SUPERIOR COURT OF WASHINGTON, COUNTY OF SKAGIT In re NO. ______________________ PRETRIAL AFFIDAVIT OF: Name: I. PERSONAL DATA ________________________, Age______ Occupation: PETITIONER RESPONDENT ______________________ Marriage/Relationship date:___________________________ Employer: ______________________ Separation date: __________________________________ Gross monthly income: ______________________ Children’s ages: __________________________________ Net monthly income: ______________________ II. SUGGESTED RESIDENTIAL TIME FOR CHILDREN With Father: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. With Mother: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. III. SUGGESTED CHILD SUPPORT If child support is at issue, complete and file an updated set of Washington State Child Support Worksheets. Based on current Worksheets, the presumptive amount of child support for ____ children is $________ per month. Child support should be set at $__________ per month, because _______________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________. IV. SUGGESTED MAINTENANCE If maintenance is at issue, complete and attach the Monthly Expense schedule, and page 1 of the Washington State Child Support Worksheets (showing income and deductions). Maintenance of $_________ per month should be paid to the husband wife, until ____________, because ____________________________________________________________________________________ ___________________________________________________________________________________________. PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT American LegalNet, Inc. www.USCourtForms.com V. ASSETS AND DEBTS If the other party has not yet filed a Pretrial Affidavit: fill in and attach four separate schedules, listing each community asset, separate asset, community debt, and separate debt. For each item, insert your figures in the appropriate columns (for “Petitioner’s Pretrial Affidavit” or “Respondent’s Pretrial Affidavit”). If the other party has filed a Pretrial Affidavit: on their four schedules, add your own figures for each item in the appropriate columns. If the other party omitted any assets or debts, add them to the appropriate schedule. Attach copies of your completed schedules. Transfer your totals from the Community Assets and Community Debts schedules to this chart, showing your proposed divisions of community property and debt: To Petitioner To Respondent Community Assets: Community Debts: Subtract Debts from Assets: Proposed judgment transfer (+/-): FINAL TOTALS: VI. OTHER FACTORS List any other factors which you believe should be considered at the settlement conference, such as special income situations, physical disabilities, dependent children of other relationships, etc. ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signed this _____ day of ______________________, at ___________________, Washington. Petitioner/Respondent_____________________________________ DATED _____________________, by: ________________________________________________________ Attorney for __________________________ WSBA No. __________ American LegalNet, Inc. www.USCourtForms.com PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT MONTHLY EXPENSES OF ___________________________ AND ________ DEPENDENTS: Housing: Rent or house payment .......................................____________ Taxes and insurance ...........................................____________ __________________________________ ........____________ Utilities: Heat (gas & oil) ....................................................____________ Electricity .............................................................____________ Water, sewer, garbage ........................................____________ Telephone............................................................____________ Cable ...................................................................____________ __________________________________ ........____________ Food and Supplies: Food for ____ persons ........................................____________ Supplies (paper, tobacco, pets)...........................____________ Meals eaten out ...................................................____________ __________________________________ ........____________ Children: Day care / babysitting ..........................................____________ Clothing................................................................____________ Tuition (if any) ......................................................____________ __________________________________ ........____________ __________________________________ ........____________ Transportation: Vehicle payments or leases.................................____________ Vehicle insurance & license.................................____________ Vehicle gas, oil, ordinary maintenance................____________ Parking.................................................................____________ __________________________________ ........____________ Health Care: Insurance .............................................................____________ Uninsured dental, orthodontic, medical, eye care____________ __________________________________ ........____________ Personal Expenses (not including children): Clothing................................................................____________ Hair care / personal care .....................................____________ Clubs & recreation ...............................................____________ Education.............................................................____________ Books, newspapers, magazines, photos.............____________ Gifts .....................................................................____________ ________________________.............................____________ Miscellaneous: Life insurance (if not deducted from income) ......____________ __________________________________ ........____________ __________________________________ ........____________ __________________________________ ........____________ __________________________________ ........____________ __________________________________ ........____________ __________________________________ ........____________ __________________________________ ........____________ __________________________________ ........____________ __________________________________ ........____________ TOTAL MONTHLY EXPENSES: ........................____________ American LegalNet, Inc. www.USCourtForms.com PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT COMMUNITY ASSETS Asset # Description of Community Asset Related Debt # Petitioner’s Position Fair Mkt Value To Petitioner Respondent’s Position To Respondent Fair Mkt Value To Petitioner To Respondent CA-1 CA-2 CA-3 CA-4 CA-5 CA-6 CA-7 CA-8 CA-9 CA-10 CA-11 CA-12 CA-13 CA-14 COMMUNITY ASSET TOTALS: PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT American LegalNet, Inc. www.USCourtForms.com SEPARATE ASSETS Asset # Related Debt # Description of Separate Asset Petitioner’s Position Fair Mkt Value To Petitioner Respondent’s Position To Respondent Fair Mkt Value To Petitioner To Respondent SA-1 SA-2 SA-3 SA-4 SA-5 SA-6 SA-7 SA-8 SA-9 SA-10 SA-11 SA-12 SA-13 SA-14 SEPARATE ASSET TOTALS: PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT American LegalNet, Inc. www.USCourtForms.com COMMUNITY DEBTS Debt # Related Asset # Description of Community Debt Petitioner’s Position Balance at Separation To Petitioner Petitioner’s Position To Respondent Balance at Separation To Petitioner To Respondent CD-1 CD-2 CD-3 CD-4 CD-5 CD-6 CD-7 CD-8 CD-9 CD-10 CD-11 CD-12 CD-13 CD-14 COMMUNITY DEBT TOTALS: PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT American LegalNet, Inc. www.USCourtForms.com SEPARATE DEBTS Debt # Related Asset # Description of Separate Debt Petitioner’s Position Balance at Separation To Petitioner Respondent’s Position To Respondent Balance at Separation To Petitioner To Respondent SD-1 SD-2 SD-3 SD-4 SD-5 SD-6 SD-7 SD-8 SD-9 SD-10 SD-11 SD-12 SD-13 SD-14 SEPARATE DEBT TOTALS: PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT American LegalNet, Inc. www.USCourtForms.com