Children

a. General Information

There are (number) _______ minor children at issue: Write how many children under 18 this case is about.

b. Children's Basic Information

Child's Name Write the full name of your first child. Date of Birth Write the first child's date of birth. State of Residence Write the state where the first child lives now. How long child lived in the state Write how long the first child has lived in that state. Disability Write any disability the first child has, or leave blank if none. Child's Name Write the full name of your second child. Date of Birth Write the second child's date of birth. State of Residence Write the state where the second child lives now. How long child lived in the state Write how long the second child has lived in that state. Disability Write any disability the second child has, or leave blank if none. Child's Name Write the full name of your third child. Date of Birth Write the third child's date of birth. State of Residence Write the state where the third child lives now. How long child lived in the state Write how long the third child has lived in that state. Disability Write any disability the third child has, or leave blank if none. Child's Name Write the full name of your fourth child. Date of Birth Write the fourth child's date of birth. State of Residence Write the state where the fourth child lives now. How long child lived in the state Write how long the fourth child has lived in that state. Disability Write any disability the fourth child has, or leave blank if none. Child's Name Write the full name of your fifth child. Date of Birth Write the fifth child's date of birth. State of Residence Write the state where the fifth child lives now. How long child lived in the state Write how long the fifth child has lived in that state. Disability Write any disability the fifth child has, or leave blank if none. Yes, the child(ren) have lived in Nevada for the past six months, or since birth. Check this box if your children have lived in Nevada for at least the past six months, or their whole lives if they are younger than six months. No, the child(ren) have NOT lived in Nevada for the past six months. Check this box if your children have NOT lived in Nevada for the past six months. Where they live(d) - Current Write the full street address where the children live right now, including the city. Who they live(d) with - Current List the names of the people the children currently live with, such as a parent or relative. Dates they live(d) there - Current (___ - present) Write the date the children started living at the current address. The word 'present' shows they still live there. Which child (or all) - Current Write which child lives here, or put 'All' if it applies to every child. Where they live(d) - Past Residence Write the full street address of a place the children lived before now, including the city. Who they live(d) with - Past Residence List the names of the people the children lived with at this past address. Dates they live(d) there - Past Residence Write the start and end dates the children lived at this past address, like May 2021 - Feb 2022. Which child (or all) - Past Residence Write which child lived here, or put 'All' if it applies to every child. Where they live(d) - Past Residence Write the full street address of another place the children lived before now, including the city. Who they live(d) with - Past Residence List the names of the people the children lived with at this past address. Dates they live(d) there - Past Residence Write the start and end dates the children lived at this past address. Which child (or all) - Past Residence Write which child lived here, or put 'All' if it applies to every child. Where they live(d) - Past Residence Write the full street address of another place the children lived before now, including the city. Who they live(d) with - Past Residence List the names of the people the children lived with at this past address. Dates they live(d) there - Past Residence Write the start and end dates the children lived at this past address. Which child (or all) - Past Residence Write which child lived here, or put 'All' if it applies to every child. If the children lived with a non-parent in the last 5 years, list the non-parent's name and current address: If the children lived with someone who is not their parent in the last five years, write that person's name and where they live now. No. Check this box if you have never been part of any court case about these children. Yes, I have participated in the following cases concerning these children Check this box if you have been part of any court case about these children, such as a party or witness. provide all specifics including the state, the court name, children involved, the case number and the date of the child custody order, if any Give the details of those cases: the state, court name, which children were involved, the case number, and the date of any custody order. No. Check this box if you do not know of any other case that could affect this one. Yes, the following cases that could affect this case Check this box if you know of other cases that could affect this one, like custody, domestic violence, or protection order cases. give all specifics including the state, the court name, the parties involved, the case number and the type of case Give the details of those cases: the state, court name, the people involved, the case number, and the type of case. No. Check this if no one else, besides you or the other people in this case, has or can claim custody or visitation of the children.

c. Possession & Access

Yes, the following people have custody or can claim custody/visitation of the children: Check this if someone else has the children or can claim a right to custody or visitation. You will list them below. (list names and addresses of anyone who claims custody/visitation rights): Write the full names and home addresses of anyone who has the children or can claim custody or visitation rights. Plaintiff believes that the father of the children is (father's name) Write the full name of the children's father. There is no dispute about who the father is. Birth Certificate. The man named above is the father listed on the birth certificate(s). Check this if the father's name is on the children's birth certificate(s).

d. Pregnancy & Paternity

Court Order. Paternity was already established by a court order through Check this if a court already decided who the father is in an earlier case. (name of court) Write the name of the court that earlier decided who the father is. in case number (case number) Write the case number from the earlier court case that decided who the father is. on (date) Write the date the earlier court order about the father was made. DNA Test. A DNA test shows who is the biological father; a copy is attached. Check this if a DNA test proves who the biological father is. Attach a copy of the test results. Parents Lived Together. The parties lived together at least 6 months before conception and lived together through the period of conception. Check this if the parents lived together for at least 6 months before the child was conceived and stayed together through that time. Admission. The man named above openly holds out the child as his own and has accepted the child into his home. Check this if the father treats the child as his own in public and has welcomed the child into his home. Domestic Violence Check this if there has been any abuse or violence in the home that the court should know about. CPS Involvement Check this if Child Protective Services has been involved with your family. Military Deployment Check this if a parent is in the military and may be sent away for duty. State of Residency Check this if which state the child lives in matters for this case. Other: Check this if there is another issue the court should think about that is not listed. Other: ____________________ Write the other issue you want the court to consider when deciding custody.

e. Child Support

Child support should be paid by Check this box if one parent should pay child support. Then fill in the details below. name of parent who should pay child support Write the full name of the parent who will pay the monthly child support. in the amount of $ Enter the dollar amount to be paid each month. Use the number from the worksheet you completed. The Child Support Worksheet calculation attached. Check this if the support amount comes from the attached worksheet you filled out. The amount already established by the District Attorney, Family Support Division, case Check this if a child support amount was already set by the District Attorney's office in another case. insert case number) R Enter the case number from the District Attorney's office that comes after the letter R. No child support is requested. Check this only if you are not asking for any child support at all. Explain why not Explain in your own words why you are not asking for child support. I'm not sure how much child support should be paid, and ask the court to set support. Check this if you don't know the amount and want the judge to decide how much support should be paid. No, no back child support or arrears are requested. The parties are not and have not received welfare benefits at any time. Check this if you are not asking for past-due support and neither parent has ever gotten welfare. The parties are currently receiving or have received welfare benefits in the past. The parties cannot waive child support arrears. Check this if either parent gets or got welfare benefits, which means past-due support cannot be waived. Child support arrears are being handled by the District Attorney, Family Support Division, case Check this if past-due support is already being managed by the District Attorney's office. insert case number) R Enter the case number from the District Attorney's office that comes after the letter R. Yes, back child support should be paid by Check this if you want one parent to pay back support they owe. Then fill in the details below. name of parent who should pay back child support Write the full name of the parent who should pay the past-due child support. in the amount of $ Enter the dollar amount of past-due support owed each month. date back child support should begin Enter the date the past-due support started adding up. No, there are no child care costs for either parent. Check this if neither parent pays any costs for child care. Yes, the monthly child care costs for the child(ren) are: $ Check this if there are monthly child care costs. Then enter the amount and who pays. the monthly child care costs for the child(ren) are: $ Enter the total dollar amount paid each month for child care. me only Check this if you alone should pay the child care costs. the other parent only Check this if the other parent alone should pay the child care costs. both parents equally Check this if both parents should split the child care costs equally.

f. Health & Medical Support

Medicaid. Check this if the children will get their health coverage through Medicaid. Private / Employer Insurance. The monthly premium should be paid by Check this if the children will be covered by private insurance or a parent's job-based plan. me only Check this if you alone will pay the monthly insurance cost. the other parent only Check this if the other parent alone will pay the monthly insurance cost. both parents equally. Check this if both parents will split the monthly insurance cost equally. Other: Check this if the children will get coverage some other way not listed above. Other: Describe the other way the children will get medical coverage. Both parents should equally pay any expenses not covered by insurance. Check this if both parents will split costs that insurance does not cover, 50/50. One parent should pay any expenses not covered by insurance, that parent is Check this if only one parent will pay costs that insurance does not cover. parent who should pay Write the name of the parent who will pay the uncovered costs. Yes, the Court should order the 30/30 Rule for payment of all unreimbursed medical / dental expenses. Check this if you want the court to order the 30/30 Rule for sharing uncovered medical and dental costs. No, the Court should not order the 30/30 Rule for payment of unreimbursed medical / dental expenses. Check this if you do not want the court to order the 30/30 Rule. The Plaintiff should claim the following children as dependents for tax purposes every year: Check this if the Plaintiff should claim the children on taxes every year. insert child(ren)'s names): List the names of the children the Plaintiff will claim on taxes. The Defendant should claim the following children as dependents for tax purposes every year: Check this if the Defendant should claim the children on taxes every year. insert child(ren)'s names): List the names of the children the Defendant will claim on taxes. The tax deduction should alternate, with Plaintiff claiming the child(ren) in Check this if the parents will take turns claiming the children on taxes. even Check this if the Plaintiff claims the children in even-numbered years. odd years, and Defendant claiming the child(ren) the other years. Check this if the Plaintiff claims the children in odd-numbered years. The tax deduction should be allocated per federal law. Check this if you want the tax claim decided by federal rules instead of choosing here. The child's birth certificate should not be changed. Check this box if you do not want any changes made to the child's birth certificate. The child's birth certificate should be changed to state that the father of the minor child is Check this box if you want the birth certificate updated to name the child's father. child is (name of father) Write the full name of the person who should be listed as the father.

g. Children's Basic Information

The child's name should be changed to Check this box if you want to change the child's name. The child's name should be changed to (write the complete first, middle, and last name the child should have) Write the full new name you want the child to have, including first, middle, and last name. because (explain why you want to change the child's name) Explain in your own words why you want to change the child's name. The other parent's name is (name of the other parent) Write the full name of the child's other parent. he/she lives at (other parent's address) Write the home address where you believe the other parent lives.

h. Possession & Access

No Visitation Requested Because: Check this box only if you are asking for no visitation at all. Most cases do not check this. No Visitation Requested Because: (explain) If you checked the box above, explain why you are asking for no visitation. Leave blank if visitation is requested. Regular Schedule: Be very specific. Include the times and days of the week for each parent's timeshare. Write out the day-to-day plan for who has the children and when. List exact days and times for each parent. Same as the regular schedule. Check this if the summer plan stays the same as the regular weekly schedule. Other: Check this if summer should follow a different plan than the regular schedule. Other: Describe the different summer plan, including days and times for each parent. Mother every year from 9am – 7pm. Check this if the mother always has the children on Mother's Day and her birthday from 9am to 7pm. Other: Check this if you want a different plan for Mother's Day and her birthday. Other: Describe your own plan for Mother's Day and the mother's birthday. Father every year from 9am – 7pm. Check this if the father always has the children on Father's Day and his birthday from 9am to 7pm. Other: Check this if you want a different plan for Father's Day and his birthday. Other: Describe your own plan for Father's Day and the father's birthday. Even years with (parent) ___ Odd years with (parent) ___ Check this to switch the child's birthday between parents based on even and odd years, from 9am to 7pm. Even years with (parent) Enter which parent has the child on their birthday in even-numbered years, like 2024 or 2026. Odd years with (parent) Enter which parent has the child on their birthday in odd-numbered years, like 2025 or 2027. Other: Check this if you want a different plan for the child's birthday. Other: Describe your own plan for the child's birthday. Even Years: MLK Jr. Day, Memorial Day, Labor Day with (parent) ___; Odd Years: MLK Jr. Day, Memorial Day, Labor Day with (parent) ___ Check this to split the three-day holiday weekends between parents based on even and odd years. Even Years: MLK Jr. Day, Memorial Day, Labor Day with (parent) Enter which parent gets MLK Jr. Day, Memorial Day, and Labor Day in even-numbered years. Odd Years: MLK Jr. Day, Memorial Day, Labor Day with (parent) Enter which parent gets MLK Jr. Day, Memorial Day, and Labor Day in odd-numbered years. Other: Check this if you want a different plan for three-day holiday weekends. Other: Describe your own plan for three-day holiday weekends. Even years with (parent) ____________________________. Write the name of the parent who gets the kids during spring break in even-numbered years. The other parent gets odd years. Other: ________________________________________ If you want a different spring break schedule, describe it here instead of the standard plan. Other: Check this box if you want to write your own spring break schedule instead of the standard plan. Even years with (parent) Check this box to use the standard plan where one parent has even years and the other has odd years. Odd years with (parent) ____________________________. Write the name of the parent who gets the kids for Thanksgiving in odd-numbered years. The other parent gets even years. Odd years with (parent) Check this box to use the standard plan where one parent has odd years and the other has even years. Other: ________________________________________ If you want a different Thanksgiving schedule, describe it here instead of the standard plan. Other: Check this box if you want to write your own Thanksgiving schedule instead of the standard plan. Even years: segment 1 with (parent) ___________________, Write the name of the parent who gets the Christmas part of winter break in even-numbered years. The other parent gets the New Year's part. Odd years: segment 1 with (parent) ___________________, Write the name of the parent who gets the Christmas part of winter break in odd-numbered years. The other parent gets the New Year's part. Segment 1 (Christmas) consists of the day school lets out until December 26 at noon. Check this box to split winter break into two parts, with parents trading the Christmas and New Year's segments each year. Other: Check this box if you want to write your own winter break schedule instead of the two-segment plan. Other: If you want a different winter break schedule, describe it here instead of the two-segment plan. Other Holidays: List any other holidays you want to plan for, like birthdays, Mother's Day, or religious days, and say which parent gets them. The parents will not establish a formal vacation plan, and will instead mutually agree on vacation days and times with the child(ren). Check this box if you and the other parent will simply agree on vacation times together without setting fixed rules. Each parent may have up to (number) ______ vacation days per year with the child(ren). Check this box if each parent gets a set number of vacation days per year and must give the other parent advance notice. Each parent may have up to (number) ______ vacation days per year Enter how many vacation days each parent may take with the children each year. at least (number) _____ days before the planned vacation. Enter how many days of advance notice a parent must give before taking a vacation with the children. Higher $ Write the child support amount for the parent who earns more money. Use the number from the worksheet you filled out earlier. Lower $ Write the child support amount for the parent who earns less money. Use the number from the worksheet you filled out earlier. Name of higher income parent: Write the full name of the parent who makes more money. This parent usually pays the support in joint custody.