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Form 4. Proposed Dissolution Resolution Statement

Arizona Revised Statutes AnnotatedRules of Family Law ProcedureEffective: September 1, 2019

Arizona Revised Statutes Annotated
Rules of Family Law Procedure (Refs & Annos)
Forms
Effective: September 1, 2019
17B A.R.S. Rules Fam.Law Proc., Form 4
Form 4. Proposed Dissolution Resolution Statement
Name:
 
Mailing Address:
 
City, State, Zip Code:
 
Daytime Phone Number:
 
Evening Phone Number:
 
Representing:
[ ] Self [ ] Petitioner [ ] Respondent
State Bar Number:
 
ARIZONA SUPERIOR COURT, COUNTY OF _____
 
Case No.
 
Petitioner
ATLAS No.
 
 
PROPOSED RESOLUTION
Respondent
STATEMENT OF:
[ ] HUSBAND
[ ] WIFE
Date of Marriage:
 
The undersigned party provides the following positions on each of the issues in this case. BE SPECIFIC.
1.
IV-D Case:
[ ]
I receive or have received public assistance which may include AFDC, TANF, or AHCCCS for my child(ren) or me.
[ ]
I have a case with the Division of Child Support Services.
2.
Legal Decision-Making and Parenting Time: The parties have the following natural or adopted child(ren) in common. (If there are no minor or disabled child(ren) common to the parties, skip to paragraph 3)
Child(ren)'s Name(s)
Date(s) of Birth
Age(s)
 
 
 
 
 
 
 
 
 
 
 
 
The child(ren) should live primarily with [ ] Mother [ ] Father and have parenting time with [ ] Mother [ ] Father as follows (check all that apply):
[ ]
Generally in accordance with __________ County Guidelines for reasonable parenting time.
[ ]
Model Parenting Time Plans (describe plan).
[ ]
Every other weekend from __________ at __________ a.m./p.m. to __________ at __________ a.m./p.m.
[ ]
One-half of the holidays on an alternating basis.
[ ]
For __________ weeks in the summer from __________ to __________ (inclusive).
[ ]
Spring Break from school.
[ ]
Other:
 
 
 
[ ] Mother or [ ] Father should have sole legal decision-making authority,
OR
[ ] Mother and Father should have joint legal decision-making authority.
3.
Child Support: (If there are no minor or disabled children common to the parties and were no minor or disabled children from the date the parties separated, skip to paragraph 5.) The financial factors necessary to calculate child support under the Arizona Child Support Guidelines are as follows (complete in full):
Father's gross monthly income:
$ _______________
Mother's gross monthly income:
$ _______________
[ ]
Father has ___ other child(ren) not listed above who he is supporting who live(s) in his household.
[ ]
Father has ___ other child(ren) not listed above for whom he pays court-ordered child support in the amount of $ __________ per month.
[ ]
Mother has ___ other child(ren) not listed above who she is supporting live(s) in her household.
[ ]
Mother has ___ other child(ren) not listed above for whom she pays court-ordered child support in the amount of $ __________ per month.
[ ]
Medical insurance should be paid by [ ] Mother [ ] Father. Monthly cost for the child(ren) in this case is $ __________
[ ]
Dental insurance should be paid by [ ] Mother [ ] Father. Monthly cost for the child(ren) in this case is $
[ ]
Vision insurance should be paid by [ ] Mother [ ] Father. Monthly cost for the child(ren) in this case is $
[ ]
Neither parent has insurance which is accessible and available at a reasonable cost.
[ ]
Mother [ ] Father should pay cash medical support in the amount of $ ___ per month.
[ ]
Monthly child care costs for ___ child(ren) in this case are $ ___.
[ ]
Extra education expenses or extraordinary child adjustments--I believe the court should add the following to the child support calculation (leave blank if none claimed):
Description of expense
Monthly Amount
 
 
 
 
[ ]
Uninsured medical/dental/vision expenses should be paid:
[ ]
Pro rata based upon each party's income, as provided in the Guidelines; or
[ ]
Other: __________ % paid d by Father and __________ % paid by Mother.
[ ]
Tax exemptions for the child(ren) should be divided:
[ ]
Pro rata based upon each party's income, as provided in the Guidelines; or
[ ]
Other:
 
4.
Past support should be paid by [ ] Mother [ ] Father for the period of __________ through __________ in the amount of $ ___.
5.
Spousal Maintenance: My position on spousal maintenance is:
[ ]
No spousal maintenance need be paid by either me or my spouse.
[ ]
I should pay my spouse $ ___ per month for __________ months.
[ ]
I should receive from my spouse $ ___ per month for __________ months.
6.
Separate Property: I believe the following property is my sole and separate property (describe):
 
 
7.
Community Liens on Separate Property: I believe I have a community interest in the following sole and separate property of my spouse:
 
 
8.
Community Property. I want to divide all of the community property (except tangible personal property) as follows:
Directions:
Column 1: List short description of each item or real and personal property.
Column 2: List your estimate of the fair market value of each item of property. List the loan or encumbrance amount(s) on the line directly below its value.
Column 3: List the amount of net value of each item you propose for Husband.
Column 4: List the amount of net value of each item you propose for Wife.
Description
Fair Market Value
(minus encumbrances)
Proposed for
Husband
Proposed for
Wife
Real Property
$
$
$
Personal Property (e.g. stocks, bonds, life insurance, etc.)
IRAs, 401(k)s, Pensions (including survivor benefits)
Vehicle(s)
Boat(s)
9.
Tangible Personal Property. I believe that the value of the tangible personal property (household furniture, furnishings, jewelry etc.) in the possession of each party is as follows:
Husband has tangible personal property in his possession valued at approximately $ __________
Wife has tangible personal property in her possession valued at approximately $ __________
My preference to divide the tangible personal property is to (list your order of preference 1--4 with 1 being most important and 4 being the least):
___
Each party should keep the tangible personal property currently in his/her possession with the exception of the following items I want from my spouse:
 
 
 
 
___
An equalization payment/credit should be made based upon the above values so each of us gets the same value.
___
We should make a list of all the tangible personal property and alternately select items from the list until all the property is divided.
___
One of us should make two (2) lists of tangible personal property both equal in value, and the other one be awarded all property on the list of his or her choice.
___
Other:
 
 
10.
Debts: The community debts should be divided as follows (complete in detail):
[ ]
All of the debt should be paid __________ % by Husband and __________ % by Wife; or
[ ]
Each of us should pay the following debts and amounts:
Amount To Be Paid By Husband
Amount To Be Paid By Wife
Creditor
Total Amount
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
11.
Attorney's Fees: If the case is settled today, I want the court to order (choose one):
[ ]
Each of us is to pay his/her own attorney's fees and costs.
[ ]
My spouse should pay $ ___ of my attorney's fees and costs within ___ days.
[ ]
I should pay $ ___ to my spouse for attorney's fees and costs within ___ days.
12.
Name Change: I want my name changed to:
 
13.
Other Issues: Briefly state the other issues that you believe must be resolved to fully settle this case:
 
 
 
 
 
 
 
 
14.
Settlement: I understand that I am required to personally meet and confer with the opposing party and their counsel at least five court days before my court date to resolve as many issues as possible unless there is a current court order prohibiting contact or a significant history of domestic violence between us. I verify that the above statements are true based on my best information and belief, and I am willing to settle and resolve this case based upon my positions as provided above. I will be prepared to show documentation to support my positions at the time of the conference or hearing.
_________________________
 
Date
Signature of [ ] Husband [ ] Wife [ ] Attorney for
[ ] Husband [ ] Wife

Credits

Added Oct. 19, 2005, effective Jan. 1, 2006. Amended Sept. 5, 2007, effective Jan. 1, 2008; Sept. 3, 2009, effective Jan. 1, 2010; Aug. 28, 2013, effective Jan. 1, 2014; Sept. 2, 2016, effective Jan. 1, 2017.
17B A. R. S. Rules Fam. Law Proc., Form 4, AZ ST RFLP Form 4
Current with amendments received through 08/15/2020.
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