, if known. Include
the VIN numbers when listing vehicles. If no community property, write “N/A”)
WIFE SHALL RECEIVE THE FOLLOWING
AS HER SOLE AND SEPARATE PROPERTY:
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
12
American LegalNet, Inc.
www.USCourtForms.com
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
HUSBAND SHALL RECEIVE THE FOLLOWING
AS HIS SOLE AND SEPARATE PROPERTY:
___________________________________
_____________________________________
___________________________________
_____________________________________
___________________________________
_____________________________________
___________________________________
_____________________________________
___________________________________
_____________________________________
___________________________________
_____________________________________
___________________________________
_____________________________________
___________________________________
____________________________________
___________________________________
_____________________________________
___________________________________
_____________________________________
___________________________________
_____________________________________
___________________________________
_____________________________________
___________________________________
_____________________________________
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that the
community debts should be divided as follows: (Be sure to list specific debts with the last four
23
numbers of the accounts, if known. If no community debts, write “N/A”.)
24
WIFE SHALL RECEIVE THE FOLLOWING DEBTS
AS HER SOLE AND SEPARATE DEBTS AND
SHALL INDEMNIFY AND HOLD HUSBAND HARMLESS FROM THESE DEBTS:
___________________________________
_____________________________________
___________________________________
_____________________________________
25
26
27
28
13
American LegalNet, Inc.
www.USCourtForms.com
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
___________________________________
___________________________________
___________________________________
_____________________________________
_____________________________________
_____________________________________
HUSBAND SHALL RECEIVE THE FOLLOWING DEBTS
AS HIS SOLE AND SEPARATE DEBTS AND
SHALL INDEMNIFY AND HOLD WIFE HARMLESS FROM THESE DEBTS:
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
26
27
28
14
American LegalNet, Inc.
www.USCourtForms.com
IT IS FURTHER ORDERED, ADJUDGED AND DECREED (check all that apply)
Neither party shall be awarded spousal support.
Wife shall receive spousal support in the amount of $____________________per
(Amount Wife to receive)
__________________, due and payable on the _________________of each
(Week or month)
(Date amount due)
1
2
3
4
_________________ for a period of ______________________________
(Week or month)
(Number of weeks, months or years)
The spousal support shall begin on _________________________________
(Date spousal support to begin)
and end on _________________________________________. Spousal support shall
(Date last spousal support payment will be made)
cease upon the remarriage of the recipient or the death of either party.
5
6
7
8
9
Husband shall receive spousal support in the amount of $____________per
(Amount to be received)
___________________, due and payable on the ________________of each
(Week or month)
(Date amount due)
__________________ for a period of ______________________________
(Week or month)
(Number of weeks, months or years)
The spousal support shall begin on _______________________________
(Date spousal support to begin)
and end on _________________________________________. Spousal support shall
(Date last spousal support payment will be made)
cease upon the remarriage of the recipient or the death of either party.
10
11
12
13
14
15
16
17
18
19
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that (check one)
Husband/
22
23
24
25
26
27
28
Neither party owes spousal support arrearages of $______________.
That amount is reduced to judgment.
IT IS FURTHERED ORDERED, ADJUDGED AND DECREED that (check only one
20
21
Wife/
box)
Neither party is awarded attorneys fees or costs.
Husband is awarded attorneys fees and costs in the amount of $_______________.
That amount is reduced to judgment.
Wife is awarded attorneys and costs in the amount of $______________. That amount
is reduced to judgment.
15
American LegalNet, Inc.
www.USCourtForms.com
1
2
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that (check one that
3
applies to wife)
4
(full name wife wants to have)_____________________________________________________.
Plaintiff/
Defendant’s name shall (check one)
change to/
stay as name of
5
6
7
8
9
10
11
NOTICE IS HEREBY GIVEN of the following provision of NRS 125.510(6):
PENALTY FOR VIOLATION OF ORDER: THE ABDUCTION,
CONCEALMENT OR DETENTION OF A CHILD IN VIOLATION OF THIS ORDER
IS PUNISHABLE AS A CATEGORY D FELONY AS PROVIDED IN NRS 193.130.
NRS 200.359 provides that every person having a limited right of custody to a child or
any parent having no right of custody to the child who willfully detains, conceals or
removes the child from a parent, guardian or other person having lawful custody or a
right of visitation of the child in violation of an order of this court, or removes the child
from the jurisdiction of the court without the consent of either the court or all persons
who have the right to custody or visitation is subject to being punished for a category D
felony as provided in NRS 193.130.
12
13
14
15
16
17
18
19
NOTICE IS HEREBY GIVEN that the terms of the Hague Convention of October 25,
1980, adopted by the 14th Session of the Hague Conference on Private International Law apply
if a parent abducts or wrongfully retains a child in a foreign country. The parties are also put on
notice of the following provisions in NRS 125.510(8):
If a parent of the child lives in a foreign country or has significant commitments
in a foreign country:
(a) The parties may agree, and the court shall include in the order for custody of
the child, that the United States is the country of habitual residence of the
child for the purposes of applying the terms of the Hague Convention as set
forth in subsection 7.
20
21
22
23
24
(b) Upon motion of one of the parties, the court may order the parent to post a
bond if the court determines that the parent poses an imminent risk of wrongfully
removing or concealing the child outside the country of habitual residence. The bond
must be in an amount determined by the court and may be used only to pay for the cost of
locating the child and returning him to his habitual residence if the child is wrongfully
removed from or concealed outside the country of habitual residence. The fact that a
parent has significant commitments in a foreign country does not create a presumption
that the parent poses an imminent risk of wrongfully removing or concealing the child.
25
26
27
28
16
American LegalNet, Inc.
www.USCourtForms.com
NOTICE IS HEREBY GIVEN of the following provision of NRS 125C.200:
1
2
3
4
5
6
7
8
9
10
If custody has been established and the custodial parent intends to move his residence to
a place outside of this state and to take the child with him, he must, as soon as possible
and before the planned move, attempt to obtain the written consent of the noncustodial
parent to move the child from this state. If the noncustodial parent refuses to give that
consent, the custodial parent shall, before he leaves this state with the child, petition the
court for permission to move the child. The failure of a parent to comply with the
provisions of this section may be considered as a factor if a change of custody is
requested by the noncustodial parent.
NOTICE IS HEREBY GIVEN that they are subject to the provisions of NRS
31A and 125.450 regarding the collection of delinquent child support payments.
NOTICE IS HEREBY GIVEN that either party may request a review of child
support pursuant to NRS 125B.145.
NOTICE IS HEREBY GIVEN that the parties are required t contact this Court
11
to determine whether the following provision applies:
12
Each party shall submit the information required in NRS 125B.055, NRS 125.130 and
NRS 125.230 on a separate form to the Court and the Welfare Division of the
Department of Human Resources within ten days from the date this Decree is filed.
Such information shall be maintained by the Clerk in a confidential manner and not part
of the public record. The parties shall update the information filed with the Court and
the Welfare Division of the Department of Human Resources within ten days should any
of that information become inaccurate.
13
14
15
16
17
18
DATED this _____ day of (month)_______________,(year)_______.
19
20
21
____________________________________
DISTRICT COURT JUDGE
22
23
24
25
26
17
27
28
American LegalNet, Inc.
www.USCourtForms.com
1
3
Respectfully submitted:
(Plaintiff’s signature) ___________________________________
(Plaintiff’s name)
______
4
(Address)
2
5
(Telephone)
6
In Proper Person
7
8
(Defendant’s signature)_________
(Defendant’s name)
(Address)
9
10
(Telephone)
11
12
_______
In Proper Person
///
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
18
American LegalNet, Inc.
www.USCourtForms.com
