Free ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) - California

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address)

FOR COURT USE ONLY

TELEPHONE NO: ATTORNEY FOR (NAME):

Attorney Bar No.

SUPERIOR COURT OF CALIFORNIA COUNTY OF YUBA 215 FIFTH STREET, SUITE 200 MARYSVILLE, CA 95901 (530) 749-7600 MARRIAGE OF: PETITIONER: vs. RESPONDENT:

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[ ] PETITIONER'S [ ] RESPONDENT'S STATEMENT OF AGREEMENT AND DISAGREEMENT 1. MINOR CHILDREN [ ] [ ] We have no minor children. We have minor child(ren) and agree as follows:

CASE NUMBER:

Custody, Visitation and Timeshare [ ] [ ] [ ] We have a full agreement regarding custody, both legal and physical, visitation or timeshare. My understanding of that agreement is set forth on Attachment A. We do not have an agreement regarding custody, both legal and physical, visitation or timeshare. My position regarding these issues is set forth on Attachment A. We attended mediation and reached agreement, a copy of which is incorporated herein and marked Attachment E.

Child Support [ ] [ ] [ ] [ ] 2. We have a current order for child support and there has been no change of circumstances since that order was issued. We have a full agreement regarding child support. We do not have a full agreement regarding child support and I have filed a current Income and Expense Declaration. The Department of Child Support Services is involved in this case.

SPOUSAL SUPPORT [ ] [ ] [ ] Neither party has requested spousal support. We have a full agreement regarding spousal support as set forth on Attachment B. We do not have a full agreement regarding spousal support and I have filed a current Income and Expense Declaration and stated my position on Attachment B.

3.

DIVISION OF PROPERTY [ [ [ [ ] ] ] ] We have no property to divide. We have prepared a written agreement dividing all of our property. We have a full unwritten agreement regarding the division of property which is set forth on Attachment C. We have no agreement regarding the division of property but my position is set forth on Attachment C.

Yuba County Superior Court Effective 7/01/03

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4.

DIVISION OF DEBTS [ [ [ [ ] ] ] ] We have no debts to divide. We have prepared a written agreement dividing all of our debts. We have a full unwritten agreement regarding the division of debts which is set forth on Attachment D. We have no agreement regarding the division of debts but my position is set forth on Attachment D.

5.

ATTORNEY'S FEES [ ] [ ] [ ] I have incurred no attorney's fees. We have a full agreement regarding the payment of attorney's fees. We do not have an agreement regarding the payment of attorney's fees.

6.

OTHER [ ] We have agreed that the following orders should be made in our case:

[ ]

Dated: Petitioner/Respondent

Yuba County Superior Court Effective 7/01/03

PETITIONER'S / RESPONDENT'S STATEMENT OF AGREEMENT AND DISAGREEMENT

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STATEMENT OF AGREEMENT AND DISAGREEMENT
ATTACHMENT A
Custody, Visitation and Timeshare [ ] [ ] [ ] We attended mediation and reached agreement, a copy of which is incorporated herein and marked Attachment E. We have the following agreement regarding legal custody: We have no agreement and my position regarding legal custody is as follows:

[ ] [ ]

We have the following agreement regarding physical custody: We have no agreement and my position regarding physical custody is as follows:

[ ] [ ]

We have the following agreement regarding visitation/timeshare: We have no agreement and my position regarding visitation/timeshare is as follows:

Yuba County Superior Court Effective 7/01/03

PETITIONER'S / RESPONDENT'S STATEMENT OF AGREEMENT AND DISAGREEMENT

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STATEMENT OF AGREEMENT AND DISAGREEMENT
ATTACHMENT B
Spousal Support [ ] [ ] We have the following agreement regarding spousal support: We have no agreement and my position regarding spousal support is as follows:

Yuba County Superior Court Effective 7/01/03

PETITIONER'S / RESPONDENT'S STATEMENT OF AGREEMENT AND DISAGREEMENT

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STATEMENT OF AGREEMENT AND DISAGREEMENT
ATTACHMENT C
Division of Property [ ] [ ] We have the following agreement regarding the division of our property: We have no agreement and my position regarding the division of our property is as follows: The following property [ ] will be [ ] should be awarded to Petitioner:

The following property [ ] will be

[ ] should be awarded to Respondent:

Yuba County Superior Court Effective 7/01/03

PETITIONER'S / RESPONDENT'S STATEMENT OF AGREEMENT AND DISAGREEMENT

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STATEMENT OF AGREEMENT AND DISAGREEMENT
ATTACHMENT D
Division of Debts [ ] [ ] We have the following agreement regarding the division of our debts: We have no agreement and my position regarding the division of our debts is as follows: The following debts [ ] will be [ ] should be awarded to Petitioner:

The following debts [ ] will be

[ ] should be awarded to Respondent:

Yuba County Superior Court Effective 7/01/03

PETITIONER'S / RESPONDENT'S STATEMENT OF AGREEMENT AND DISAGREEMENT

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