1 FORM 9 2 3 4 IN THE CIRCUIT COURT OF THE STATE OF OREGON 5 FOR THE COUNTY OF LANE 6 In the Matter of the Marriage of: 7 8 ________________________________, Co-Petitioner, 9 and 10 11 ________________________________, Co-Petitioner. 12 13 14 9 ______________________________, Child who is at least 18 and under 21 years of age, unm arried and unem ancipated. (ORS 107.108) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) Case No. ____________________ GENERAL JUDGMENT OF DISSOLUTION OF MARRIAGE [W ith Children]; and MONEY AW ARD 15 16 IT APPEARING that the above nam ed Petitioners filed their Petition for Dissolution with the Court on 17 _____________________________, 20___, and that 18 9 the waiting period has expired 9 the Court has waived the waiting period; and 19 20 21 22 23 24 25 26 IT APPEARING that the Petitioners have subm itted a Motion and supporting Affidavit for Judgm ent and the court being fully advised; and IT APPEARING that irreconcilable differences have caused the irrem ediable breakdown of this m arriage. THE COURT FOUND FURTHER THAT: 9 Husband 9 W ife has/have been a resident of and dom iciled in the state of Oregon continuously for six m onths im m ediately prior to the filing of the Petition for Dissolution of Marriage. CHILDREN OF THE M ARRIAGE The following children were born to or adopted by the parties before or during this m arriage: 27 ________________________________________________________________________________________ 28 ___________________________________________________________________________________________ Page 1 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 9 Husband is not the father, or paternity has not been established, of wife’s child/ren nam ed 2 ____________________________________________________________________________________ 3 born during the m arriage on the following date(s): ____________________________________________3. 4 5 9 W ife is not now pregnant. 9 W ife is now pregnant. Husband 9 is 9 is not the father of the wife’s child due ____________________. (Insert date) 6 7 8 9 CHILD CUSTODY JURISDICTION Home State Jurisdiction: 9The child(ren) have lived in Oregon for the last six m onths. 9The child(ren) are not now living in Oregon, but have lived in Oregon for at least six consecutive 10 m onths (at least part of which period occurred in the last six m onths), and a parent or acting parent continues 11 to live in Oregon. 12 Significant Connection Jurisdiction: 13 9 The child(ren) and have significant connections to Oregon and (Nam e of parent or caretaker) 14 substantial evidence about the child(ren)’s care, protection, training, and personal relationships is available 15 here, AND: 16 17 9 There is no ‘home state’ because the child(ren) have not lived in any one state for six consecutive months, at least a part of which period occurred in the last six months: or 18 9 19 Temporary Emergency Jurisdiction: 20 9 The ‘home state’ has declined jurisdiction in favor of Oregon. The chid(ren) are physically present in Oregon and have been abandoned or an emergency 21 exists requiring the child(ren)’s protection because the child(ren), sibling(s), and/or parent are subjected 22 to or threatened with mistreatment or abuse. 23 9 There is not another child custody proceeding pending in a court of a state having jurisdiction und 24 ORS 109.741 - 109.747. This Order based on Temporary Emergency Jurisdiction remains in effect until and 25 Order is obtained from a Court of a state having ‘home state’ or ‘significant connection” jurisdiction. If a child 26 custody proceeding has not been or is not commenced in a court of a state having either ‘home state’ or 27 ‘significant connection’ jurisdiction, this Order becomes a final determination if Oregon becomes the ‘home 28 state’ of the child(ren). Page 2 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 9 2 There is another child custody proceeding pending in a court of a state having jurisdiction under ORS 109.741 - 109.747. This Order based on Temporary Emergency Jurisdiction remains in effect until the 3 Day of 4 ,20 , or until an Order is obtained from the other state within that period. 5 9 Oregon does not have jurisdiction under the Uniform Child Custody Jurisdiction Act because: ___________________________________________________________________________________ 6 __________________________________________________________________________________ 7 __________________________________________________________________________________ 8 CHILD/REN WHO ARE AT LEAST 18 AND UNDER 21 YEARS OF AGE 9 ________________________________________________(child/ren’s name(s)) is at least 18 and under 21 years of age, is unmarried and unemancipated and has: 10 9W aived further appearance in these proceedings. 9Signed and stipulated to the terms of judgment evidenced by the signature below. 9Fully participated in the proceedings and the judgment effectively binds him/her to the terms. 11 12 13 14 15 16 NOW, THEREFORE, IT IS HEREBY ORDERED AND ADJUDGED: The terms of this judgment are effective immediately. The marital status of the parties shall terminate on the date this judgment is signed by the judge. PARENTING PLAN 17 18 Custody of the child/ren is awarded as follows: 19 9 20 21 22 23 W ife is awarded legal custody of the following child/ren: ___________________________________________________________________________________. 9 Husband is awarded legal custody of the following child/ren: ___________________________________________________________________________________. 9 The parties are awarded joint legal custody of the following child/ren: 24 ____________________________________________________________________________________. 25 9 ___________________________ shall have the right to reasonable parenting time with the child/ren, 26 27 9 Specific parenting time rights shall be as follows: ____________________________________________________________________________________ 28 ____________________________________________________________________________________ Page 3 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 ____________________________________________________________________________________ 2 ____________________________________________________________________________________ 3 ____________________________________________________________________________________ 4 9 The terms on the attached additional sheets, labeled “Exhibit 1,” shall also be incorporated herein by 5 reference. 6 7 8 9 9 Neither parent shall move to a residence more than 60 miles further distant from the other parent without giving the other parent reasonable notice of the change of residence and providing a copy of such notice to the court, or 9 W ife and Husband shall each provide contact addresses and contact telephone numbers to the other 10 11 12 13 14 15 16 17 18 19 9 the __________________________________________________________. and notify each other of any emergency circumstances or substantial changes in the children’s health. NOTICE ABOUT PARENTING TIME AND CHILD SUPPORT The terms of child support and parenting time (visitation) are designed for the child’s benefit and not the parents’ benefit. You must pay support even if you are not receiving parenting time. You must comply with parenting time and visitation orders even if you are not receiving child support. Violation of child support orders and visitation or parenting time orders is punishable by fine, imprisonment or other penalties. Publicly funded help is available to establish, enforce, and modify child support orders. Paternity establishment services are also available. Contact your local district attorney, the domestic relations court clerk, or the Department of Human Resources at 1-800-850-0228 or 503-378-5567 for information. Publicly funded help may be available to establish, enforce, and modify parenting time or visitation orders. Forms are available to enforce parenting time or visitation orders. Contact the domestic relations or civil court clerk for information. 20 CHILD SUPPORT, INCLUDING CASH MEDICAL SUPPORT 21 Check either (a) or (b) below: 22 (a) 23 9 No child support shall be ordered at this time because: 9 24 Child support in the amount of $________ monthly has already been ordered and docketed with the _____________________ County Circuit Court, case number 25 9 26 27 (b) 28 9 . Other reason:________________________________________________________ Child support shall be paid by ________________________________ to _______________ __________________ beginning on the first day of the month following the date of the judgment and Page 4 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 continuing on the 1st day of each month thereafter. The support for each child shall continue until the child 2 reaches eighteen (18) years of age, or is otherwise emancipated. 3 reaches the age of twenty-one (21) so long as the child is a student attending school as defined by Oregon 4 law. Until further order, the total payment per month shall be $___________________, for _____________ 5 children. 6 The support shall continue until the child Cash Medical Support: Of the amount ordered above, $___________________ is Cash 7 Medical Support for out-of-pocket medical expenses exceeding $250 per year per child and/or for 8 payment toward reimbursement of public health care costs. The cash medical support amount ordered 9 is in addition to any percentage of uninsured costs either of the parties is ordered to pay below. 10 (Check if applicable) 12 9Neither Husband or Wife have appropriate private or public health care coverage available for the parties’ child/ren (see 4(3) below). Cash medical support9 is 9 is not ordered and the 13 court’s findings in this regard are as follows:_________________________________________ 14 ___________________________________________________________________________ 15 _________________________________________________________________________ 16 _________________________________________________________________________ 17 (Check if applicable) 18 9Husband 9 Wife and/or 9 Child[ren] are eligible for public medical assistance and cannot 19 be ordered to pay cash medical support. 20 (Check if applicable) 21 9T h is 22 ____________________________________________________________________________________ 23 (list court/agency and case no.) 11 order shall m od ify and rep lac e the follow in g ex is ting order: 24 _________________________________________________________________________________ 25 because the court finds that the existing order was issued by an Oregon court or agency, one 26 of the parents or the child/ren receiving support under the order still resides in Oregon and 27 circumstances have changed since this order was entered. 28 Page 5 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 CALCULATION 9 3 4 attached to and incorporated in this judgm ent. 9 5 6 The child support worksheet on which the support am ount was calculated is labeled “Exhibit ____" and The support award does not deviate from the am ount presum ed correct under the guidelines set out in the Oregon Adm inistrative Rules. 9 7 The support am ount presum ed correct under the guidelines set out in Oregon Adm inistrative Rules 8 is $ ________________. The support award deviates from this am ount because this Court finds that application 9 of the form ula would be unjust or inappropriate in this case because _______________ 10 ________________________________________________________________________________________. 11 HEALTH CARE COVERAGE (Check one.) 12 9 Co-Petitioner(s), (print name(s))__________________ 13 A.) PRIVATE INSURANCE IS AVAILABLE 14 _________________________________, shall name the child/ren as beneficiaries of the following 15 appropriate private health care coverage for the duration of the support obligation (describe type/s of 16 coverage)_______________________________________________________________________ 17 _________________________________________________________________________________. 18 9 Neither Co-Petitioners have appropriate 19 B.) NO PRIVATE INSURANCE IS AVAILABLE NOW 20 private health care coverage available for the parties’ children. 21 1.) 9 Co-Petitioner(s), (print name(s))__________________________________________is 22 ordered to apply to enroll the child/ren in public health care coverage. If the child/ren is/are accepted 23 for enrollment, this coverage shall be maintained. 24 2.) 9 Co-Petitioner(s), (print name(s))______________________________________have/has 25 already applied to enroll the child/ren in public health care coverage. If the child/ren is/are accepted 26 for enrollment, this coverage shall be maintained. 27 28 3.) 9 The child/ren are currently enrolled in public health care coverage. This coverage shall be maintained. 4.) 9 Co-Petitioner(s), (print name(s))________________________________________is/are Page 6 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 ordered to provide appropriate private health care coverage when such coverage becomes available 2 to them through any source. 3 9 4 C.) RESPONSIBILITY FOR UNINSURED HEALTH EXPENSES 5 ____________________________________________should pay_____% and 9 Co-Petitioner, (print 6 name)____________________________________________, should pay_____% of the uninsured 7 health, accidental, dental, orthodontic, and optical costs incurred by the child/ren, including costs for 8 prescriptions. This obligation is in addition to any cash medial support ordered above as part of the 9 child support award. 10 Co-Petitioner, (print name) PAYM ENT 11 9 Exceptions to withholding. Incom e withholding is not ordered at this tim e because there is no support 12 arrearage, the paying parent has not previously been granted an exem ption from withholding, and: 13 9 The parents, and the State, if support rights are assigned, have agreed in writing to an 14 alternative arrangem ent; or 9 Good cause not to require withholding is found because 15 16 ____________________________________________________________________________________ 17 ____________________________________________________________________________________ 18 ____________________________________________________________________________________ 19 All paym ents of child support shall be m ade: (Check either (a) or (b)below) 9 To the Oregon Departm ent of Justice, Child Support Accounting Unit, P.O. Box 14506, Salem , 20 (a) 21 Oregon, 97309 9 by electronic paym ent withdrawal (EPW ) or electronic funds transfer (EFT). Creditor is 22 entitled to collection, accounting, disbursem ent, and enforcem ent of this obligation through the State of 23 Oregon’s Departm ent of Justice, and such services shall be provided by the Departm ent of Justice. 24 (b) 25 9 Pursuant to the above exception, directly to ____________________________________’s checking or savings account. A receipt of deposit shall be kept by the parent paying support as proof of paym ent. 26 A canceled check is also prim a facie evidence that paym ent has been m ade. The person receiving support 27 shall provide the paying parent with current deposit slips and/or bank nam e, account nam e and account 28 num ber. Page 7 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 NOTICE OF INCOM E W ITHHOLDING This support order is enforceable by incom e withholding under state law. W ithholding shall occur im m ediately, whenever there is an arrearage at least equal to the support paym ent for one m onth, whenever the obligated parent requests such withholding, or whenever the obligee requests withholding for good cause. The District Attorney or, as appropriate, the Division of Child Support Services of the Departm ent of Justice will assist in securing such withholding. Exceptions m ay apply in som e circum stances. NOTICE ABOUT PERIODIC REVIEW AND M ODIFICATION OF CHILD SUPPORT ORDERS If your child support case is handled by the District Attorney or the Division of Child Support Services (DCS), this agency will review your child support order if at least three years have passed since the order was entered, m odified, or last reviewed. This review will take place only if a parent requests. The purpose of the review is to see if the am ount ordered is still within the guidelines for child support set out in Oregon law. The review could result in an increase or decrease in the support am ount, depending on the parents’ financial circum stances and the needs of the child. This “periodic review” service is provided at no cost to parents, but is available only for cases handled by the District Attorney or DCS. The support agency handling your case will also review your support order for com pliance with the guidelines whenever a substantial change in circum stance has occurred. You can request this “change in circum stance” m odification from the support agency. But any support order (not just orders handled by the District Attorney or DCS) can be m odified because of a change in circum stance, so a private attorney is able to assist you with this, too. You m ay also represent yourself. 15 16 17 9 Husband 9 W ife shall be entitled to claim the following child(ren) as dependent(s) for tax 18 purposes beginning the year this judgm ent is entered (list names):______________________________________ 19 ___________________________________________________________________________________________ 20 ___________________________________________________________________________________________ 21 9 Other (specify):_____________________________________________________________________ 22 ___________________________________________________________________________________________ 23 24 25 LIFE INSURANCE COVERAGE FOR CHILD(REN) 9 _____________________________________ shall obtain and m aintain life insurance for the benefit 26 of the parties’ child/ren throughout the period of the support obligation if he/she is insurable. This parent shall 27 m aintain coverage in an am ount sufficient to provide, in the event of this parent’s death, continued support 28 at least at the level of and for the duration of the support obligation. Page 8 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 SPOUSAL SUPPORT AND LIFE INSURANCE 2 TRANSITIONAL SPOUSAL SUPPORT 3 4 9 Transitional support should be paid by . Paym ents should be m ade in the following m anner: 5 6 7 9 In m onthly installm ents of $ 10 (date): or 9In one paym ent of $ , due on C O M P E N S AT O R Y S P O U S AL S U P P O R T 9 Com pensatory support should be paid by 15 16 17 18 9 In m onthly installm ents of $ until (date) : or 9 In one paym ent of $ 23 , due on (date). 9 Other: SPOUSAL M AINTENANCE 9 Spousal m aintenance should be paid by 21 22 . beginning on the first day of the m onth following the date of the judgm ent and continuing on the first day of each m onth thereafter 19 20 to . Paym ents should be m ade in the following m anner: 13 14 (Date) . 9Other: 11 12 , beginning on the first day of the m onth following the date of the judgm ent and continuing on the first day of each m onth thereafter until 8 9 to to . Paym ents should be m ade in the following m anner: 9 In m onthly installm ents of $ ,beginning on the first day of the m onth following the date of the judgm ent and continuing on the first day of each m onth thereafter 24 9 until 25 9In one paym ent of $ 26 9Other: (date) or 9 indefinitely: or , due on (date) 27 28 All paym ents of spousal support should be m ade: 9To the Oregon Departm ent of Justice, P. O. Box 14506, Salem , Oregon, 97309. Creditor requests that Page 9 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 collection, accounting, disbursem ent and enforcem ent services be provided by the State of Oregon’s Departm ent 2 of Justice: or 9 Directly into 3 ‘s checking or savings account. A receipt of deposit should be 4 kept by the paying spouse as proof of paym ent. The spouse receiving support should provide the paying spouse 5 with current deposit slips and/or bank nam e, account nam e, and account num ber. 6 9If child support is also ordered in this case and if enforcem ent services are provided through the State 7 of Oregon’s Departm ent of Hum an Resources, the spousal support order should be enforceable by incom e 8 withholding under ORS 25.311. 9 9 should obtain and m aintain life insurance for the benefit of 10 throughout the period of the support obligation. The paying spouse should m aintain coverage in an am ount 11 sufficient to provide, in the event of the paying spouse’s death, continued support at least at the level of and for 12 the duration of the support obligation. 13 14 15 REAL PROPERTY DISTRIBUTION 16 Check either (a) or (b): 17 (a) 9 Neither wife nor husband has any interest in any real property located in this or in any other state. 18 (b) 9 ___________________________ has/have an interest in real property located at the address of 19 20 9 This property shall be distributed as follows: 21 22 23 9 The legal description of the property is attached as “Exhibit ____” and incorporated into this Judgm ent. 24 25 26 shall be responsible for the preparation, signing and recording of a deed, transferring the real property as required by this judgm ent. 9 Distribution of this property is not within the jurisdiction of this court. 27 28 Page 10 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 PERSONAL PROPERTY DISTRIBUTION 9 The wife and husband have divided between them all personal effects, household goods and other 3 personal property they own separately or together, and each shall be awarded those item s now in their 4 possession. 5 9 The wife is awarded the following personal property: 6 ________________________________________________________________________________________ 7 ________________________________________________________________________________________ 8 ___________________________________________________________________________________________ 9 9 The wife is awarded her retirem ent benefits, pension plan, profit-sharing plan, deferred com pensation plan, 10 11 12 13 and/or stock option plan held by wife’s em ployer, free of any interest in the husband. 9 The husband is awarded his retirem ent benefits, pension plan, profit-sharing plan, deferred com pensation plan, and/or stock option plan held by husband’s em ployer, free of any interest in the wife. 9 The husband is awarded the following personal property: 14 ________________________________________________________________________________________ 15 ________________________________________________________________________________________ 16 ___________________________________________________________________________________________ 17 18 DISTRIBUTION OF DEBTS 19 Each party shall be responsible for the paym ent of all debts incurred by him or her individually since the 20 date of the separation; all debts which are distributed to him or her by the court; and all debts which are secured 21 by property distributed to that party. Also, if any creditor asks the spouse not responsible for a debt to pay all or 22 a portion of it, and he or she does so, the spouse responsible for that debt shall reim burse the other spouse for 23 any m onies he/she paid to the creditor after the date this judgm ent was entered. 24 25 26 9 There are no outstanding debts of this m arriage. (a) Husband’s Responsibility 9 Husband shall pay the debts listed below. 27 Nam e of Creditor 28 ________________________________________________________________________________________ W hat debt is for Am ount ________________________________________________________________________________________ Page 11 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 ________________________________________________________________________________________ 2 ________________________________________________________________________________________ 3 ________________________________________________________________________________________ 4 ___________________________________________________________________________________________ 5 (b) W ife’s Responsibility 9 W ife shall pay the debts listed below. 6 7 Nam e of Creditor 8 ________________________________________________________________________________________ 9 ________________________________________________________________________________________ 10 ________________________________________________________________________________________ 11 ________________________________________________________________________________________ 12 ___________________________________________________________________________________________ W hat debt is for Am ount 13 14 15 16 W ithin 30 days of the date of this judgm ent, each party should execute, acknowledge, and deliver whatever docum ents are necessary to accom plish the distribution of debts and property ordered by the court. 17 18 FORM ER NAM E 9 19 ’s form er nam e of is restored. 20 21 22 COURT COSTS AND FEES (a) If Court Costs and Fees were Deferred: (please check the boxes below that apply) 23 9 Husband (or) 9 W ife shall be liable for all the court costs and service fees that were deferred. 24 9 Husband and W ife shall each be liable for one half the court costs and service fees that were deferred. 25 26 9 The State of Oregon shall have judgm ent against 9 Husband 9 W ife for 9 one-half 9 all the filing fees. 27 9 ____________ County shall have a judgm ent against 9 Husband 9 W ife for 9 one-half 9 all the service 28 fees. (b) If Court Costs and Fees w ere Paid by the Parties: (please check the boxes below that apply) Page 12 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 9 Husband 9 W ife shall be liable for 9 one-half 9 all the court costs and service fees that have been paid in this suit, and judgm ent shall be entered accordingly. 3 4 REQUIRED INFORM ATION ABOUT THE PARTIES 5 6 7 8 9 W ife Full nam e: ____________________________ Residence, m ailing or contact address: ______ _____________________________________ Soc. sec. no.: Provided by UTCR 2.100 Affidavit Driver’s license # _____________________ Em ployer nam e ______________________ Em ployer address _____________________ Em ployer telephone ___________________ Husband Full nam e: ______________________________ Residence, m ailing or contact address: ________ _______________________________________ Soc. sec. no.: Provided by UTCR 2.100 Affidavit Driver’s license # ________________________ Em ployer nam e __________________________ Em ployer address ________________________ Em ployer telephone ______________________ 10 11 12 Both parties shall inform the Court and the Departm ent of Justice (P.O. Box 14506, Salem , Oregon 97309) in writing of any change in the inform ation required by this section within ten (10) days of such change, unless a finding of unreasonable risk has been m ade in this case. 13 14 If the court has ordered that a party be allowed not to disclose inform ation by m eans of this Judgm ent, the Departm ent of Justice shall not disclose the inform ation in the preceding section to the other parent. 15 16 17 OTHER INFORM ATION ABOUT THE PARTIES 18 W ife Husband 19 Date of birth: ____________ Age:_________ Date of birth:________________ Age: _______ 20 All form er legal nam es of the wife are: ______________________________________________ 21 All form er legal nam es of the husband are: ___________________________________________ 22 Date of m arriage: _____________ Place of m arriage: ___________________________________ 23 There are _____ children of the parties, whose nam es, ages and dates of birth are: 24 Nam e Age Expected/Date of Birth 25 ________________________________________________________________________________________ 26 ________________________________________________________________________________________ 27 ___________________________________________________________________________________________ 28 Page 13 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 M ONEY AW ARD 2 3 (Child Support Obligation A. 4 CHILD SUPPORT 1. 2. 3. 4. 5. 5 6 7 6. 7. 8 9 10 B. 11 Judgm ent Creditor ______________________________________________________ Attorney for Judgm ent Creditor ____________________________________________ Judgm ent Debtor _______________________________________________________ Am ount of Judgm ent representing back child support:__________________________ Am ount of Judgm ent:_______________ per m onth, starting the first day of the m onth following the date of the judgm ent. ‘ Of this Child Support Award, $ ________________constitutes “cash medical support” Interest a. Interest accrues at 9% per annum , sim ple interest. b. Interest accrues on the judgm ent on each unpaid installm ent as it becom es due on the first day of each m onth. SPOUSAL SUPPORT 1. 2. 3. 4. 12 9 included 9 not included) 13 5. 14 15 6. 16 Judgm ent Creditor _____________________________________________________ Attorney for Judgm ent Creditor ___________________________________________ Judgm ent Debtor ______________________________________________________ Am ount of Judgm ent: _______________ per m onth, starting the first day of the m onth following the date of the judgm ent, and term inating after the paym ent due on ___________. Interest a. Interest accrues at 9% per annum , sim ple interest. b. Interest accrues on the judgm ent on each unpaid installm ent as it becom es due on the first day of each m onth. Spousal support paym ents are taxable to the obligee spouse and deductible to the obligor spouse. All paym ents term inate upon the death of either party. 17 C. PROPERTY AND DEBT DIVISION (Judgm ents against Husband) 18 1. 2. 3. 4. 5. 19 20 21 Judgm ent Creditor _____________________________________________________ Attorney for Judgm ent Creditor ___________________________________________ Judgm ent Debtor ______________________________________________________ Am ount of Judgm ent ___________________________________________________ Interest a. Interest accrues at 9% per annum , sim ple interest. b. Date from which interest runs: date judgm ent is entered. 22 D. PROPERTY AND DEBT DIVISION (Judgm ents against W ife) 23 1. 2. 3. 4. 5. 24 25 26 Judgm ent Creditor _____________________________________________________ Attorney for Judgm ent Creditor ___________________________________________ Judgm ent Debtor ______________________________________________________ Am ount of Judgm ent ___________________________________________________ Interest a. Interest accrues at 9% per annum , sim ple interest. b. Date from which interest runs: date judgm ent is entered. 27 E. COURT COSTS (i.e., filing fees, hearing fees, trial fees) 28 1. 2. Judgm ent Creditor _____________________________________________________ Attorney for Judgm ent Creditor ___________________________________________ Page 14 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 3. 4. 5. 2 3 4 5 6 7 8 F. Judgm ent Debtor ______________________________________________________ Am ount of Judgm ent ___________________________________________________ Interest a. Interest accrues at 9% per annum , sim ple interest. b. Date from which interest runs: date judgm ent is entered. SERVICE FEES 1. 2. 3. 4. 5. Judgm ent Creditor _____________________________________________________ Attorney for Judgm ent Creditor ___________________________________________ Judgm ent Debtor ______________________________________________________ Am ount of Judgm ent ___________________________________________________ Interest a. Interest accrues at 9% per annum , sim ple interest. b. Date from which interest runs: date judgm ent is entered. 9 10 11 DATED this ________ day of ________________________________, 20____. 12 ________________________________________________ 13 Circuit Judge ____________________________________ 14 15 16 17 18 19 20 APPLICATION FOR CHILD SUPPORT SERVICES: By signing below, I apply for child support services from the Child Support Program (CSP). (Note: If you never received TANF, Tribal TANF or AFDC in any state, an annual $25,00 fee will a pply if over $500 is collected and distributed to the fam ily each year.) 21 22 ______________________________________ Co-Petitioner, Pro Se (signature) ____________________________________ Date ______________________________________ Co-Petitioner, Pro se (signature) ____________________________________ Date 23 24 25 26 27 28 Page 15 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 Both parties have agreed to the term s of this judgm ent: 2 3 ______________________________________ Co-Petitioner, Pro Se (signature) ____________________________________ Co-Petitioner, Pro Se (signature) ______________________________________ Print Nam e ______________________________________ Address ______________________________________ City, State, Zip Code ______________________________________ Telephone or Contact Telephone ____________________________________ Print Nam e __________________________________ Address ___________________________________ City, State, Zip Code ___________________________________ Telephone or Contact Telephone 4 5 6 7 8 9 10 11 12 13 9If applicable, child who is at least 18 and under 21 years of age, has stipulated (agreed) to the term s of this judgm ent: (sign only your nam e) ______________________________________ Child, signature 14 STATE OF ______________ 15 County of _______________ ) ) ss. ) 16 17 18 19 SUBSCRIBED AND SW ORN to before m e this ____ day of ______________, 20____, by _____________________. ___________________________________ Notary Public for ____________/Court Clerk My Com m ission Expires: ______________ 20 21 Certificate of Docum ent Preparation 22 23 You are required to truthfully com plete this certificate regarding the docum ent you are filing with the court. I certify that: (check all that apply) 24 9 W e selected this docum ent for ourselves. 25 9 W e were provided this docum ent by an attorney. 26 9 W e com pleted this docum ent without paid assistance. 27 9 W e paid or will pay m oney to _______________________________ for assistance in preparing this docum ent. 28 _______________________________ Signature _____________________________________ Signature Page 16 - JUDGMENT OF DISSOLUTION OF MARRIAGE X:\Local Documents\Family Court\2008\Judgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com