CUSTODY WORKSHEET
PLEASE COMPLETE AND RETURN TO:
Independent Paralegal Services, P.O. Box 15329, Portland, OR 97293.
Phone: (503)228-0316 or (800)266-0316
Fax: 503-228-3394 email:
https://www.hightail.com/u/IndependentDocPrep
PLEASE INCLUDE FEE OF $150.00 PAYABLE TO: INDEPENDENT PARALEGAL SERVICES WHEN RETURNING THIS FORM
Use all the space you need, the fields expand as you type.
Do you believe this action will be uncontested? Is the other party serving in the military? Is the other party legally incapacitated?
Are there court actions pending regarding the children? Are there any support petitions pending or currently in effect?If yes, give details on back of page
Information about You:
Your full name:
Your complete contact address (home address not required)
Your county of residence:
Contact phone no (for court forms).:
Your year of birth: Age:
Length of time you have been a continuous Oregon resident:
Last 4 digits of your Social Security No:
Last 4 digits of your Driver’s License and Name of State
Information about Other Party:
The other party’s full name
The other party’s complete address, including COUNTY
The other party’s year of birth Age
Last 4 digits of other party’s Social Security No:
Last 4 digits of other party’s Driver’s License and Name of State
Information about Your Children:
Name, ages, year of birth for children born from this relationship:
For each minor child listed above list addresses where child has resided during the past five years, give dates and name of person child resided with
Please indicate how parenthood has been established. Check one.
by voluntary acknowledgment on birth certificate.
by administrative order. (Include county, state, case no.)
by judicial order. (Include county, state, case no.)
(If you answer yes to any of the three questions below give details on back of page.)
A. Has (Has not) participated as a party, witness, or in any other capacity, in any other litigation concerning the custody of the child(ren) in a court of this or any other state.
B. Has (Has no) information on any proceeding concerning the child(ren) pending in a court of this or any other state.
C. Does(Does not) know of any person, not a party to this proceeding, who has physical custody of the child(ren) or claims to have custody or visitation rights with the above-named child(ren)
Name, address, phone no. of each party’s employer:
Custody:
Who will have custody of the children? Who will pay child support?
Parenting Plan:
You are required to file a Parenting Plan with your custody forms. If you have questions regarding the parenting plan you should consult with an attorney or mediator.
Sketch out the details of your parenting plan and include it when returning your questionnaire.
A parenting plan can be either General or Detailed.
General Parenting Plan
A general parenting plan may include a general outline of how parental responsibilities and parenting time will be shared and may allow the parents to develop a more detailed agreement on an informal basis. However a general parenting plan must set forth the minimum amount of parenting time and access a non-custodial parent is entitled to have.
If you chose a General Plan list it here. Our general parenting plan is as follows:
Detailed Parenting Plan
A detailed parenting plan may include but need not be limited to, provisions relating to: residential schedule; holiday, birthday and vacation planning; weekends, including holidays and school in-service days preceding or following weekends; decision-making and responsibility; information sharing and access; relocation of parents; telephone access; transportation; and methods for resolving disputes.
Our detailed Parenting Plan is as follows:
Weekdays:
The children will be in the care of father on the following dates and times:
The children will be in the care of mother on the following dates and times:
Weekends:
The children will be in the care of father on the following dates and times:
The children will be in the care of mother on the following dates and times:
Summer Schedule: (choose one)
_1. The children’s schedule will remain the same in summer.
2. The schedule will be different is summer.
a. The children will be in the care of father on the following dates and times in summer:
b. The children will be in the care of mother on the following dates and times in summer:
Holidays: (check one or both)
When we are using an alternating weekend plan and the holiday schedule results in one parent having the children 3 weeks in a row, the alternating weekend pattern will restart so that neither parent goes without having the children for more than 2 weeks in a row.
If a parent has the children on a weekend which is followed by a holiday or a day when school is not in session, that parent will also have the child for that day. (Except for holidays listed below.)
Holidays Even Years Odd Years Every Year Beginning /ending
Mothers Day
Fathers Day
Thanksgiving*
Christmas Day
Christmas Eve
New Years Eve
New Years Day
MLK Day
Presidents Day
Easter
Memorial Day
July 4th
Labor Day
Veteran’s Day
Other:
Other:
*List details for sharing the children on Thanksgiving, if this applies to your situation:
Winter Break (choose one)
_1. The children’s schedule will remain the same for winter break. OR
_2. The children will spend half of the winter break with each parent. OR
3. The schedule for winter break will be as follows:
a. The children will be in the care of father on the following dates and times:
b. The children will be in the care of mother on the following dates and times:
Spring Break: (choose one)
_1. The children’s schedule will remain the same for spring break. OR
_2. The children will alternate spring break with each parent. In even years the children will be with and in odd years the children will be with OR
3. The children will spend half of the spring break with each parent. List details:
Children’s birthdays: (choose one)
_1. The children’s schedule will remain the same for their birthdays.
_2. The children’s birthdays will be planned so that each parent participates in the celebration.
3. The children’s birthdays will be according to the following plan:
Other Holidays and Vacations: (Give details)
Primary Residence of Children (choose one)
1. The children will primarily reside with
2. Neither parent’s home will be considered the “primary residence”
Alternate Care (Optional)
1. We choose not to specify arrangements for alternate care.
2. Our arrangements for alternate care are as follows:
Temporary Changes: (choose one)
1. We agree temporary changes to this plan can be made between us
verbally or must be in writing.
Missed Parenting Time: (choose one)
1. If a parent must postpone parenting time due to a medical issue, the time will be rescheduled. If parenting time is missed for any other reason there will be no makeup unless agreed otherwise verbally or must be in writing.
Major Decisions (such as education, religion, non-emergency health care, etc.
(Choose one)
1. Both parents will share the responsibility of making major decisions. This is known by the courts as joint custody.
2. (name of parent) will have sole decision making authority for the children. This is known by the courts as sole custody.
a. this parent must consult with the other before making a major decision.
b. this parent will have the option of consulting with the other parent regarding major decisions.
c. other (describe)
Relocation of Parent
If one parent moves more than 60 miles away from the other, they must provide notice to the other parent and at least day’s written notice to the court (unless the court ordered otherwise.)
Parent/Child Communication (choose one)
1. Both parents have the right to communicate with the children during reasonable hours by phone, writing or email, without interference or monitoring by the other parent.
2. Procedures for telephone, written or email access to the children will be as follows:
Transportation to exchange children (choose one)
1. We will equally share in this responsibility so long as we live in the same locale.
2. Procedures for exchanging the children are as follows:
Dispute Resolution (choose one)
1. If disputes arise over this plan and we can’t resolve them we will resolve the dispute as follows, with court action as a last resort.
a. mediation
b. other
c. OR
2. Mediation of other dispute resolution method will not be required before filing a court action.
Other Terms: List other issues that you want included in this plan:
Child Support:
Select one of the following:
1. We I agree on child support in the amount of $ for all children listed. (We still must complete a child support worksheet for you and the court can still order support according to the guidelines).
OR,
2. Please compute child support based on the state guidelines and contact me prior to completing the paperwork.
When will support begin?
Which day of the month will support be due?
Medical and Life Insurance for Children:
Who will provide medical insurance for the children? Dental?
Vision? For uncovered medical, dental and vision expenses husband will pay % and wife will pay % Is this insurance available through union or employment?
Will the person paying child support be required to maintain life insurance?If yes, how much?
Tax Matters: please check one
1. Mother will claim the children as dependents.
2. Father will claim the children as dependents.
3. We will alternate claiming the children. Father will have odd even years and mother will have odd even years
4. We will each claim one or more children every year. Mother will claim the following children every year and father will claim the following children every year
Income Information Needed to Compute Child Support:
1. Gross income for each party: You $ Other party $
2. Mandatory union dues deducted from paycheck: You $ Other party $
3. Child care costs (this means day care costs needed while a parent works or seeks employment). Indicate amount and which parent pays $paid by
4. List the number of children under age 21 from other marriages or relationships that reside with you or for whom you pay support: (Only list children over age 18 if they are attending school.)
5. List the number of children under age 21 from other marriages or relationships that reside with the other party or for whom the other party pays support:. (Only list children over age 18 if they are attending school.)
6. Amount paid for medical insurance for children (indicate amount paid for children only and which parent pays) $paid by:. What is the amount paid for your own health insurance? What is the amount the other party pays for their own health insurance?
7. Amount of spousal support (formerly known as alimony) either of you are paying or receiving $paid by: received by:
8. Amount of Social security or Veterans Benefits, if any, received on behalf of the children $
Out of a 365 day year, how many overnights will be spent with you? with the other party? (Use a two year average for # of overnights.)
Select ONE of the following: 1. The other party and I will agree in writing to a direct payment of support from one parent to the other AND there are no support arrears or money owed to the state for support AND the person paying support has not been previously been granted an exception from withholding. 2Support will be paid through the state and will be subject to income withholding.
Your contact info:
If we have questions, how should we contact you?
email address phone number
FORM SELECTION AND FEE AGREEMENT
By using this service I acknowledge that I am aware that Independent Paralegal Services are not attorneys and cannot advise me.
I understand that this service is not representing either or both of us, and that we may have sought a larger or different settlement through attorney-assisted negotiation/litigation. I have been encouraged to consult with private attorneys to understand my legal rights and obligations,
Please select the forms you wish us to prepare for you and print your name below
I select the following forms and request that Independent Paralegal Services prepare them specifically as I have directed. All documents shall be prepared for a flat fee of $150.00. Requested amendments and changes after customer has approved and received the documents may require additional fees. I further specifically request that if Independent Paralegal Services is aware of any changes or modifications that must be made to the forms in order to make them acceptable for filing that such modifications be made by Independent Paralegal Svcs.
If there are minor children from my marriage I understand that the court requires me and the other party to attend the court’s Parenting Classes. I understand that there are state guidelines on child support. I understand that the court can order child support consistent with the guidelines even if we agree to a different amount.
Checks returned due to insufficient funds will be immediately forwarded to a collection agency. Collection efforts will include re-depositing the check electronically at which time processing fees, bank fees and all state authorized fees shall also be debited from your account.
Select ONE of the following:
Co-Petition kit of standard forms (both parties agree to sign)
Sole-Petition kit of standard forms (one party signs, the other party is served)
Date:
Print name:
When we have completed your documents we will give you filing instructions. You must file for in the county where you or the other party now reside. The court filing fee is $287.00.
BILLING INFORMATION:
You may mail a check or money order or supply credit card information as payment for our fee of $150.00 (we do not collect the court filing fee from you, you will pay that directly to the court). Payment of our $150.00 fee must be provided before we begin work on your file. We accept debit cards, Discover, Visa and MasterCard. If you wish to use PayPal the account is . You may call and give us the info over the phone or provide below:
Account No.
Name of account holder
Expiration date
Billing address
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