Stanislaus — 1. Status of Case

Source: https://www.stanislaus.courts.ca.gov/system/files/supplemental_dec_no_19-no_kids.pdf

Case Name (Petitioner’s last name vs. Respondent’s last name): Case Number

1 Attachment 19 to Declaration for Default or Uncontested Dissolution or Legal Separation (Form FL-170) 2 1. STATUS OF CASE 3 a. The parties were married on __________________ and separated on __________________. 4 b. This is a marriage of ________ year(s) and _______ month(s).

5 c. Respondent was served with a Summons and Petition on _____________________. d. Respondent has not filed a Response and default has been submitted or entered. 6 e. There is/are ______ minor child(ren) of this marriage.

7 2. NAME CHANGE (Only if you checked Item 7(1) of the Petition for Dissolution)

8 The Petitioner requests his/her former name be restored to

9 ________________________________. 10 3. SPOUSAL SUPPORT (Only if you checked Item 7(f), 7(g) or both in the Petition for Dissolution)

Petitioner requests that the Court find that Petitioner has WAIVED spousal support and that11

Respondent has not requested spousal support. Accordingly, spousal support is denied to both parties and the Courts jurisdiction to award spousal support is terminated.12 Petitioner requests that the Court find the issue of spousal support as to both parties is

13 RESERVED effective forthwith upon entry of Judgment.

Petitioner requests that the Court order permanent spousal support based on the facts set14 forth in the attached Spousal Support Questionnaire, pursuant to Family Code Section 4320.

15 4. PROPERTY DIVISION (Only if you checked Item 4, 5(a or b) or 7(h) of the Petition for Dissolution) 16 Petitioner requests that the Court find that there are no community assets and or debts to divide.17 Petitioner requests that the Court order the community assets and debts to be divided as set 18 forth in the attached COMMUNITY PROPERTY DECLARATION (FL-160).

Petitioner requests that the Court confirm the separate property assets and/or debts as set19 forth in the attached SEPARATE PROPERTYATTACHMENT.

20 5. OTHER ORDERS (Optional) 21 Petitioner requests that the Court make other orders as set forth on OTHER ORDERS attachment. 22 I declare under penalty of perjury under the laws of the State of California that the above stated facts are true and correct.23 Dated: ____________________________________________(Sign) 24 __________________________________(Print name), Petitioner

25

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___

Case Name (Petitioner’s last name vs. Respondent’s last name): Case Number

1 SPOUSAL SUPPORT QUESTIONNAIRE (Complete if requesting a permanent spousal support order) 2 The Petitioner requests spousal support commencing (date) ________________, in the amount TO BE 3 DETERMINED by court based upon the following facts:

EARNING CAPACITY/MARITAL STANDARD OF LIVING: 4

Marketable skills:

5

I have the following job skills:

6 ____________________________________________________________________________________ 7 ____________________________________________________________________________________

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8

Job market for those skills: 9

I am currently employed with (employer’s name) __________________________________________

10 _______________________________________ and have been since (date) __. My 11 position there is as a (position title) ________________________________ earning $ per

hour/week/month.12

13 I am currently unemployed. I am making the following attempts to seek employment: ____________________________________________________________________________________ 14 ____________________________________________________________________________________ 15 ____________________________________________________________________________________

16 I have been unable to find employment that utilizes my marketable job skills for the following reasons: (Describe the possible need for retraining or education to get more marketable skills or employment, the time and expense to get 17 education/training to develop skills, and if your earning ability was impaired by periods of unemployment during the marriage devoted to domestic duties.) ____________________________________________________________________________________18 ____________________________________________________________________________________ 19 ____________________________________________________________________________________

20 CONTRIBUTIONS TO SUPPORTING SPOUSE: 21 During the marriage I contributed to the education, training, career, or license of my spouse or partner as 22 follows: ____________________________________________________________________________________ 23 ____________________________________________________________________________________

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Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___

Case Name (Petitioner’s last name vs. Respondent’s last name): Case Number

ABILITY TO PAY/EARNING CAPACITY:

11 The other party has the ability to pay spousal support because: (Describe current employment and earning 22 capacity, all other sources of income other than employment and their current standard of living.) ____________________________________________________________________________________ 33 ____________________________________________________________________________________ 44 ____________________________________________________________________________________

55 NEEDS OF EACH PARTY/MARITAL STANDARD OF LIVING:

66 During the marriage I was able to do the following which I am currently unable to do without an order for spousal support: (Describe whether you were able to buy property, vehicles or other assets; if you took vacations, had club 77 memberships, etc.; and, if you were able to build a savings or incurred debt.)

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88 ____________________________________________________________________________________ 99 ____________________________________________________________________________________

1010 OBLIGATIONS AND ASSETS:

1111 I currently have the following assets and obligations:

____________________________________________________________________________________1212

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1313 ____________________________________________________________________________________

1414 The other party has the following assets and obligations: 1515 ____________________________________________________________________________________

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1616 ____________________________________________________________________________________ 1717

DURATION OF MARRIAGE:

1818 We were married on _________________, and separated on ___________________, which is _______ 1919 year(s) and _______ month(s) of marriage.

2020 GAINFUL EMPLOYMENT/INTERESTS OF CHILDREN: 2121 My ability to work will will not unduly interfere with the interests of the dependent children in my custody because:2222 ____________________________________________________________________________________ 2323 ____________________________________________________________________________________ ____________________________________________________________________________________ 2424

2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___

Case Name (Petitioner’s last name vs. Respondent’s last name): Case Number

AGE AND HEALTH:

11 I am _________ years old and my health is as follows: 22 ____________________________________________________________________________________ ____________________________________________________________________________________ 33 ____________________________________________________________________________________

44 The other party is ________ years old and his her health is as follows: 55 ____________________________________________________________________________________

66 ____________________________________________________________________________________ ____________________________________________________________________________________ 77

HISTORY OF DOMESTIC VIOLENCE:

88

There is is not a history of domestic violence between myself and the other party which has been

99 documented by the following: (Describe any restraining orders, arrests, convictions and any emotional distress and consequences of such violence against you by the other party.) 1010 ____________________________________________________________________________________ 1111 ____________________________________________________________________________________

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1212

1313 TAX CONSEQUENCES:

I understand that any award of spousal support will be tax deductible to the other party and will be taxable1414

to me.

1515 BALANCE OF HARDSHIPS:

1616 I understand that the court will be considering the status of both parties based upon the information contained herein. 1717 GOAL OF BECOMING SELF-SUPPORTING: 1818 I understand that it is the goal of the State of California that a supported party will be self-supporting within a “reasonable period of time” and except in marriages of long duration (10 years or more, or as1919 determined by the court), a “reasonable period of time” to be self-supporting may be one-half the length of the marriage (calculated from date of marriage to date of separation) or as determined by the court. 2020 JUST AND EQUITABLE: 2121 In considering this request, I ask the court to consider the following additional factors: (Describe any other 2222 factors you would like the court to know in making its order.) ____________________________________________________________________________________

2323 ____________________________________________________________________________________

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2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___

Case Name (Petitioner’s last name vs. Respondent’s last name): Case Number

COMMUNITY ASSETS AND DEBTS

11 Petitioner requests that the Court order the community assets and or debts are divided as follows: 22

Petitioner be awarded the following community assets and or debts as his/her sole and separate 33 property:

44 Description of Asset/Debt Market Value Loan or Debt Net Value - = 55 - = - = 66 - = - = 77 - = 88 - = - = 99 - = - = 1010 Total awarded to Petitioner: $

1111

1212 Respondent be awarded the following community assets and or debts as his/her sole and separate property:1313

Description of Asset/Debt Market Value Loan or Debt Net Value 1414 - = - = 1515 - = - =1616 - = 1717 - = - = 1818 - = - = 1919 - = Total awarded to Respondent: $ 2020

2121

2222

2323

2424

2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___

Case Name (Petitioner’s last name vs. Respondent’s last name): Case Number

EQUALIZATION OF PROPERTY DIVISION

11

22 Equalizing Amount (Check and complete only if property division was unequal)

33 Petitioner requests that the Court find the division of assets and debts results in

Petitioner Respondent receiving $_______________ more in net assets and debts 44
resulting in an equalization payment due to Petitioner Respondent in the amount of

55 $______________ which is one-half the difference between the total net assets and debts going

to each party. 66

77 Payment Terms (Check and complete if you are NOT waiving an equalizing payment)

88 In order to equalize the division of assets and debts, Petitioner Respondent requests 99 that Petitioner Respondent pay the sum of $_______________, payable as follows:

1010 $__________ per month commencing within thirty (30) days of entry of judgment 1111 until paid in full.

Per the following terms:1212

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1313 _______________________________________________________________________ 1414 _______________________________________________________________________

1515 Waiver of Equalizing Payment (Check box below if you are waiving the right to receive an equalizing payment. Note: you CANNOT waive the Respondent’s right to receive an equalizing payment.) 1616 Petitioner requests that the Court find the division of assets and debts results in Respondent 1717 more in net assets and debts than the other party. Petitioner knowingly, freely and without duress

or undo pressure WAIVES and releases all rights and claims to receive an equalizing payment1818 from the other party at any time.

1919

2020 Equal Division (Check if the division of property was equal) Petitioner acknowledges the division of community assets and debts constitutes an equal 2121 division of property.

2222

2323

2424

2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___

Case Name (Petitioner’s last name vs. Respondent’s last name): Case Number

RETIREMENT BENEFITS

11

22 WAIVER OF RETIREMENT BENEFITS 33 Petitioner requests that the Court order that all benefits accrued during the marriage, now or in the future

44 by Respondent under the employee benefit plan:

55 ___________________________________________________________________________________, 66 [Name of pension or other employee benefit plan]

based on Respondent’s employment with ________________________________________________,

77 shall be awarded to Respondent as his/her sole and separate property. Petitioner will not assert any 88 claim to these benefits, and WAIVES and releases all claims, rights, and interest in and to these benefits

under the plan, including, but not limited to, survivor benefits and agrees to execute all documents

99 required by the Plan or employer to release said interest. 1010

1111

1212 DIVISION OF RETIREMENT BENEFITS

Petitioner requests that the Court find that based on Petitioner’s Respondent’s employment with1313
______________________________________________________, during the marriage, a community

1414 interest has arisen in the following plan:

1515 ___________________________________________________________________________________, 1616 [Name of pension or other employee benefit plan]

The parties shall cooperate in the preparation of a Qualified Domestic Relations Order (QDRO) or

1717 retirement benefits order for each plan, which proposed order(s) shall set forth the respective community 1818 interests of the parties and govern the disposition of benefits upon qualification by the plan(s) based upon

the time rule. The court shall reserve jurisdiction over the preparation of the order(s), and division of said

1919 retirement benefits. 2020

2121

2222

2323

2424

2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___

Case Name (Petitioner’s last name vs. Respondent’s last name): Case Number

SEPARATE PROPERTY

11

Petitioner requests that the Court find the following assets and or debts shall be established as 22 Petitioner’s separate property:

33 Description of Asset/Debt Date Why do you believe this is Separate Property? Acquired (Examples: Acquired prior to Marriage, After 44 Separation, Inheritance, Gift or Bequest)

55

66

77

88

99

1010

1111

1212

Petitioner requests that the Court find the following assets and or debts shall be established as1313 Respondent’s separate property:

1414 Description of Asset/Debt Date Why do you believe this is Separate Property? Acquired (Examples: Acquired prior to Marriage, After 1515 Separation, Inheritance, Gift or Bequest)

1616

1717

1818

1919

2020

2121

2222

2323

2424

2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___

Case Name (Petitioner’s last name vs. Respondent’s last name): Case Number

11 OTHER ORDERS:

22 ______________________________________________________________________

33 ______________________________________________________________________

44 ______________________________________________________________________

55 ______________________________________________________________________

66 ______________________________________________________________________

77 ______________________________________________________________________

88 ______________________________________________________________________

99 ______________________________________________________________________

1010 ______________________________________________________________________

1111 ______________________________________________________________________

1212 ______________________________________________________________________

1313 ______________________________________________________________________

1414 ______________________________________________________________________

1515 ______________________________________________________________________

1616 ______________________________________________________________________

1717 ______________________________________________________________________

1818 ______________________________________________________________________

1919 ______________________________________________________________________

2020 ______________________________________________________________________

2121 ______________________________________________________________________

2222 ______________________________________________________________________

2323 ______________________________________________________________________

2424 ______________________________________________________________________

2525 ______________________________________________________________________

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___