IN THE SUPERIOR COURT FOR CLARK COUNTY, WASHINGTON In re the Marriage of: No. Petitioner, PRETRIAL DOMESTIC RELATIONS SETTLEMENT CONFERENCE AFFIDAVIT OF Respondent. ________________________________ and INTRODUCTION The following information, other than proposals for settlement, is being provided to the above entitled court under penalty of perjury. I. A. B. C. D. E. F. G. H. Name: Age and date of birth: Employer: Occupation: Length of employment with present employer: Date of marriage: Date of separation: Names and ages of dependent children and with whom they reside: (1) (2) Of this marriage: Of prior marriage: PERSONAL DATA _________________'S PRETRIAL DOMESTIC RELATIONS SETTLEMENT CONFERENCE AFFIDAVIT - 1 American LegalNet, Inc. www.FormsWorkflow.com II. A. Resolved Issues: ISSUES B. Unresolved Issues: III. OTHER FACTORS AND COMMENTS (E.g. physical disabilities, employability, special schools or training, etc.) _________________'S PRETRIAL DOMESTIC RELATIONS SETTLEMENT CONFERENCE AFFIDAVIT - 2 American LegalNet, Inc. www.FormsWorkflow.com IV. PROPOSED COMMUNITY PROPERTY DIVISION (Stated in Dollars) Community Property Assets to Husband Less Debts to Husband Less/Plus Judgment Lien TOTAL: Assets to Wife Less Debts to Wife Less/Plus Judgment Lien TOTAL: Separate Property Assets to Husband Less Debts to Husband Less/Plus Judgment Lien TOTAL: Assets to Wife Less Debts to Wife Less/Plus Judgment Lien TOTAL: _________________'S PRETRIAL DOMESTIC RELATIONS SETTLEMENT CONFERENCE AFFIDAVIT - 3 American LegalNet, Inc. www.FormsWorkflow.com V. ADDITIONAL PROPOSALS FOR SETTLEMENT A. Children. Attach a complete Parenting Plan when questions of parenting functions or residential provisions for children are part of the proceedings. B. Maintenance. I (request) (am willing to pay): 1. Amount: 2. Duration: 3. Basis: C. Attorney Fees. I (request) (am willing to pay): $______________ D. Proposed Terms for Marital Lien: 1. Principal Amount: 2. Periodic Payments: a. Amount: b. Frequency: 3. Interest Rate: 4. Maturity Date: 5. Suggested Collateral: 6. Other: _________________'S PRETRIAL DOMESTIC RELATIONS SETTLEMENT CONFERENCE AFFIDAVIT - 4 American LegalNet, Inc. www.FormsWorkflow.com VI. ASSETS Please attach all appraisals, assessments or evaluations for property items of significant value listed below, if any. A. Community Property Description of Item FMV Amount Owing Net Value Proposed Award to Husband Proposed Award to Wife TOTALS: B. Separate Property Description of Item FMV Amount Owing Net Value Proposed Award to Husband Proposed Award to Wife TOTALS: _________________'S PRETRIAL DOMESTIC RELATIONS SETTLEMENT CONFERENCE AFFIDAVIT - 5 American LegalNet, Inc. www.FormsWorkflow.com VII. PENSION INFORMATION Assuming you and/or your spouse have a retirement plan as of the date of trial (DO NOT REPEAT IF INCLUDED IN SECTION VI. ABOVE). YOU Name of Plan (s) SPOUSE Type of Plan Years of Credit Service Vested (Yes or No) Monthly Retirement Benefit at Age of Eligibility to Draw Present Value of Pension (If Present value determined by Employer, union or the like, attach letter (s); if otherwise determined, attach computation page). _________________'S PRETRIAL DOMESTIC RELATIONS SETTLEMENT CONFERENCE AFFIDAVIT - 6 American LegalNet, Inc. www.FormsWorkflow.com VIII. LIABILITIES A. Community Liabilities Creditor Monthly Payment Proposed Unpaid Balance at Award to Separation Husband Proposed Award to Wife TOTALS: B. Separate Liabilities Creditor Monthly Payment Proposed Unpaid Balance at Award to Separation Husband Proposed Award to Wife TOTALS: _________________'S PRETRIAL DOMESTIC RELATIONS SETTLEMENT CONFERENCE AFFIDAVIT - 7 American LegalNet, Inc. www.FormsWorkflow.com IX. FINANCIAL STATUS Please see the Financial Declaration (Form WPF DRPSCU 01.0550 (6/2004) attached hereto and incorporated herein by reference. Also attach: (a) current wage stubs for the past two (2) months; and (b) copies of tax returns for the past two (2) years or W2's, if unavailable. X. CHILD SUPPORT If child support is an issue in this case, please see the Child Support Worksheet, attached hereto and incorporated herein by this reference. Respectfully submitted, ____________________________________ Of Attorneys for W.S.B.A. # I DECLARE, UNDER PENALTY OF PERJURY under the laws of the State of Washington, that the foregoing facts are full, true and correct to the best of my knowledge. DATED this ________ day of _____________________________, ________. ____________________________________ (Signature of party) _________________'S PRETRIAL DOMESTIC RELATIONS SETTLEMENT CONFERENCE AFFIDAVIT - 8 American LegalNet, Inc. www.FormsWorkflow.com SUPERIOR COURT OF WASHINGTON COUNTY OF In re: NO. Petitioner, and FINANCIAL DECLARATION [ ] PETITIONER [ ] RESPONDENT (FNDCLR) Respondent. Name: Date of Birth: I. SUMMARY OF BASIC INFORMATION Declarant's Total Monthly Net Income (from § 3.3 below) Declarant's Total Monthly Household Expenses (from § 5.9 below) Declarant's Total Monthly Debt Expenses (from § 5.11 below) Declarant's Total Monthly Expenses (from § 5.12 below) Estimate of the other party's gross monthly income (from § 3.1f below) $ $ $ $ []$ [ ] unknown II. PERSONAL INFORMATION 2.1 2.2 2.3 Occupation: The highest year of education completed: Are you presently employed? [ ] Yes [ ] No a. If yes: (1) Where do you work. Employer's name and address must be listed on the Confidential Information Form. FINANCIAL DECLARATION (FNDCLR) - Page 1 of 6 WPF DRPSCU 01.1550 (6/2004) - RCW 26.18.220 (1) American LegalNet, Inc. www.FormsWorkflow.com (2) When did you start work there (month/year)? _______________________ When did you last work (month/year)? _______________________ What were your gross monthly earnings? Why are you presently unemployed? $ b. If no: (1) (2) (3) III. INCOME INFORMATION If child support is at issue, complete the Washington State Child Support Worksheet(s), skip Paragraphs 3.1 and 3.2. If maintenance, fees, costs or debts are at issue and child support is NOT an issue this entire section should be completed. (Estimate of other party's income information is optional.) 3.1 GROSS MONTHLY INCOME. If you are paid on a weekly basis, multiply your weekly gross pay by 4.3 to determine your monthly wages and salaries. If you are paid every two weeks, multiply your gross pay by 2.15. If you are paid twice monthly, multiply your gross pay by 2. If you are paid once a month, list that amount below. Name a. b. c. d. Wages and S