Children

a. General Information

There are (number) ______ minor children in common: Write how many minor children you and your spouse have together.

b. Children's Basic Information

Child's Name Write the full name of your first child. Date of Birth Write the birth date of your first child. State of Residence Write the state where your first child lives. How long child lived in the state Write how long this child has lived in that state. Disability Write any disability this child has, or leave blank if none. Child's Name Write the full name of your second child. Date of Birth Write the birth date of your second child. State of Residence Write the state where your second child lives. How long child lived in the state Write how long this child has lived in that state. Disability Write any disability this child has, or leave blank if none. Child's Name Write the full name of your third child. Date of Birth Write the birth date of your third child. State of Residence Write the state where your third child lives. How long child lived in the state Write how long this child has lived in that state. Disability Write any disability this child has, or leave blank if none. Child's Name Write the full name of your fourth child. Date of Birth Write the birth date of your fourth child. State of Residence Write the state where your fourth child lives. How long child lived in the state Write how long this child has lived in that state. Disability Write any disability this child has, or leave blank if none. Child's Name Write the full name of your fifth child. Date of Birth Write the birth date of your fifth child. State of Residence Write the state where your fifth child lives. How long child lived in the state Write how long this child has lived in that state. Disability Write any disability this 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 the last six months or since they were born. 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. Current: Where they live(d) Write the address where the children live now. Current: Who they live(d) with Write the names of the people the children live with now. Current: Dates they live(d) there ______ - present Write the date the children started living at this current home. Current: Which child (or all) Write which child this applies to, or write 'all' if it applies to every child. Past Residence: Where they live(d) Write a past address where the children lived in the last five years. Past Residence: Who they live(d) with Write the names of the people the children lived with at this past home. Past Residence: Dates they live(d) there Write the start and end dates the children lived at this past home. Past Residence: Which child (or all) Write which child this applies to, or write 'all' if it applies to every child. Past Residence: Where they live(d) Write another past address where the children lived in the last five years. Past Residence: Who they live(d) with Write the names of the people the children lived with at this past home. Past Residence: Dates they live(d) there Write the start and end dates the children lived at this past home. Past Residence: Which child (or all) Write which child this applies to, or write 'all' if it applies to every child. Past Residence: Where they live(d) Write another past address where the children lived in the last five years. Past Residence: Who they live(d) with Write the names of the people the children lived with at this past home. Past Residence: Dates they live(d) there Write the start and end dates the children lived at this past home. Past Residence: Which child (or all) Write which child this applies to, or write 'all' if it applies to every child. The names and current addresses of each non-parent the children lived with during the last five years are: List the names and current addresses of any people who are not the parents but lived with the children at any time in the last five years. Write 'None' if this does not apply. No. Check this box if neither of you has ever been part of any court case about these children. Yes, I/we 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 box if either of you has been involved in a court case about these children, such as being a party or a witness. Yes, I/we 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): Give the details of any past case about these children, including 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 (give all specifics including the state, the court name, the parties involved, the case number and the type of case): Check this box if you know of other cases that could affect this one, like custody, domestic violence, or protection order cases. 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): Describe each other case you know about, including the state, court name, people involved, case number, and type of case. No. Check this box if no one besides the parents has custody or can ask for custody or visitation.

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 box if someone other than the parents has custody or could ask for custody or visitation of the children. 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): List the names and addresses of anyone other than the parents who has custody or could claim custody or visitation rights. Joint. The petitioners should share joint legal custody of the child(ren). Check this if both parents will share the right to make big decisions about the children, like school, doctors, and religion. Sole. The petitioners agree that sole legal custody of the children should be granted to (name of parent) Check this if only one parent will make the big decisions about the children. You will name that parent below. to (name of parent) Write the full name of the parent who will make all the major decisions for the children. Nevada is not the "home state" of the child(ren) and cannot enter custody orders. Check this only if the children have not lived in Nevada long enough for the court to decide custody here. Joint. The petitioners should share joint physical custody of the child(ren) (each parent would have the children roughly 40-60% of the time). A proposed parenting timeshare and holiday schedule is attached as Exhibit 1. Check this if the children will spend close to equal time living with each parent (about 40-60% with each). Primary. The petitioners agree that primary physical custody of the minor children should be granted to (name of parent) Check this if the children will live mostly with one parent but still spend time with the other. You will name that parent below. should be granted to (name of parent) Write the full name of the parent the children will live with most of the time. Sole. The petitioners agree that sole physical custody of the minor children should be granted to (name of parent) Check this if the children will live with only one parent and the other parent will not have regular time. You will name that parent below. be granted to (name of parent) Write the full name of the parent the children will live with full-time. Nevada is not the "home state" of the child(ren) and cannot enter custody orders. Check this only if the children have not lived in Nevada long enough for the court to decide custody here.

d. Child Support

The child support calculation would require (name of parent who would pay child support) Write the full name of the parent who would pay child support based on the worksheet calculation. to pay $________ per month in child support. Enter the dollar amount of child support owed each month, as figured on the attached worksheet. Petitioners agree to set child support at the amount above in compliance with the child support guidelines. Check this box if both parents agree to use the amount calculated on the worksheet. Child support should continue as already ordered by the District Attorney, Family Support Division, case (insert case number) R Check this box if there is already a child support order from the District Attorney that should stay in place. case (insert case number) R______________ Enter the case number for the existing District Attorney support order. It usually starts with the letter R. (name of parent who pays child support) ____________________ to pay Write the full name of the parent who pays support under the existing District Attorney order. $________ per month in child support. Enter the monthly child support amount required by the existing District Attorney order. The petitioners want to set child support at a different amount. Check this box if both parents want a child support amount that is different from the worksheet calculation. no one will pay child support Check this box if you both agree that neither parent will pay child support. child support will be paid by Check this box if one parent will pay a set amount of child support. (name of parent who will pay) ______________________ Write the full name of the parent who will pay the agreed different amount. in the amount of $________ per month. Enter the monthly dollar amount of child support the parents agreed to. The parent who would receive child support is not currently receiving public assistance and has not applied for assistance. Each parent writes their initials here to confirm the receiving parent is not getting or applying for public assistance. The basic needs of the child are met or exceeded by the agreed child support obligation. Each parent writes their initials here to confirm the agreed amount covers the child's basic needs. Both parents are aware that if either party seeks a review of the child support obligation for any authorized reason, the court will calculate the child support obligation in accordance with the child support guidelines in effect at the time of the review. Each parent writes their initials here to show they understand the court will use current guidelines if support is reviewed later. No child support arrears exist or the parties waive any rights to arrears. The parties are not and have not received welfare benefits at any time. Check this if no past-due child support is owed, or both of you agree to give up any claim to it. This only applies if you never got welfare. The parties are currently receiving or have received welfare benefits in the past. The Petitioners cannot waive child support arrears. Check this if you got welfare benefits. In that case you are not allowed to give up past-due child support. Child support arrears are being handled by the District Attorney, Family Support Division, case Check this if a government office is already managing the past-due child support case for you. (insert case number) R Enter the case number for the support office handling your back child support. It usually starts with the letter R. The petitioners agree that (name of parent who will pay back child support) Check this if you both agree that one parent will pay the past-due child support. (name of parent who will pay back child support) Write the full name of the parent who will pay the back child support. will pay child support arrears in the total amount of $ Enter the total dollar amount of back child support that will be paid to the other parent. No, there are no child care costs for either parent. Check this if neither parent pays for child care, like daycare or a babysitter. Yes, the monthly child care costs for the child(ren) are: $ Check this if there are monthly child care costs, like daycare or a babysitter. Yes, the monthly child care costs for the child(ren) are: $ Enter how much the child care costs each month in dollars. both parents equally Check this if both parents will split the child care cost evenly. one parent only (parent name) Check this if only one parent will pay for child care. one parent only (parent name): Write the full name of the parent who will pay the child care cost.

e. Health & Medical Support

Medicaid. Check this if the children get their health coverage through Medicaid (government health insurance). Private / Employer Insurance. The monthly premium will be paid by: Check this if the children are covered by private insurance, such as a plan from a parent's job. both parents equally Check this if both parents will split the monthly insurance cost evenly. one parent only (parent name) Check this if only one parent will pay the monthly insurance cost. one parent only (parent name): Write the full name of the parent who will pay the insurance premium. Other: Check this if the children get health coverage some other way not listed above. Other: Describe how the children will get health coverage if it is not Medicaid or private insurance. Both parents will equally pay any expenses not covered by insurance. Check this box if you both agree to split medical costs that insurance does not cover equally, 50/50. One parent will pay any expenses not covered by insurance, that parent is Check this box if only one parent will pay all medical costs that insurance does not cover. name of parent who will pay Write the full name of the parent who will pay these uncovered medical costs. Yes, the petitioners will follow the 30/30 Rule for payment of unreimbursed medical / dental expenses. Check this box if you want the 30/30 Rule in your case, where the paying parent shows proof within 30 days and the other parent pays back half within 30 days. No, petitioners will not follow the 30/30 Rule for payment of unreimbursed medical / dental expenses. Check this box if you do not want the 30/30 Rule used in your case. The tax deduction for the child(ren) should be allocated per federal law. Check this box to let IRS rules decide who claims the children on taxes, usually the parent the children live with most. Petitioners have agreed to claim the children as follows for tax purposes: Check this box if you both agreed on who claims each child, then fill in the table below. Child(ren)'s Name: Write the full name of the first child being claimed on taxes. Parent's Name: Write the full name of the parent who will claim this child on their taxes. every year Check this box if this parent claims this child every single year. even years Check this box if this parent claims this child only in even-numbered years, like 2024 or 2026. odd years Check this box if this parent claims this child only in odd-numbered years, like 2025 or 2027. Child(ren)'s Name: Write the full name of the second child being claimed on taxes. Parent's Name: Write the full name of the parent who will claim this child on their taxes. every year Check this box if this parent claims this child every single year. even years Check this box if this parent claims this child only in even-numbered years, like 2024 or 2026. odd years Check this box if this parent claims this child only in odd-numbered years, like 2025 or 2027. Child(ren)'s Name: Write the full name of the third child being claimed on taxes. Parent's Name: Write the full name of the parent who will claim this child on their taxes. every year Check this box if this parent claims this child every single year. even years Check this box if this parent claims this child only in even-numbered years, like 2024 or 2026. odd years Check this box if this parent claims this child only in odd-numbered years, like 2025 or 2027. Child(ren)'s Name: Write the full name of the fourth child being claimed on taxes. Parent's Name: Write the full name of the parent who will claim this child on their taxes. every year Check this box if this parent claims this child every single year. even years Check this box if this parent claims this child only in even-numbered years, like 2024 or 2026. odd years Check this box if this parent claims this child only in odd-numbered years, like 2025 or 2027.

f. Possession & Access

No Visitation Requested Because: (explain) Check this box only if you are not asking for any visitation time with the child. No Visitation Requested Because: (explain) Explain in plain words why you are not asking for visitation time. Regular Schedule: Be very specific. Include the times and days of the week for each parent's timeshare. Write out the normal week-to-week plan. List the exact days and times each parent has the child, like 'Mom: Saturday 7pm to Wednesday 3pm.' Same as the regular schedule. Check this box if the summer plan stays the same as your normal weekly schedule. Other: Check this box if you want a different plan for the summer than the regular schedule. Other: Describe the summer plan you want, including the days and times for each parent. Mother every year from 9am – 7pm. Check this box if the mother will have the child every year on Mother's Day and her birthday from 9am to 7pm. Other: Check this box if you want a different plan for Mother's Day and the mother's birthday. Other: Describe the plan you want for Mother's Day and the mother's birthday, including times. Father every year from 9am – 7pm. Check this box if the father will have the child every year on Father's Day and his birthday from 9am to 7pm. Other: Check this box if you want a different plan for Father's Day and the father's birthday. Other: Describe the plan you want for Father's Day and the father's birthday, including times. Even years with (parent) / Odd years with (parent) Check this box if parents will switch who has the child on their birthday based on even and odd years. Even years with (parent) Name the parent who has the child on their birthday in even-numbered years (like 2024, 2026). Odd years with (parent) Name the parent who has the child on their birthday in odd-numbered years (like 2025, 2027). Other: Check this box if you want a different plan for the child's birthday. Other: Describe the plan you want for the child's birthday, including times. Even Years: MLK Jr. Day, Memorial Day, Labor Day with (parent) Check this box 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) Name the parent who has the child for MLK Jr. Day, Memorial Day, and Labor Day in even-numbered years. Odd Years: MLK Jr. Day, Memorial Day, Labor Day with (parent) Name the parent who has the child for MLK Jr. Day, Memorial Day, and Labor Day in odd-numbered years. Other: Check this box if you want a different plan for the three-day holiday weekends. Other: Describe the plan you want for the three-day holiday weekends, including times. Even years with (parent) _________________________. Write the name of the parent who gets the children for Easter or Spring Break during even-numbered years. Other: _________________________________________ Describe any different Easter or Spring Break plan you both agree on, if the standard option doesn't work for you. Other: Check this box if you want to use a custom Easter or Spring Break schedule instead of the standard one. Even years with (parent) Check this box to use the standard plan where one parent has the children on even years and the other on odd years. Odd years with (parent) _________________________. Write the name of the parent who gets the children for Thanksgiving during odd-numbered years. Odd years with (parent) Check this box to use the standard plan where one parent has the children on odd years and the other on even years. Other: _________________________________________ Describe any different Thanksgiving plan you both agree on, if the standard option doesn't work for you. Other: Check this box if you want to use a custom Thanksgiving schedule instead of the standard one. 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 the Christmas part ending December 26 at noon. Even years: segment 1 with (parent) __________________, Write the name of the parent who gets the first part (Christmas) of Winter Break during even-numbered years. Odd years: segment 1 with (parent) __________________, Write the name of the parent who gets the first part (Christmas) of Winter Break during odd-numbered years. Other: Check this box if you want to use a custom Winter Break schedule instead of the standard one. Other Holidays: List any other holidays you want to include and explain how you will share them, such as birthdays or religious days. 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 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 each year and must give the other parent notice ahead of time. Each parent may have up to (number) ______ vacation days 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.