Minnesota > Local County > Hennepin > District Court > Family
Alternative Informational Statement - Minnesota
| Alternative Informational Statement Form. This is a Minnesota form and can be used in Family District Court Hennepin Local County . |
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ALTERNATIVE INFORMATIONAL STATEMENT (Family Court Matters) See Minnesota General Rules of Practice 30402 STATE OF MINNESOTA FOURTH JUDICIAL DISTRICT COURT COUNTY OF HENNEPIN FAMILY COURT DIVISION In Re the Marriage of: PRO SE INFORMATIONAL STATEMENT _______________________________ Name of Petitioner Vs _______________________________ File No.______________________ Name of Respondent PLEASE READ THE FOLLOWING CAREFULLY. COURT PERSONNEL ARE NOT ALLOWED TO HELP YOU COMPLETE THIS FORM. These questions must be answered to help the Court make a schedule for dissolution of your marriage. This statement is your opportunity to tell the Court those factors that will require consideration in scheduling. If the information is incomplete, the Court will design its own schedule from the information supplied. If you are representing yourself, please complete questions 1 through 6. If you are an attorney, please complete the entire Scheduling Informational Statement. Some questions have more than one part. Be sure to read and answer all questions completely. 1. This form is being filled out: Jointly (both parties together) Separately Check or complete the following (if they apply): An Order for Protection petition has been filed at some time during the marriage. An Order for Protection is in effect. Is the Court file number for the Order for Protection 2. Final Hearing by Default The parties are in agreement on all matters and this dissolution will proceed by default. Yes No If you answered yes to the preceding question, please check all of the following that apply: Default hearing by General Rules of Practice, Rule 306. Marriage includes minor children Approval without a hearing pursuant to M.S.A. 518.13, subd. 5. The marriage includes minor child(ren), a lawyer represents each party and each party has signed a stipulation. The marriage does not include minor child(ren) and each party has signed a stipulation. The marriage does not include minor children; at least 50 days have elapsed since service of the Summons and Petition, and the Respondent has not appeared in the action. Last Revised 5/22/02 1 <<<<<<<<<********>>>>>>>>>>>>> 2 3. Children A. Do you have minor child(ren) born or adopted into the marriage? Yes No If yes, how many: _________ B. If there are minor children: Do you agree who will have custody? Yes No Do you agree on a visitation schedule? Yes No C. A problem of emotional or physical disability or chemical dependency exists on the part of one party or the other which affects the welfare of the child(ren). Husband Wife Children D. Attach an additional page(s) to explain what custody and/or visitation plan is best for the children. (If you cannot agree, each person should submit separate plans.) 4. Asset and Debt Information A. Are you satisfied that you have sufficient information about your assets and debts to make an informed decision about how they should be divided? Yes No If yes, do you agree or disagree about how the assets and debts should be divided? Agree Disagree If no, check the following terms that still need to be evaluated: a. Home b. Business c. Retirement benefits and pensions, (include 401K plans, IRAs, deferred compensation) d. Saving and checking accounts e. Life insurance policies f. Stock options, bonds, mutual funds, etc. g. Personal property h. Automobiles and trucks i. Boats, motorcycles, snowmobiles, etc. j. Collectibles k. Vacation property l. Other B. Do you agree on how to divide the debts from the marriage? Yes No If no, estimate the total debt: __________ C. Have you filed or do you plan on filing bankruptcy? Yes No D. Do you agree on the amount of spousal maintenance (alimony), if any? Yes No If no, please explain why or why not on an attached page. E. Do you agree on the amount of child support? Yes No If yes, is the amount agreed upon pursuant to the child support guidelines? Yes No If no, please explain why not on an attached page. Last Revised 5/22/02 2 <<<<<<<<<********>>>>>>>>>>>>> 3 5. Alternative Dispute Resolution Have the parties talked with a third person to decide any of the problems listed in this form? Yes No If yes, please check one or all of the following: Property/Financial problems Custody problems Visitation problems Third person is on the Supreme Courts roster of qualified neutrals. a. Meeting: The parties (or their attorneys) met on ______________ to discuss case management issues. (date) b. ADR Process: (check one) (descriptions can be obtained from the Court Administrator): You Both Parties agree that ADR is appropriate and choose the following: Mediation Arbitration (non-binding) Arbitration (binding) Mediation/Arbitration Early Neutral Evaluation Moderated Settlement Conference Mini-Trial Consensual Special Magistrate Impartial Fact-Finder Divorce with Dignity Collaborative Law Hennepin County Settlement Program Other (describe) _____________________________________________________________ You Both Parties agree that ADR is appropriate but request that the Court select the process. You Both Parties agree that ADR is not appropriate because: the case implicates the federal or state constitution other (explain with particularity) _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ domestic violence has occurred between the parties c. Provider (check one) You Other Party have selected the following ADR neutral: ________________________ cannot agree on an ADR neutral and request the Court to appoint one agreed to select an ADR neutral on or before ___________________ (date) d. Deadline (check one) You Other Party recommend that the ADR process be completed by__________________ (date) Last Revised 5/22/02 3 <<<<<<<<<********>>>>>>>>>>>>> 4 6. List any other information that may help the Court schedule your dissolution on attached sheets if necessary. _____________________________________ _____________________________________ Signature of Pro Se Petitioner Signature of Pro Se Respondent _____________________________________ _____________________________________ Address Address _____________________________________ _____________________________________ City, State, Zip Code City, State, Zip Code _____________________________________ _____________________________________ Home Telephone Home Telephone _____________________________________ __
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