APPENDIX D. PRETRIAL CONFERENCE STATEMENT RULE 8.3

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:

INITIALS____________
BIRTH 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 for each child.

2. EMPLOYMENT/INCOME

Provide the following data for each employer.

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 _______________________
(c) Purchase Price $______________________
(d) Present FMV(Date of Valuation)$______________________
(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 _______________________
(c) Purchase Price $______________________ (
d) Present FMV (Dateof 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 _______________________
(c) Purchase Price $______________________
(d) Present FMV (Dateof 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

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 ________________ (
c) Encumbrances ________________
(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 _________________
(c) Encumbrances _________________
(d) Net Value_________________
(e) Monthly Payments_________________
F. Other Personal Property (For Each Asset)
1. Description of Item_________________
(a) In Possession of_________________
(b) Market Value _________________
(c) Encumbrances _________________
(d) Net Value_________________
(e) Monthly Payments_________________

11. DEBTS (Not listed previously) 
A)
1. Secured debts:
(a) Creditor_________
(b) Total Amount Owing $________ (As of What Date)_________
(c) Monthly Payments$________
(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$________ (As of What Date)____________
(c) Monthly Payment$________
(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