COMPLAINT FOR DIVORCE (WITH MINOR CHILDREN) D-7

Transcription

1 COMPLAINT FOR DIVORCE (WITH MINOR CHILDREN) D-7 The District Court Filing Office is located on the first floor at: 75 Court Street Reno, NV

2 COMPLAINT FOR DIVORCE (WITH CHILDREN) PACKET D-7 USE THIS COMPLAINT FOR DIVORCE PACKET ONLY IF ALL OF THE FOLLOWING STATEMENTS ARE TRUE: You are currently married. You and your spouse have minor child(ren) together, either natural born or adopted. The minor child(ren) have lived in Nevada for at least six months. You wish to divorce. You or your spouse has lived in Nevada for more than six weeks and intends to remain a resident of Nevada for the foreseeable future. Do Not Copy Or File This Page The penalty for willfully making a false statement under penalty of perjury is a minimum of 1 year, and a maximum of 4 years in prison, in addition to a fine of not more than $5, N.R.S REV 03/2016 ER D7 VISUAL INSTRUCTIONS

3 INSTRUCTIONS FOR COMPLETING FORMS CAREFULLY READ ALL INSTRUCTIONS BEFORE STARTING TO FILL OUT ANY OF THE FORMS. Use black or blue ink only. Neatly print the information requested. Do not use correction fluid/tape on the forms. This packet contains the following forms: 1. Civil Cover Sheet 2. Family Court Information Sheet 3. Complaint for Divorce With Children a. Appendix A: Child Custody Schedule b. Appendix B: Child Support Worksheets 4. General Financial Disclosure Form 5. Declaration of Resident Witness 6. Summons 7. Declaration of Personal Service 8. Definitions of Terms Used in this Packet Do Not Copy Or File This Page REV 03/2016 ER D7 VISUAL INSTRUCTIONS

4 INSTRUCTIONS: STEP 1 Do Not Copy Or File This Page Complete the Civil (Family-Related) Cover Sheet as Shown: 1) Print your name, address, telephone number, and date of birth. Print the name, address, telephone number, and date of birth of your spouse. 2) Check the correct box. If an interpreter is required, please print the language needed. 3) Check the box labeled "Marriage Dissolution Case." Also check the box labeled Divorce With children. 4) Print the name and date of birth of the minor child(ren) involved in this case. 5) Date and sign the form. REV 03/2016 ER D7 VISUAL INSTRUCTIONS

5 CIVIL (FAMILY/JUVENILE-RELATED) COVER SHEET WASHOE County, Nevada Case No. (Assigned by Clerk's Office) I. Party Information (provide both home and mailing addresses if different) Plaintiff/Petitioner (name/address/phone): Defendant/Respondent/Co-petitioner (name/address/phone): D.O.B. Attorney (name/address/phone): D.O.B. Attorney (name/address/phone): Will an Interpreter be required for court hearings? Yes No Will an Interpreter be required for court hearings? Yes No If yes, what language will need to be interpreted? If yes, what language will need to be interpreted? Contact court clerk for further information about interpreters II. Nature of Controversy (Please check applicable bold category and applicable subcategory, if appropriate) Family-Juvenile Related Cases Domestic Relations Case Filing Types Other Family Related Case Filing Types Marriage Dissolution Case Request for Temporary Protective Order (TP) Annulment (AN) Request for Extended Temporary Protective Order Divorce - With Children (DC) Other Domestic Relation Case Filings Divorce - Without Children (DO) Name Change-Minor (NM) Foreign Decree (FD) Permission to Marry (MM) Joint Petition - With Children (JC) Other Domestic Relation Filings (OF) Joint Petition - Without Children (JN) ntal Health (IC) Separate Maintenance (LS) Paternity - (PY) Custody (Non-Divorce) (CU) Guardianship Case Filing Types Guardianship of an Adult (GA) Support (Non-Divorce) Guardianship of a Minor (GB) Intrastate (Title IV-D) (UF) Guardianship Trust (OG) Other Support (Non-Title IV-D) (UO) Visitation (Non-Divorce) (VS) Estimated Estate Value: Termination of Parental Rights (TPR) State-Initiated TPR Petition (District Attorney filing only) (TS) Other TPR Petition (Private Request) (TV) Juvenile-Related Case Filing Types Miscellaneous Juvenile Petition Adoptions Emancipation Petition (EM) Adult (AA) Minor (AM) Children involved in this case: Name: Name: Name: DOB: DOB: DOB: Date Signature of initiating party or representative For Clark and Washoe Counties, please use their Family Court Cover Sheet for family-related case filings. Please see the Family Court Clerk in those counties for copies of their forms. Nevada AOC - Research Statistics Unit Pursuant to NRS \ Rev 3.1 \ July 1, 2014 Form PA 201 Rev 3.1

6 INSTRUCTIONS: STEP 2 Do Not Copy Or File This Page Complete the Family Court Information Sheet as Shown: You will be assigned a Case No. and Department No. when you file the Complaint with the court. 1) Print your name. 2) Print your spouse s name. 3) Complete the requested information for you and your spouse. Print do not have if one or both of you do not have a Social Security number. 4) Print the name, social security number, and date of birth for each child involved in this case. 5) Complete the remaining questions. REV 03/2016 ER D7 VISUAL INSTRUCTIONS

7 1 2 IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE , Plaintiff/Petitioner, vs., Defendant/Respondent. CONFIDENTIAL FAMILY COURT INFORMATION SHEET Case No. Dept. No Name: Name: Social Security #: Social Security #: Date of Birth: Date of Birth: IF THIS CASE INVOLVES CHILDREN, PLEASE COMPLETE THE FOLLOWING: Residential Address: Mailing Address: City, State, Zip: Residential Address: Mailing Address: City, State, Zip: Telephone #: Telephone #: Are you employed? YES [ ] NO [ ] Are you employed? YES [ ] NO [ ] Name of Employer: Name of Employer: Business Address: Business Address: City, State, Zip: City, State, Zip: Telephone #: Telephone #: Driver s License #: Driver s License #: Date of Birth: Date of Birth: Ethnicity: [ ] White (Not Hispanic) Ethnicity: [ ] White (Not Hispanic) [ ] African-American [ ] Hispanic [ ] African-American [ ] Hispanic [ ] Asian or Pacific Islander [ ] Asian or Pacific Islander [ ] Native American/Alaskan Native [ ] Other [ ] Native American/Alaskan Native [ ] Other CHILDREN INVOLVED IN THIS CASE Name: SSN: DOB: Name: SSN: DOB: Name: SSN: DOB: Name: SSN: DOB: Name: SSN: DOB: If there are more than five children, list their names on a separate sheet of paper and attach. Does this case involve family violence: [ ] Yes [ ] No Are you requesting Child Support Enforcement Services from the District Attorney s Office (IV-D) Services? [ ] Yes [ ] No Court Personnel Only: [ ] Custodial Parent [ ] Non-Custodial Parent This document contains the social security number of a person as required by NRS , NRS 125, 230, and NRS 125B.055

8 INSTRUCTIONS: STEP 3 Do Not Copy Or File This Page Complete the Complaint For Divorce as Shown: 1) Print your name, address, telephone number, and . You will be assigned a Case No. and Department No. when you file the Complaint with the court. 2) Print your name. 3) Print your spouse s name. 4) Complete pages 1-15, following the instructions on each page. REV 05/2016 ER D7 VISUAL INSTRUCTIONS

9 Code: 1430 Name: Address: Telephone: Self-Represented Litigant IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE , Plaintiff/Petitioner, vs., Defendant/Respondent. / Case No. Dept. No COMPLAINT FOR DIVORCE WITH CHILDREN A. I have resided in and been physically present in the State of Nevada, for the last six weeks, and intend to continue to make the State of Nevada my home for an indefinite period of time. is a resident of the State of. We were married (State in which my spouse lives) on, and ever since have been married. (Date of marriage, to include month, day, and year) B. IS -OR- IS NOT -OR- UNKNOWN pregnant at this time. I AM -OR- AM NOT pregnant at this time / / / / / / REV 6/2016 ER 1 COMPLAINT FOR DIVORCE CHILDREN

10 Minor Child(ren) On the lines below: Provide the information requested regarding each minor child born to, or adopted by, you and your spouse. You must list where the child currently lives, where the child has lived for the past 5 years, and the names and current addresses of the C. Child s Name: Date of Birth: Male Date Child Moved Here persons with whom the child lived at each address. Child s Address (Street Address, City, State) Person(s) With Whom Child Lived (Name and Current Address) Female Relationship To Child Child s Name: Date of Birth: Male Female Date Child Moved Here Child s Address (Street Address, City, State) Person(s) With Whom Child Lived (Name and Current Address) Relationship To Child Child s Name: Date of Birth: Male Female Date Child Moved Here Child s Address (Street Address, City, State) Person(s) With Whom Child Lived (Name and Current Address) Relationship To Child If more room is needed, attach additional sheets. REV 6/2016 ER 2 COMPLAINT FOR DIVORCE CHILDREN

11 Please identify any other court case in which you have participated as a party, witness, or in any other way concerning the custody of or visitation with the child(ren) listed above. If there are no other court cases, please check this box. Name(s) of child(ren) involved: Court: 7 Case number: Date of custody determination: Please identify any court case that could affect this case, including any case relating to domestic violence, protective orders, termination of parental rights, adoptions, guardianships, dependency, and paternity actions. If there are no other court cases, please check this box. Name(s) of child(ren) involved: Court: Type of case: Case number: Date of last order: 3. Please identify the names and addresses of any person(s) not a party to this court case who claims a right to legal custody, physical custody or visitation with the child(ren). If this is not applicable, please check this box. Name(s) of child(ren) involved: Name and address of person(s) claiming custody or visitation rights: If more room is needed, attach additional sheets. 28 REV 6/2016 ER 3 COMPLAINT FOR DIVORCE CHILDREN

12 Legal Custody of The Minor Child(ren) Place an X in a box to select ONLY ONE of the options below. D. Who should have legal custody of the minor child(ren)? BOTH PARENTS: JOINT LEGAL CUSTODY -OR- ME: SOLE LEGAL CUSTODY -OR- MY SPOUSE: SOLE LEGAL CUSTODY Physical Custody of the Child(ren) Place an X in a box to select ONLY ONE of the options below. E. Who should have physical custody of the minor child(ren)? BOTH PARENTS: JOINT PHYSICAL CUSTODY -OR- ME: PRIMARY PHYSICAL CUSTODY -OR / / / / / / / / / / / / MY SPOUSE: PRIMARY PHYSICAL CUSTODY REV 6/2016 ER 4 COMPLAINT FOR DIVORCE CHILDREN

13 F. Custody / Visitation and Exchange Schedule Place an X in a box to select ONLY ONE of the custody schedules provided below. A more detailed description of each custody schedule is provided in Appendix A. If you select Option 4, or would like to modify Options 1-3, write in your proposed custody / visitation schedule below. Option 1 Week On / Week Off: The minor child(ren) will spend one week with you and then the following week they will spend with your spouse. This schedule will alternate weekly throughout the year. The exchange will take place on at A.M. -OR- P.M. (Day of the week) (Time) The parties will exchange the child(ren) at. (Location) Option 2 Repeating two / two / three: The minor child(ren) will spend two days with you, then two days with your spouse, three days with you, two days with your spouse, two days with you, three days with your spouse, alternating throughout the year. The first exchange will take place on the first Friday following this Court s Order. The exchanges will take place at A.M. -OR- P.M. (Time) The parties will exchange the child(ren) at. (Location) NOTE: This schedule is often used when the parents have a young child or children. Option 3 Three Weekends A Month: The minor child(ren) will spend the first three full weekends (starts on the first Friday of the month) with ME -OR- MY SPOUSE. Remaining weekdays and weekends will be spent with ME -OR- MY SPOUSE. 27 / / / 28 REV 6/2016 ER 5 COMPLAINT FOR DIVORCE CHILDREN

14 The exchange will take place on Friday at A.M. -OR- P.M. and (Time) Sunday at A.M. -OR- P.M. (Time) The parties will exchange the child(ren) at. (Location) Option 4 Schedule Described Below: I request the following schedule (Include instructions for transportation and exchange): If more room is needed, attach additional sheets. REV 6/2016 ER 6 COMPLAINT FOR DIVORCE CHILDREN

15 G. Check box if this holiday applies Holiday Spring Break Mother s Day Father s Day 4 th of July Halloween Fall Break Thanksgiving Break 1 st Half Winter Break 2 nd Half Winter Break National Holidays not listed above that result in a 3-day weekend. Other: Holiday Visitation Schedule Please fill out the below holiday visitation schedule. Undesignated religious or school holidays shall follow the parents regular timeshare schedule, unless detailed below. For example, Christmas typically falls during the 1 st half of Winter Break. If nothing is identified in Other, the parent who has the 1 st half of the break, has the child(ren) for Christmas. Exchange Times Begins upon release of school and ends when school resumes. Begins 7 p.m. evening before Mother s Day; ends 9 a.m. the morning after. Begins 7 p.m. evening before Father s Day; ends 9 a.m. the morning after. Begins 7 p.m. on July 3rd; ends 9 a.m. on July 5th. Begins 7 p.m. on October 30th; ends 9 a.m. on November 1st. Begins upon release of school and ends when school resumes. Begins upon release of school and ends when school resumes. Begins upon release of school and ends at 9 a.m. halfway through the break. Begins at 9 a.m. halfway through the break and ends when school resumes. Begins upon release of school and ends when school resumes. Example: morial Day Weekend. Even Numbered Years Odd Numbered Years Other: Other: Other: 28 If more room is needed, attach additional sheets. REV 6/2016 ER 7 COMPLAINT FOR DIVORCE CHILDREN

16 Summer Visitation Schedule Place an X in a box to select ONLY ONE of the summer visitation schedules provided below. If you select Option 3, or would like to modify Options 1 or 2, write in your proposed visitation schedule below. H. Option 1: Visitation Remains the Same. Option 2: Alternating Two Week Timeshares: The minor child(ren) will spend two weeks with you and then the following two weeks they will spend with your spouse. This will alternate for the remainder of the summer break. Option 3: Schedule Described Below: I request the following summer visitation schedule: If more room is needed, attach additional sheets. Transportation for ALL Exchanges Complete the statement below I. Transportation will be provided by the parent PICKING UP -OR- DROPPING OFF -OR- OTHER: the child(ren). (Explain how transportation shall be provided.) / / / / / / REV 6/2016 ER 8 COMPLAINT FOR DIVORCE CHILDREN

17 1 2 Alimony Place an X in a box to select ONLY ONE of the two statements below J. Alimony is not appropriate in this case. -OR ME -OR- MY SPOUSE should receive alimony in the amount of $ (Amount of alimony) per month, due on the for (Day / Date of payment each month) (Number of months or years) MONTHS -OR- YEARS. The alimony will begin on:. (Date first alimony payment will be made) Health Care for Child(ren) Complete ALL of the statements below. Place an X in a box in front of the selected answer in statements 1-3. K. 1. The child(ren) are covered by a health insurance policy (this includes dicaid, Tricare, private health insurance, etc.). YES -OR- NO 2. Who will provide health insurance for the minor child(ren)? ME -OR- MY SPOUSE -OR- BOTH PARENTS 3. and I will equally share all costs of insurance for the minor child(ren), including, premiums, deductibles, and any uncovered medical, dental, or vision expenses. If either parent incurs a medical expense on behalf of the child(ren), they will provide the other parent with proof of payment and a copy of the bill within 30 days of receiving it, and the other parent will have 30 days to reimburse their half of the amount paid or to set up payment arrangements through the health care provider. REV 6/2016 ER 9 COMPLAINT FOR DIVORCE CHILDREN

18 Child Support Calculation Fill in the information requested below. The child support MUST be based on the formula as set out in the Nevada Revised Statutes. You may not just state an arbitrary amount and you may not state no child support to be paid. Included in Appendix B, you will find, child support calculation worksheets to assist you with calculating child support. L. My gross monthly income is: $. (Amount earned per month before deductions) s gross monthly income is: $. (Amount earned per month before deductions) Deviations If you are requesting an amount of child support that is lower or higher than the statutory amount, your reason(s) for requesting a different amount must be based upon one or more of the following factors. Place an X in all that apply. Include the dollar amount of deviation for each category The cost of health insurance $ Special educational needs of the child $ The cost of child care $ The amount of time the child spends with each parent $ The relative income of both parents $ Any other necessary expenses for the benefit of the child $ The age of the child $ Any expenses reasonably related to the mother s pregnancy and confinement $ Legal responsibility of the parent for the support of others $ The cost of transportation of the child to and from visitation if the custodial parent moved with the child from the jurisdiction that ordered the support and the non-custodial parent remained $ The value of services contributed by either parent $ Any public assistance paid to support the child $ 26 Explain: REV 6/2016 ER 10 COMPLAINT FOR DIVORCE CHILDREN

19 If more room is needed, attach additional sheets. The amount of child support for ME -OR- MY SPOUSE after any deviation(s) is $ per month. This amount of child support is in compliance with NRS 125B.070. (Amount of child support) Child Support Payment Place an X in a box to select ONLY ONE of the two statements below M. The parent paying child support will pay the support directly to the other parent. -OR- A wage assignment is or should be put in place and payment should be enforced through the District Attorney s Office. Tax Deduction Place an X in a box to select ONLY ONE of the three statements below. N. Every year, ME -OR- MY SPOUSE should claim the child(ren) as dependents for tax purposes. -OR- 22 The tax deduction should alternate, with me claiming the child(ren) in EVEN 23 NUMBERED -OR- ODD NUMBERED years, and my spouse claiming the child(ren) in the other years. -OR- The tax deduction should be shared by each of us claiming one or more children each year. I will claim: REV 6/2016 ER 11 COMPLAINT FOR DIVORCE CHILDREN

20 will claim: Division of Debts Place an X in a box to select ONLY ONE of the two statements below. O. and I have divided all community debts or there are no community debts to be divided. -OR- The community debts should be divided as follows: I should be responsible for the debts listed below: If more room is needed, attach additional sheets. should be responsible for the debts listed below: If more room is needed, attach additional sheets. REV 6/2016 ER 12 COMPLAINT FOR DIVORCE CHILDREN

21 Division of Property Place an X in a box to select ONLY ONE of the two statements below. P. and I have previously divided all community property or there is no community property to be divided. -OR- The community property should be divided as follows: I should receive the property listed below: If more room is needed, attach additional sheets. should receive the property listed below: If more room is needed, attach additional sheets. REV 6/2016 ER 13 COMPLAINT FOR DIVORCE CHILDREN

22 Wife s Name Place an X in a box to select ONLY ONE of the two statements below. Q. Wife does not wish to change her name. -OR- Wife wishes to return to her former name of: (Print full name: first, middle, and last) Additional Relief State any additional relief requested. R. I request the following additional relief: If more room is needed, attach additional sheets. S. and I are incompatible in marriage and there is no hope for reconciliation. T. I reserve the right to amend this Complaint, and to request additional and/or modified relief. U. I ask for judgment as follows: 1. That I be granted a divorce; REV 6/2016 ER 14 COMPLAINT FOR DIVORCE CHILDREN

23 That the court grant me the relief requested in this complaint; 3. For other and further relief as the court may deem just and proper in this action. This document does not contain the Social Security number of any person. I declare, under penalty of perjury under the law of the State of Nevada, that the foregoing is true and correct. Date: Your Signature: Print Your Name: REV 6/2016 ER 15 COMPLAINT FOR DIVORCE CHILDREN

24 INSTRUCTIONS: STEP 3a Do Not Copy Or File This Page Child Custody Schedules Please review Appendix A: Custody Schedules. These example schedules may be used to assist you in filling out the Complaint. REV 03/2016 ER D7 VISUAL INSTRUCTIONS

25 APPENDIX A: Custody Schedules These custody schedules are provided to you as examples. You may select a pre-set schedule as shown in Options 1 3, OR you may select to create your own visitation schedule in Option 4. Option 1: Week On / Week Off (Joint Physical Custody) You and your spouse will have equal time with the minor child(ren). The minor child(ren) will spend one week (seven days) with you and then the following week they will spend one week (seven days) with your spouse. This schedule will alternate weekly throughout the year. Example provided below (with exchanges taking place on Friday afternoon): Your custodial days / weeks with the minor child. Your spouse s custodial days / weeks with the minor child. Option 1: Week On / Week Off Custody Schedule Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday

26 Option 2: Repeating Two / Two / Three (Joint Physical Custody) You and your spouse will have equal time with the minor child(ren). On week one, the minor child(ren) will spend two days with you, followed by two days with your spouse, ending the week with three days with you. On week two, the minor child(ren) will spend two days with your spouse, followed by two days with you, ending the week with three days with your spouse. This schedule will alternate throughout the year. NOTE: This schedule is often used when the parents have small children. Example with exchanges taking place in the a.m. (see below), in some cases at school drop off, on exchange days). Your custodial days with the minor child(ren). Your spouse s custodial days with the minor child(ren). Option 2: Repeating Two / Two / Three Custody Schedule (A.M. Drop Off) Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday OR P.M. Drop Off Option 2: Repeating Two / Two / Three Custody Schedule (P.M. Drop Off) Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday

27 Option 3: Three Weekends a Month (Primary Physical Custody) You OR your spouse will have more custodial time with the minor child(ren). Beginning on the first Friday of the month, the minor child(ren) will spend the first three full weekends, with the noncustodial spouse. The remaining weekends will be spent with the spouse with primary custody of the minor child(ren). Example provided below (exchanges taking place on Friday, in some cases at school drop off, on exchange days, and Sunday afternoon). Primary spouse s custodial days with the minor child(ren). Other spouse s visitation days with the minor child(ren). Option 3: Three Weekends a Month Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Option 4: Create your own. Option 4: Create your own. Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday

28 INSTRUCTIONS: STEP 3b Do Not Copy Or File This Page Use Appendix B to assist with calculating child support. Worksheet A should be used if you are requesting Primary Physical Custody. Worksheet B should be used if you are requesting Joint Physical Custody. 1) Use Worksheet A if you are requesting one parent have primary physical custody. If you are requesting joint physical custody, please continue to Worksheet B (on the next page). REV 03/2016 ER D7 VISUAL INSTRUCTIONS

29 APPENDIX B: Child Support Worksheets Worksheet A - Primary Physical Custody Child Support Calculation Worksheet If you are asking for primary physical custody, fill out this worksheet. Primary physical custody exists when one parent has the child more than 60% (219 days) of the time calculated over a one year period. Determine the Gross Monthly Income (GMI) of the non-custodial parent (estimate if unknown). Gross monthly income is the income received from all sources. If you do not know the parent s gross monthly income, you can calculate the number with the formula on the last page. Determine Child Support Obligation. GMI $.18 (for 1 Child) X.25 (for 2 Children) =.29 (for 3 Children).31 (for 4 Children) Add.02 for each additional child Monthly Child Support: $ OR $100 per child $ (write the higher amount) Higher Amount: $ Apply the Presumptive Maximum (rarely applicable). Usually, this is the maximum amount a parent may be required to pay per month per child (and can reduce not increase the amount that would be owed under step ). This amount changes every year on July 1 st and can be found by going to and searching the phrase presumptive maximum. Make sure you are using the most current chart. Presumptive Maximum Reduction to: $ Or not applicable Deviations. You may request an amount of child support that is lower or higher than the amount in or, but your reason(s) must be based upon one of the following factors. ( check all that apply) The cost of health insurance The cost of childcare Special educational needs Age of the child Parent s legal responsibility to support others The value of services contributed by either parent Public assistance paid to support the child Expenses reasonably related to the mother s pregnancy and confinement Cost of transportation for visitation if the custodial parent moved out of the jurisdiction The amount of time the child spends with each parent Any other necessary expenses for the benefit of the child The relative income of both parents Explain: Total Child Support: $ Family Law Self-Help Center Child Support Worksheet A

30 Worksheet B - Joint Physical Custody Child Support Calculation Worksheet If you are asking for joint physical custody, fill out this worksheet. A joint physical custody arrangement exists when each parent has the child at least 40% (146 days) of the time calculated over a one year period. Parent 1 s Name: Parent 2 s Name: Determine Each Parent s Gross Monthly Income (GMI) (estimate other parent s income if unknown). Gross monthly income is the income received from all sources. If you do nott know a parent s gross monthly income, you can calculate the number with the formula on the last page.. Determine Each Parent s Child Support Obligation. Parent 1 GMI $ Parent 2 GMI $.18 (for 1 Child).25 (for 2 Children) X.29 (for 3 Children) =.31 (for 4 Children) Add.02 for each additional child Parent 1 s Monthly Child Support: $ OR $100 per child $ (write the higher amount and use in step 3) Higher Amount: $ Parent 2 s Monthly Child Support: $ OR $100 per child $ (write the higher amount and use in step 3) Higher Amount: $ Subtract the lower earning parent s amount of child support in from the higher earning parent s amount. Higher - Lower $ $ = Child Support Obligation $ paid by Name of higher income parent: Apply the Presumptive Maximum (rarely applicable). Usually, this is the maximumm amount a parent may be required to pay per month per child (and can reduce not increase the amount that would be owed under step ). This amount changes every year on July 1 st and can be found by going to and searching the phrase presumptive maximum. Make sure you u are using the most current chart. Presumptive Maximum Reduction to: $ Or not applicable Deviations. You may request an amount of child support that is lower or higher than the amount in or, but yourr reason(s) must be based upon one of the following factors. ( check all that apply) The cost of health insurance Expenses reasonably related to the mother s The cost of childcare pregnancy and confinement Special educational needs Cost of transportation for visitation if the Age of the child custodial parent moved out of the jurisdiction Parent s legal responsibility to support others The amount of time the child spendss with each parent The value of servicess contributed by either parent Any other necessary expenses for the benefit of the child Public assistance paid to support the child The relative income of both parents Explain: Total Child Support: $ Family Law Self-Help Center Child Support Worksheet B

31 To Determine a Parent s Gross Monthly Income: Gross monthly income is a parent s income from all sources before taxes. To find this number, calculate the following: Parent 1 Parent 2 *Monthly Wages from Employment (before taxes) $ $ Monthly Tip Income $ $ Monthly Self-Employment Income (after business expenses) $ $ Monthly Unemployment Benefits $ $ Social Security $ $ Social Security Disability $ $ Retirement / Pension $ $ Other: $ $ TOTAL INCOME $ $ *To Determine a Parent s Employment Income: If you do not know a parent s gross monthly income from employment, you can calculate the number if you know the 1) hourly wage, 2) weekly income, or 3) annual income. Gross Monthly Income Based on Annual Income: Annual Income $ 12 = $ Gross Monthly Income Based on Weekly Income: Weekly Income $ x 52 = Annual Income $ Annual Income $ 12 = $ Gross Monthly Income Based on Hourly Wage: Hourly Wage $ x # of Hours Worked per week = Weekly Income $ Weekly Income $ x 52 = Annual Income $ Annual Income $ 12 = $

32 INSTRUCTIONS: STEP 4 Do Not Copy Or File This Page Completing the General Financial Disclosure Form as Shown: 1) Print your name, address, , and telephone number. 2) Print the names of the parties, the case number and department number just as they appear on all other forms in this case. 3) Answer all of the questions on each page of the form. There are a total of eight (8) pages that need to be completed. REV 03/2016 ER D7 VISUAL INSTRUCTIONS

33 MISC Name: Address: Phone: Attorney for Nevada State Bar No. Judicial District Court, Nevada Plaintiff, vs. Defendant. Case No. Dept. GENERAL FINANCIAL DISCLOSURE FORM A. Personal Information: 1. What is your full name? (first, middle, last) 2. How old are you? 3.What is your date of birth? 4. What is your highest level of education? B. Employment Information: 1. Are you currently employed/ self-employed? ( check one) No Yes If yes, complete the table below. Attached an additional page if needed. Date of Hire Employer Name Job Title Work Schedule (days) Work Schedule (shift times) 2. Are you disabled? ( check one) No Yes If yes, what is your level of disability? What agency certified you disabled? What is the nature of your disability? C. Prior Employment: If you are unemployed or have been working at your current job for less than 2 years, complete the following information. Prior Employer: Date of Hire: Date of Termination: Reason for Leaving: Rev Page 1 of 8

34 Monthly Personal Income Schedule A. Year-to-date Income. As of the pay period ending my gross year to date pay is. B. Determine your Gross Monthly Income. Hourly Wage Hourly Wage = 52 Number of hours worked per week Weekly Income Weeks = 12 Annual Income Months = Gross Monthly Income Annual Salary Annual Income 12 Months = Gross Monthly Income C. Other Sources of Income. Source of Income Frequency Amount 12 Month Average Annuity or Trust Income Bonuses Car, Housing, or Other allowance: Commissions or Tips: Net Rental Income: Overtime Pay Pension/Retirement: Social Security Income (SSI): Social Security Disability (SSD): Spousal Support Child Support Workman s Compensation Other: Total Average Other Income Received Total Average Gross Monthly Income (add totals from B and C above) Page 2 of 8

35 D. Monthly Deductions Type of Deduction Amount A. Business Income: 1. Court Ordered Child Support (automatically deducted from paycheck) 2. Federal Health Savings Plan 3. Federal Income Tax Amount for you: 4. Health Insurance For Opposing Party: For your Child(ren): 5. Life, Disability, or Other Insurance Premiums 6. dicare 7. Retirement, Pension, IRA, or 401(k) 8. Savings 9. Social Security 10. Union Dues 11. Other: (Type of Deduction) Total Monthly Deductions (Lines 1-11) Business/Self-Employment Income & Expense Schedule What is your average gross (pre-tax) monthly income/revenue from self-employment or businesses? $ B. Business Expenses: Attach an additional page if needed. Advertising Type of Business Expense Frequency Amount 12 Month Average Car and truck used for business Commissions, wages or fees Business Entertainment/Travel Insurance Legal and professional Mortgage or Rent Pension and profit-sharing plans Repairs and maintenance Supplies Taxes and licenses (include est. tax payments) Utilities Other: Total Average Business Expenses Page 3 of 8

36 Personal Expense Schedule (Monthly) A. Fill in the table with the amount of money you spend each month on the following expenses and check whether you pay the expense for you, for the other party, or for both of you. Expense Monthly Amount I Pay For Other Party For Both Alimony/Spousal Support Auto Insurance Car Loan/Lease Payment Cell Phone Child Support (not deducted from pay) Clothing, Shoes, Etc Credit Card Payments (minimum due) Dry Cleaning Electric Food (groceries & restaurants) Fuel Gas (for home) Health Insurance (not deducted from pay) HOA Home Insurance (if not included in mortgage) Home Phone Internet/Cable Lawn Care mbership Fees Mortgage/Rent/Lease Pest Control Pets Pool Service Property Taxes (if not included in mortgage) Security Sewer Student Loans Unreimbursed dical Expense Water Other: Total Monthly Expenses Page 4 of 8

37 Household Information A. Fill in the table below with the name and date of birth of each child, the person the child is living with, and whether the child is from this relationship. Attached a separate sheet if needed. 1 st Child s Name Child s DOB Whom is this child living with? Is this child from this relationship? Has this child been certified as special needs/disabled? 2 nd 3 rd 4 th B. Fill in the table below with the amount of money you spend each month on the following expenses for each child. Type of Expense 1 st Child 2 nd Child 3 rd Child 4 th Child Cellular Phone Child Care Clothing Education Entertainment Extracurricular & Sports Health Insurance (if not deducted from pay) Summer Camp/Programs Transportation Costs for Visitation Unreimbursed dical Expenses Vehicle Other: Total Monthly Expenses C. Fill in the table below with the names, ages, and the amount of money contributed by all persons living in the home over the age of eighteen. If more than 4 adult household members attached a separate sheet. Name Age Person s Relationship to You (i.e. sister, friend, cousin, etc ) Monthly Contribution Page 5 of 8

38 Personal Asset and Debt Chart A. Complete this chart by listing all of your assets, the value of each, the amount owed on each, and whose name the asset or debt is under. If more than 15 assets, attach a separate sheet. Line Description of Asset and Debt Thereon Gross Value Total Amount Owed 1. $ - $ = $ 2. $ - $ = $ 3. $ - $ = $ 4. $ - $ = $ 5. $ - $ = $ 6. $ - $ = $ 7. $ - $ = $ 8. $ - $ = $ 9. $ - $ = $ 10. $ - $ = $ 11. $ - $ = $ 12. $ - $ = $ 13. $ - $ = $ 14. $ - $ = $ 15. $ - $ = $ Total Value of Assets (add lines 1-15) $ - $ = $ Net Value Whose Name is on the Account? You, Your Spouse/Domestic Partner or Both B. Complete this chart by listing all of your unsecured debt, the amount owed on each account, and whose name the debt is under. If more than 5 unsecured debts, attach a separate sheet. Line # Description of Credit Card or Other Unsecured Debt Total Amount owed Whose Name is on the Account? You, Your Spouse/Domestic Partner or Both 1. $ 2. $ 3. $ 4. $ 5. $ 6. $ Total Unsecured Debt (add lines 1-6) $ Page 6 of 8

39 CERTIFICATION Attorney Information: Complete the following sentences: 1. I (have/have not) retained an attorney for this case. 2. As of the date of today, the attorney has been paid a total of $ on my behalf. 3. I have a credit with my attorney in the amount of $. 4. I currently owe my attorney at total of $. 5. I owe my prior attorney at total of $. IMPORTANT: Read the following paragraphs carefully and initial each one. This document does not contain the Social Security Number of any person. I swear or affirm under penalty of perjury that I have read and followed all instructions in completing this Financial Disclosure Form. I understand that, by my signature, I guarantee the truthfulness of the information on this Form. I also understand that if I knowingly make false statements I may be subject to punishment, including contempt of court. I have attached a copy of my 3 most recent pay stubs to this form. I have attached a copy of my most recent YTD income statement/p&l state to this form, if self-employed. I have not attached a copy of my pay stubs to this form because I am currently unemployed. Signature Date Page 7 of 8

40 CERTIFICATE OF SERVICE I hereby declare under the penalty of perjury of the State of Nevada that the following is true and correct: That on (date), service of the General Financial Disclosure Form was made to the following interested parties in the following manner: Via 1 st Class U.S. Mail, postage fully prepaid addressed as follows: Via Electronic Service, in accordance with the Master Service List, pursuant to NEFCR 9, to: Via Facsimile and/or Pursuant to the Consent of Service by Electronic ans on file herein to: Executed on the day of, 20. Signature Page 8 of 8

41 INSTRUCTIONS: STEP 5 Do Not Copy Or File This Page Complete the Declaration of Resident Witness as Shown: In order to get a divorce in Nevada, either you OR your spouse must have lived, and been physically present in, Nevada for more than six weeks prior to the filing of the divorce with the court. This Declaration must be completed by someone other than you or your spouse, who is 18 years of age or older, who is a resident of the State of Nevada, and who personally knows that your spouse or you have been physically present in Nevada for at least six weeks prior to filing a Complaint. This person is called the Resident Witness. 1) Print your name, address, telephone number, and . You will be assigned a Case No. and Department No. when you file the Complaint and this form with the court. 2) Print your name. 3) Print your spouse s name. 4) The Resident Witness (someone other than your spouse or you) must complete the Declaration form from this point forward. 5) The Resident Witness must sign and date the Declaration on page 2. REV 03/2016 ER D7 VISUAL INSTRUCTIONS

42 Code: 1521 Name: Address: Telephone: Self-Represented Litigant IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE , Plaintiff / Petitioner / Joint Petitioner, vs., Defendant / Respondent / Joint Petitioner. / Case No. Dept. No DECLARATION OF RESIDENT WITNESS I,, do hereby declare under penalty of (Name of Resident Witness) perjury that the following is true. I am over the age of eighteen and competent to testify of my own knowledge to the following: 1. I have lived in the State of Nevada for years and presently live at: (Number) (Your Street Address) (City, State, Zip Code) REV 12/ Declaration of Resident Witness

43 To my personal knowledge,, (Name of Plaintiff or Defendant) a. lives at: (Street Address) (City, State, Zip Code) b. has lived at that address since and has been physically (Month and Year) present within the State of Nevada on a daily basis for at least six weeks prior to the filing of the Complaint -or- Joint Petition in this case. c. has physically lived in the State of Nevada since: (Month and Year /or Year Only) and is a bona fide resident of the State of Nevada. 3. I see him / her an average of times a WEEK -OR- MONTH. (Number) He / She is my: (select one option below) Friend Co-Worker Other: 17 Relative Neighbor This document does not contain the Social Security Number of any person. I declare under penalty of perjury, under the law of the State of Nevada, that the foregoing statements are true and correct.* Date: Signature: Printed Name: Telephone: * The penalty for willfully making a false statement under penalty of perjury is a minimum of 1 year, and a maximum of 4 years in prison, in addition to a fine of not more than $5, N.R.S REV 12/ Declaration of Resident Witness

44 INSTRUCTIONS: STEP 6 Do Not Copy Or File This Page Complete the Summons as Shown: You will be assigned a Case No. and Department No. when you file the Complaint and this form with the court. 1) Print your name. 2) Print your spouse s name. 3) Print Complaint for Divorce With Children as the object of this action. 4) Print your name, address, phone number, and . REV 03/2016 ER D7 VISUAL INSTRUCTIONS

45 Code: 4085 IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE , Plaintiff / Petitioner / Joint Petitioner, vs., Defendant / Respondent / Joint Petitioner. / Case. No. Dept. No SUMMONS TO THE DEFENDANT: YOU HAVE BEEN SUED. THE COURT MAY DECIDE AGAINST YOU WITHOUT YOUR BEING HEARD UNLESS YOU RESPOND IN WRITING WITHIN 20 CALENDAR DAYS. READ THE INFORMATION BELOW VERY CAREFULLY. A civil complaint or petition has been filed by the plaintiff(s) against you for the relief as set forth in that document (see complaint or petition). When service is by publication, add a brief statement of the object of the action. See Nevada Rules of Civil Procedure, Rule 4(b). The object of this action is:. 1. If you intend to defend this lawsuit, you must do the following within 20 calendar days after service of this summons, exclusive of the day of service: a. File with the Clerk of the Court, whose address is shown below, a formal written answer to the complaint or petition, along with the appropriate filing fees, in accordance with the rules of the Court, and; b. Serve a copy of your answer upon the attorney or plaintiff(s) whose name and address is shown below. 2. Unless you respond, a default will be entered upon application of the plaintiff(s) and this Court may enter a judgment against you for the relief demanded in the complaint or petition. Dated this day of, 20. Issued on behalf of Plaintiff(s): JACQUELINE BRYANT CLERK OF THE COURT Name: By: Address: Deputy Clerk Second Judicial District Court Phone Number: 75 Court Street Reno, Nevada REVISED 12/2015 ER 1 SUMMONS

46 Do Not Copy Or File This Page INSTRUCTIONS: STEP 7 Copying and Filing Documents Take the original and two (2) copies of the completed forms to the Filing Office to be filed. Each form must be stapled. The Filing Office will not accept forms that are not stapled. The Filing Office is located on the first floor of the courthouse at 75 Court Street, Reno, NV. A copy machine is available at the Law Library located on the first floor of the courthouse at 75 Court Street, Reno, NV (to the left of the Filing Office). There is a per page charge to use the copy machine. There will be a filing fee charged when the documents are filed. Fee information is available at the Filing Office, Family Division Self-Help Center, and online at: You can call the Filing Office at (775) to confirm the amount of the fee. FILING FEE WAIVERS If you cannot afford the filing fee, you may apply to have your filing fee waived. To apply, you must fill out and file the application found in the Application for Waiver of Fees and Costs packet, which may be obtained at the following locations: Family Division Self Help Center, 1 South Sierra Street, Reno, NV, First Floor Filing Office, 75 Court Street, Reno, NV, First Floor Law Library, 75 Court Street, Reno, NV, First Floor Online at: (select the Forms and Packets tab on the right hand side of the home screen) The Filing Office will keep the original documents and return file-stamped copies to you. Please make sure to keep copies of all the forms you file for your personal records. INSTRUCTIONS: STEP 8 Setting a Case Management Conference You must set a case management conference. One will not be set automatically for you. Contact the Family Division Self Help Center for further information. REV 03/2016 ER D7 VISUAL INSTRUCTIONS

47 Do Not Copy Or File This Page INSTRUCTIONS: STEP 9 Serving the Documents Your spouse must be personally served within 120 calendar days after the Complaint is filed or your case may be dismissed. Both the Summons and Complaint must be personally served. Personal Service Personal Service is completed by a person other than yourself by: handing a copy of the summons and complaint along with all other documents you have filed with the Court to your spouse; or leaving a copy at your spouse s home with a person of suitable age and discretion who lives there; or delivering a copy to an agent authorized to receive service (such as an attorney). Personal Service cannot be completed by you. Service may be completed by: the Civil Division of the Sheriff s Office in the County in which your spouse resides or works; or a responsible adult over the age of 18 years (such as a friend or relative); or a private process service. Filing the Summons and Declaration of Service After service is completed, the Declaration of Service on the second page of the original Summons must be filled out by the person who performs the service (see Instructions: Step 11). You must file the original Summons and Declaration of Service with the court. Without proof of service on your spouse, the court cannot grant a decree of divorce. Your spouse has 20 calendar days after the date of service in which to file an Answer to the Complaint. If your spouse does not file an Answer, please contact the Family Division Self Help Center for further information regarding a default packet. Service by Publication If you do not know where your spouse is, you may file an Ex Parte Motion for Publication of Summons in order to serve your spouse by publishing the Summons in the newspaper. Contact the Family Division Self Help Center for further information. REV 03/2016 ER D7 VISUAL INSTRUCTIONS

48 INSTRUCTIONS: STEP 10 Do Not Copy Or File This Page Complete the Declaration of Personal Service as Shown: This Declaration must be completed by the person who serves your spouse (see Instructions: Step 10). Service may be made by the Sheriff s Office in the county in which your spouse resides or works, a responsible person who is 18 years of age or older, or by a private process service. Service cannot be completed by you. The person who completes service must fill out the Declaration and sign it. It is your responsibility to file the original Summons and Declaration of Service with the court after service has been made. 1) The person who completed service must fill out this form. 2) Check the box(s) to indicate the documents served. REV 03/2016 ER D7 VISUAL INSTRUCTIONS

49 DECLARATION OF PERSONAL SERVICE (To be filled out and signed by the person who served the Defendant or Respondent) I,, declare: (Name of person who completed service) 1. I am not a party to this action and am over 18 years of age. 2. I WAS OR WAS NOT able to complete service. 3. I personally served the Defendant/Respondent OR, (Name of person you served) a person who was of suitable age and discretion, by handing him/her a copy of the following (check all that apply): Summons; Complaint; Civil Cover Sheet; Family Court Information Sheet; Declaration of Resident Witness; Notice of Case Management Conference; Motion to ; (Name of motion) Other:, at the following address: General Financial Disclosure Form; on the day of, Defendant/Respondent DOES OR DOES NOT live at that address. This document does not contain the Social Security Number of any person. I declare, under penalty of perjury under the law of the State of Nevada, that the foregoing is true and correct.* Signature: (Signature of person who completed service) Date: Printed Name: (Name of person who completed service) *The penalty for willfully making a false statement under penalty of perjury is a minimum of 1 year, and a maximum of 4 years in prison, in addition to a fine of not more than $5, N.R.S REVISED 12/2015 ER 2 SUMMONS