Minnesota > Statewide > District Court > Dissolution
Affidavit In Support Of Responsive Motion For Temporary Relief With Children DIV-1103 - Minnesota
| Affidavit In Support Of Responsive Motion For Temporary Relief With Children Form. This is a Minnesota form and can be used in Dissolution District Court Statewide . |
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State of Minnesota County Judicial District: Court File Number: Case Type: District Court Dissolution with Children In Re the Marriage of: Name of Petitioner and Affidavit In Support Of Responsive Motion For Temporary Relief With Children Name of Respondent STATE OF MINNESOTA COUNTY OF ) ) SS ) My name is 1. I am the (check one): Petitioner/Plaintiff and I state under oath that: Respondent/Defendant in this case, and I make this Affidavit in support of my Responsive Motion For Temporary Relief With Children. 2. A juvenile court proceeding or child protection case involving any or all of the child(ren) in this case: IS NOT taking place in any county or state IS taking place in and the file number is 3. County in the State of . An Order for Protection involving me and the other party and/or the child(ren): DOES NOT exist in any county or state DOES exist in . The Order for Protection is dated County in the State of and the DIV1103 State ENG Rev 1/02-D www.courts.state.mn.us/forms Page 1 of 9 American LegalNet, Inc. www.FormsWorkflow.com file number is attached. . A copy of the Order for Protection is 4. My spouse and I have Full Name of Child (first, middle, last) minor child(ren) who is/are: Date of Birth (mo/day/year) Age 5. The child(ren) currently live with: Petitioner/Plaintiff Respondent/Defendant Other who is the child(ren)'s: Mother Father Other relation to the children. address of the child(ren) is City of , State of , zip code . The in the The child(ren) has/have lived at this address since the date 6. I want the Court to grant temporary legal custody of the child(ren): (check one) a. Jointly to me and my spouse because b. Solely to (check one): Me My spouse because DIV1103 State ENG Rev 1/02-D www.courts.state.mn.us/forms Page 2 of 9 American LegalNet, Inc. www.FormsWorkflow.com 7. Write your response to paragraph 6 in the other party's Affidavit: 8. I want the Court to grant temporary physical custody of the child(ren) (check one): a. Jointly to me and my spouse, with the child(ren) living with me at the following times: and the children living with my spouse at the following times b. Solely to: Me My spouse 9. I believe that my request for physical custody is in the child(ren)'s best interests because 10. Write down your response to paragraphs 7 and 8 in the other party's Affidavit: DIV1103 State ENG Rev 1/02-D www.courts.state.mn.us/forms Page 3 of 9 American LegalNet, Inc. www.FormsWorkflow.com 11. I am asking for (check one): supervised unsupervised child(ren) and my spouse because parenting time for the 12. Write down your response to paragraph 9 in the other party's Affidavit: 13. I am asking for the parenting time schedule in my Responsive Motion and I believe this schedule is in the child(ren)'s best interests because 14. If your parenting time schedule is different from the other party's, write down your response to paragraph 10 in the other party's Affidavit: 15. I am asking the Court to decide temporary child support. DIV1103 State ENG Rev 1/02-D www.courts.state.mn.us/forms Page 4 of 9 American LegalNet, Inc. www.FormsWorkflow.com My income is $ My spouse's income is $ 16. from from I am NOT asking for temporary spousal maintenance. I am asking the Court to decide temporary spousal maintenance LATER. I am asking the Court for spousal maintenance. I do not have enough income to meet my needs. My spouse has income to meet his or her needs and is able to help me. My income and expenses are in my Application for Temporary Relief. I need $ myself because per month in spousal maintenance. I cannot support 17. Write down your response to paragraph 12 in the other party's Affidavit: 18. I am asking the Court to order my spouse to pay my attorney's fees: YES NO. If YES, I need attorney's fees because 19. My spouse should go to an evaluation: YES NO. If YES, the evaluations should be ordered for: (check all that apply) DIV1103 State ENG Rev 1/02-D www.courts.state.mn.us/forms Page 5 of 9 American LegalNet, Inc. www.FormsWorkflow.com Alcohol use Drug use Anger management/Domestic abuse or Other (please specify) 20. Write down your response to paragraph 14 of the other party's Affidavit: 21. I am asking the Court to order that I have sole use and possession of our home located at (the address) I am asking the Court to order that my spouse have sole use and possession of our home located at (the address) I am asking the Court to order that my spouse and I stay in the home located at (the address) I am asking the Court for the relief checked above because 22. Write down your response to paragraph 15 of the other party's Affidavit: DIV1103 State ENG Rev 1/02-D www.courts.state.mn.us/forms Page 6 of 9 American LegalNet, Inc. www.FormsWorkflow.com 25. My spouse and I have already divided our personal belongings, household goods and furniture: (check one): YES NO. If NO, I am asking for the temporary use and possession of the following personal property, household goods and furniture (list the specific items): because I am asking that my spouse have the temporary use and possession of the following household goods and furniture (list the specific items): because 26. My spouse and I own motor vehicle(s): YES NO. If YES, I want the temporary use and possession of the following motor vehicle(s): (list year/make/model for each vehicle) because I want my spouse to have the temporary use and possession of the following motor vehicle(s): (list year/make/model for each vehicle) because I will make the payments and insurance costs for my vehicle(s): YES NO. If no, I want my spouse to make these payments because DIV1103 State ENG Rev 1/02-D www.courts.state.mn.us/forms Page 7 of 9 American LegalNet, Inc. www.FormsWorkflow.com My spouse should make the payments and insurance costs for his/her vehicle(s): YES NO. If NO, I want my spouse to make these payments because 27. My spouse and I have debts: YES NO. If YES, I am asking the Court to order the debts to be paid temporarily as I asked in my Motion because 28. I want to change certain medical, dental, automobile or life insurance policies: YES NO. If YES, I want to make the following changes: because 29. I am asking for insurance to be reinstated: YES NO. a. b. c. d. What insurance has lapsed or been cancelled: The date that the insurance lapsed or was cancelled: Who let the insurance lapse or cancelled it: Why should the insurance be reinstated: If YES, explain: 30. I believe that my spouse's income will increase: YES NO. If
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