Children

a. General Information

There are (number) _______ minor children in common: Write the total number of children you and your spouse have together who are under 18.

b. Children's Basic Information

Child's Name Enter the full name of your first child. Date of Birth Enter the day this child was born. State of Residence Write the state where this child currently lives. How long child lived in the state Write how long this child has lived in that state, like '3 years' or 'since birth'. Disability If this child has a disability, describe it here. Otherwise leave blank or write 'none'. Child's Name Enter the full name of your second child. Date of Birth Enter the day this child was born. State of Residence Write the state where this child currently lives. How long child lived in the state Write how long this child has lived in that state, like '3 years' or 'since birth'. Disability If this child has a disability, describe it here. Otherwise leave blank or write 'none'. Child's Name Enter the full name of your third child. Date of Birth Enter the day this child was born. State of Residence Write the state where this child currently lives. How long child lived in the state Write how long this child has lived in that state, like '3 years' or 'since birth'. Disability If this child has a disability, describe it here. Otherwise leave blank or write 'none'. Child's Name Enter the full name of your fourth child. Date of Birth Enter the day this child was born. State of Residence Write the state where this child currently lives. How long child lived in the state Write how long this child has lived in that state, like '3 years' or 'since birth'. Disability If this child has a disability, describe it here. Otherwise leave blank or write 'none'. Child's Name Enter the full name of your fifth child. Date of Birth Enter the day this child was born. State of Residence Write the state where this child currently lives. How long child lived in the state Write how long this child has lived in that state, like '3 years' or 'since birth'. Disability If this child has a disability, describe it here. Otherwise leave blank or write '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 the last six months, or their whole life if 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 last six months. Where they live(d) - Current Write the address where your children live right now. Who they live(d) with - Current Write the names of the people your children live with at this address now. Dates they live(d) there - Current (___ - present) Write the date your children moved into this current home. It will show as 'date - present'. Which child (or all) - Current Write which child lives here, or write 'all' if every child does. Where they live(d) - Past Residence Write a past address where your children lived in the last five years. Who they live(d) with - Past Residence Write the names of the people your children lived with at this past address. Dates they live(d) there - Past Residence Write the start and end dates your children lived at this past address. Which child (or all) - Past Residence Write which child lived here, or write 'all' if every child did. Where they live(d) - Past Residence Write another past address where your children lived in the last five years. Who they live(d) with - Past Residence Write the names of the people your children lived with at this past address. Dates they live(d) there - Past Residence Write the start and end dates your children lived at this past address. Which child (or all) - Past Residence Write which child lived here, or write 'all' if every child did. Where they live(d) - Past Residence Write another past address where your children lived in the last five years. Who they live(d) with - Past Residence Write the names of the people your children lived with at this past address. Dates they live(d) there - Past Residence Write the start and end dates your children lived at this past address. Which child (or all) - Past Residence Write which child lived here, or write 'all' if every child did. If the children lived with a non-parent in the last 5 years, list the non-parent's name and current address: If your children lived with someone who is not a parent in the last five years, write that person's name and where they live now. No. Check this if you have never been part of any case about these children, whether as a party, witness, or in any other role. Yes, I have participated in the following cases concerning these children (provide all specifics including the state, the court name, children involved, the case number and the date of the child custody order, if any): Check this if you have been part of a past case about these children. You will list the details next. Yes, I have participated in the following cases concerning these children (provide all specifics including the state, the court name, children involved, the case number and the date of the child custody order, if any): List each case you were part of, including the state, court name, which children were involved, the case number, and the date of any custody order. No. Check this if you do not know of any other case that could affect this one. Yes, the following cases that could affect this case (give all specifics including the state, the court name, the parties involved, the case number and the type of case): Check this if you know of another case, like a custody, domestic violence, or protection order case, that could affect this one. You will list the details next. Yes, the following cases that could affect this case (give all specifics including the state, the court name, the parties involved, the case number and the type of case): List each related case, including the state, court name, the people involved, the case number, and what kind of case it is. No. Check this if no one outside this case has custody of the children or could claim a right to custody or visiting time.

c. Possession & Access

Yes, the following people have custody or can claim custody/visitation of the children: (list names and addresses of anyone who claims custody/visitation rights): Check this if someone besides you or the other party has custody or could ask for custody or visiting time. You will list them next. Yes, the following people have custody or can claim custody/visitation of the children: (list names and addresses of anyone who claims custody/visitation rights): Write the full names and addresses of anyone who has custody or could claim custody or visiting rights to the children. Joint Custody. The parties should share joint physical custody of the child(ren) (each parent must have the child(ren) roughly 40% of the time, or 146 days per year). A proposed parenting timeshare and holiday schedule is attached as Exhibit 1. Check this if you want both parents to share time with the child roughly equally (at least 40% of the year for each). Primary Custody. The (check one) Plaintiff / Defendant should have primary physical custody of the child(ren). A proposed parenting timeshare and holiday schedule is attached as Exhibit 1. Check this if one parent should have the child most of the time, and pick which parent below. Plaintiff Check this if the person who started the case should have primary custody. Defendant Check this if the other parent should have primary custody. Sole Custody. The (check one) Plaintiff / Defendant should have sole physical custody of the child(ren). Check this if only one parent should have the child all the time, and pick which parent below. Plaintiff Check this if the person who started the case should have sole custody. Defendant Check this if the other parent should have sole custody. Nevada is not the "home state" of the child(ren) and cannot enter custody orders. Check this if the child has not lived in Nevada long enough for Nevada courts to decide custody. Domestic Violence Check this if there has been 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 or may be deployed in the military. State of Residency Check this if where a parent or child lives is an issue the court should weigh. Other: Check this if there is another issue not listed that the court should consider. Other: ____________________ Briefly describe the other issue you want the court to think about.

d. Child Support

Child support should be paid by (name of parent who should pay child support) Check this box if you want the court to order one parent to pay child support each month. name of parent who should pay child support Write the full name of the parent who should pay the child support. in the amount of $________ per month Enter the monthly dollar amount of child support. Use the number from the attached worksheet. The Child Support Worksheet calculation attached. Check this if the amount comes from the child support worksheet you filled out and attached. The amount already established by the District Attorney, Family Support Division, case (insert case number) R Check this if a government office already set the support amount in another case. insert case number) R________________ Write the case number from the District Attorney or Family Support Division office. No child support is requested. (Explain why not): Check this if you are not asking for any child support at all. Explain why not Explain why no child support is being asked for. The court needs a reason. I'm not sure how much child support should be paid, and ask the court to set support. Check this if you do not know the amount and want the judge to decide it. 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 no past-due support is owed and neither parent ever got welfare benefits. 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 has gotten welfare benefits. Past-due support cannot be skipped in this case. Child support arrears are being handled by the District Attorney, Family Support Division, case (insert case number) R Check this if a government office is already handling the past-due support in another case. insert case number) R________________ and should continue as ordered in that case. Write the case number for the past-due support case handled by the government office. Yes, back child support should be paid by (name of parent who should pay back child support) Check this if you want the court to order one parent to pay past-due support. name of parent who should pay back child support Write the full name of the parent who should pay the past-due support. in the amount of $________ Enter the monthly dollar amount of past-due support that should be paid. date back child support should begin Enter the date the past-due support should start counting from. No, there are no child care costs for either parent. Check this if neither parent pays for child care. Yes, the monthly child care costs for the child(ren) are: $________. Check this if a parent pays for child care each month. Yes, the monthly child care costs for the child(ren) are: $________ Enter the total monthly dollar amount spent on child care. me only Check this if you should pay all the child care costs. the other parent only Check this if the other parent should pay all the child care costs. both parents equally Check this if both parents should split the child care costs evenly.

e. Health & Medical Support

Medicaid. Check this if the children will get their health coverage through Medicaid, a government program. Private / Employer Insurance. Check this if the children will be covered by private insurance or a plan through someone's job. me only Check this if you alone should pay the monthly cost of the insurance. the other parent only Check this if the other parent alone should pay the monthly cost of the insurance. both parents equally. Check this if both parents should split the monthly insurance cost evenly. 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 should split costs that insurance does not pay for. One parent should pay any expenses not covered by insurance, that parent is (name of parent who should pay) Check this if only one parent should pay costs that insurance does not cover. parent who should pay) Write the full 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 require each parent to share proof and repay half of uncovered costs within 30 days. 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 repayment rule. Plaintiff should claim the following children as dependents for tax purposes every year: (insert child(ren)'s names): Check this if the Plaintiff should claim certain children on taxes every year. Plaintiff should claim the following children as dependents for tax purposes every year: (insert child(ren)'s names): List the names of the children the Plaintiff will claim on taxes each year. Defendant should claim the following children as dependents for tax purposes every year: (insert child(ren)'s names): Check this if the Defendant should claim certain children on taxes every year. Defendant should claim the following children as dependents for tax purposes every year: (insert child(ren)'s names): List the names of the children the Defendant will claim on taxes each year. The tax deduction should alternate, with Plaintiff claiming the child(ren) in (check one) even / odd years, and Defendant claiming the child(ren) the other years. Check this if the parents should take turns claiming the children on taxes from year to year. even Check this if the Plaintiff should claim the children in even-numbered years. odd years Check this if the Plaintiff should claim the children in odd-numbered years. The tax deduction should be allocated per federal law. Check this if you want the tax claim to follow federal rules instead of a set arrangement.

f. Possession & Access

No Visitation Requested Because: (explain) Check this box only if you are not asking for any visitation time with the child. Most parents leave this blank. No Visitation Requested Because: (explain) If you checked the box above, briefly explain why you are not requesting visitation. Regular Schedule: Be very specific. Include the times and days of the week for each parent's timeshare. Write out the weekly schedule for each parent. List exact days and times each parent has the child, like 'Mom: Saturday 7pm to Wednesday 3pm.' Same as the regular schedule. Check this if the summer schedule should match the regular weekly schedule above. Other: Check this if you want a different schedule during summer break. Other: Describe the summer schedule you want, including days and times for each parent. Mother every year from 9am – 7pm. Check this if the children should be with their mother every Mother's Day and on her birthday from 9am to 7pm. Other: Check this if you want a different arrangement for Mother's Day and the mother's birthday. Other: Describe the schedule you want for Mother's Day and the mother's birthday. Father every year from 9am – 7pm. Check this if the children should be with their father every Father's Day and on his birthday from 9am to 7pm. Other: Check this if you want a different arrangement for Father's Day and the father's birthday. Other: Describe the schedule you want for Father's Day and the father's birthday. Even years with (parent) ___. Odd years with (parent) ___. Check this to split the child's birthday by year, alternating which parent has the child in even and odd years. Even years with (parent) Name the parent who will have the child on their birthday during even-numbered years (like 2024, 2026). Odd years with (parent) Name the parent who will have the child on their birthday during odd-numbered years (like 2025, 2027). Other: Check this if you want a different arrangement for the child's birthday. Other: Describe the schedule you want for the child's birthday. Even Years: MLK Jr. Day, Memorial Day, Labor Day with (parent) ___ Check this to split three-day holiday weekends between parents by alternating even and odd years. Even Years: MLK Jr. Day, Memorial Day, Labor Day with (parent) Name the parent who gets MLK Jr. Day, Memorial Day, and Labor Day during even-numbered years. Odd Years: MLK Jr. Day, Memorial Day, Labor Day with (parent) Name the parent who gets MLK Jr. Day, Memorial Day, and Labor Day during odd-numbered years. Other: Check this if you want a different arrangement for three-day holiday weekends. Other: Describe the schedule you want for three-day holiday weekends. Even years with (parent) ___________________________. Write which parent's name will have the child during Easter or Spring Break in even-numbered years. Other: ______________________________________________ If you want a different Easter or Spring Break schedule, describe it here. Other: Check this box if you are using a custom Easter or Spring Break plan instead of the standard one. Even years with (parent) Check this box to use the even/odd year rotation for Easter or Spring Break. Odd years with (parent) ___________________________. Write which parent's name will have the child during Thanksgiving in odd-numbered years. Odd years with (parent) Check this box to use the even/odd year rotation for Thanksgiving. Other: ______________________________________________ If you want a different Thanksgiving schedule, describe it here. Other: Check this box if you are using a custom Thanksgiving plan instead of the standard one. Even years: segment 1 with (parent) ___________________, Write which parent's name will have the child for the Christmas part of winter break in even-numbered years. Odd years: segment 1 with (parent) ___________________, Write which parent's name will have the child for the Christmas part of winter break in odd-numbered years. 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 that switch between parents each year. Other: Check this box if you are using a custom winter break plan instead of the standard one. Other: If you want a different winter break schedule, describe it here. Other Holidays: List any other holidays you want to plan for, such as birthdays or Mother's/Father's Day, and who has the child. 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 agree on vacation days as they come up instead of setting a fixed plan. 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 each year with advance notice. Each parent may have up to (number) ______ vacation days per year Enter how many vacation days each parent can take with the child every year. at least (number) _____ days before the planned vacation. Enter how many days ahead a parent must tell the other parent before taking a vacation. Higher $ Write the child support amount for the parent who earns more money. Take this number from the earlier part of the worksheet. Lower $ Write the child support amount for the parent who earns less money. Take this number from the earlier part of the worksheet.

g. Child Support

Child Support Obligation $ Subtract the lower amount from the higher amount and write the result here. This is the support amount for joint custody. Name of higher income parent: Write the full name of the parent who earns more money. This parent pays the support shown above.