Joint Procedure Committee - May 21-22, 2009, Agenda

Joint Procedure Committee - May 2009 Agenda

N.D.R.Ct.

APPENDIX D. RULE 8.3 PRETRIAL CONFERENCE STATEMENT

STATE OF NORTH DAKOTA ) In District Court

County of ________________. ) __________ Judicial District

Civil No. __________

A.B., Plaintiff )

) N.D.R.CT. 8.3,

vs. ) PRETRIAL CONFERENCE

) STATEMENT

C.D., Defendant )

1. PERSONAL INFORMATION

Full Name _____________________

Present Mailing Address _____________________

_____________________

Employer _____________________

Street Address _____________________

City, State, Zip _____________________

Birth date and present age _____________________

Marriage Date _____________________

Separation Date

(Different Residences) _____________________

Date(s) of Temporary Order(s), if any _____________________

Minor children born to this marriage or who will be affected by this legal

action:

~~FULL NAME~~ INITIALS BIRTH~~DATE~~ YEAR AGE LIVING WITH

_____________________________ __________ _________ ___________

Is the wife pregnant? ______ Yes ______ No. If yes, the due date is __________.

Are parenting rights and responsibilities of any child contested? ______ Yes ______ No. If yes, attach your proposed parenting plan ~~proposal for custody and visitation~~ for each child ~~for whom custody is~~

~~contested.~~

2. EMPLOYMENT/INCOME

Provide the following data for each employer.

HUSBAND WIFE

A) Name of Employer ____________ ____________

Length of Employment ____________ ____________

Income Per Month:

(1) Gross income ____________ ____________

Guideline deductions:

Federal Income Tax ____________ ____________

State Income Tax ____________ ____________

FICA/Medicare ____________ ____________

Health Insurance for Children ____________ ____________

Union Dues ____________ ____________

Mandatory Retirement ____________ ____________

(2) Subtotal of Guideline Deductions ____________ ____________

(3) Net Income

(Line 1-Line 2) ____________ ____________

Other guideline considerations

Specify: ____________ ____________

(4) Subtotal of Other Deductions ____________ ____________

(5) NET TAKE HOME PAY ____________ ____________

(Line 3-Line 4) ____________ ____________

Tax withholding figures above are based upon ____________ ____________

Married or Single taxpayer with # of exemptions:

(Example M-4 or S-2)

B) Employment benefits: Identify all benefits in addition to wages including

bonuses paid or due, automobile or travel expense reimbursement, other

per diem compensation, memberships paid by the employer or in kind

benefits.

____________ ____________

C) Other Income:

(1) Public Assistance

Per Month (AFDC/GA) ____________ ____________

(2) Social Security, Including Child

Benefits, Per Month ____________ ____________

(3) Unemployment/Workers Comp. Per Month ____________ ____________

(4) Interest Income Per Month ____________ ____________

(5) Dividend Income Per Month ____________ ____________

(6) Other Income Per Month ____________ ____________

(7) Last Year's Tax Refunds Federal ____ Federal ____

State ______ State ______

3. CHILD SUPPORT/SPOUSAL SUPPORT

A) Child or spousal support established in separate proceeding:

(1) Is either party entitled to child or spousal support from a

separate proceeding?

Yes ___ No ___. If yes, for each party entitled to child or spousal

support, specify the amount: $________.

(2) Is either party required to pay child or spousal support from a

separate proceeding?

Yes ___ No ___. If yes, for each party required to pay child or

spousal support, specify the amount: $________.

B) Child or spousal support established by temporary order in this

proceeding:

(1) Is either party required to pay child or spousal support under a

temporary order in this proceeding?

Yes ___ No ___. If yes, specify the amount: Child Support

$________. Spousal Support $________.

(2) Is any arrearage claimed under an existing temporary order?

Yes ___ No ___. If yes, specify the amount: Child Support

$________. Spousal Support $________.

4. LIVING EXPENSES

Specify the amount of your total monthly expenses $______; and attach an

itemized list of your monthly expenses.

5. REAL PROPERTY: (For Each Parcel of Property)

1. Description of Property ________

(a) In Possession of ________

(b) Date Acquired ________

(d) Present FMV (Date of Valuation) $_______

(e) First Mortgage Bal. $_______

(f) Second Mortgage Balance or Home Improvement Loan $_______

(g) Net Value $_______

(h) Monthly Payment $_______

(i) Income from Property $_______

6. BUSINESS/FARM ASSETS (For Each Asset)

1. Description of Asset ________

(a) In Possession of ________

(b) Date Acquired/Age ________

(d) Present FMV (Date of Valuation) $_______

(e) Debt Balance $_______

(f) Net Value $_______

(g) Monthly Payment $_______

(h) Income from Property $_______

7. FINANCIAL ASSETS (For Each Asset)

1. Description of Asset ________

(a) In Possession of ________

(b) Date Acquired/Age ________

(d) Present FMV (Date of Valuation) $_______

(e) Debt Balance $_______

(f) Net Value $_______

8. LIFE INSURANCE (For Each Policy)

a) Name of Company ____________________

b) Policy No. ____________________

c) Type of Insurance ____________________

d) Face Amount ____________________

e) Cash Value ____________________

f) Loans ____________________

g) Insured ____________________

h) Beneficiary ____________________

i) Owner ____________________

9. PENSION PLAN AND/OR PROFIT SHARING PLAN

Husband Wife

(a) Through employment: (1) Value ____________ ____________

(b) Private Plans (IRA, Keogh, SEP) Value ____________ ____________

(d) Military Pension or Disability Yes___ No___ Yes___ No___

10. PERSONAL PROPERTY: (For Each Asset)

A. Household Items in Husband's Possession

Description of Item Value

1. _______________________________________ ____________

B. Household Items in Wife's Possession

Description of Item Value

1. _______________________________________ ____________

C. Household Items in Joint Possession

Description of Item Value

1. _______________________________________ ____________

D. Motor Vehicles (For Each Asset)

1. Year, Make, Model ____________________

(a) In Possession of ____________________

(b) Market Value ____________________

(d) Net Value ____________________

(e) Monthly Payments ____________________

E. Boats, Campers, Snowmobiles, Trailers (For Each Asset)

1. Year, Make, Model ____________________

(a) In Possession of ____________________

(b) Market Value ____________________

(d) Net Value ____________________

(e) Monthly Payments ____________________

F. Other Personal Property (For Each Asset)

1. Description of Item ____________________

(a) In Possession of ____________________

(b) Market Value ____________________

(d) Net Value ____________________

(e) Monthly Payments ____________________

11. DEBTS (Not listed previously)

A) 1. Secured debts:

(a) Creditor ____________

(b) Total Amount Owing $___________

(As of What Date) ____________

(d) When Incurred ____________

(e) Party Obliged ____________

(f) Collateral ____________

(g) Date of final payment ____________

TOTALS: Husband __________ Wife __________ Joint __________

B) 1. Unsecured debts: (Include Attorney's Fees and Costs)

(a) Creditor ____________

(b) Total Amount Owing $___________

(As of What Date) ____________

(d) When Incurred ____________

(e) Party Obliged ____________

(f) Consideration ____________

(g) Date of final payment ____________

TOTALS: Husband __________ Wife __________ Joint __________

I hereby represent that the above is a complete disclosure of all property

interests and liabilities, and that the values set forth are the best

estimates of the property's market value.

__________________________________________

(Plaintiff) (Defendant)

__________________________________________

Attorney for (Plaintiff) (Defendant)

__________________________________________

Attorney Identification Number

__________________________________________

Address

[Adopted effective August 1, 1996; amended effective____________________.]