Settlement Agreement For Dissolution Of Marriage With Children {Form 228}

Rule 17.200--Form 228 Settlement Agreement for a Dissolution of Marriage with Children Use this form only if you and your spouse both agree to the terms of a Settlement Agreement. Do not use this form if: · You and your spouse have no children under the age of 18. · You and your spouse have no children 18 years of age or older who still need support. · There are no children under age 18 who were adopted or born during this marriage. Caution: This form may require you to provide protected or sensitive information. If filing electronically and you include protected information on this form, fill out or update the Protected If filing in paper, you may use form 211 to provide any protected information in full. If you do not understand how to use this form, or if you should use this form, talk to an attorney. Information Disclosure form (211) if you have not already done so. In the Iowa District Court for County where your case is filed County Upon the Petition of Equity case no. Petitioner Full name: first, middle, last Settlement Agreement for a Dissolution of Marriage with Children and concerning Respondent Full name: first, middle, last 1. Personal Information Fill in all information that you know. If you have been assaulted by your spouse and you fear for your safety, you may leave your address, phone number, and email blank. Birth year State ZIP code A. Petitioner's birth year and present residence: Petitioner's present street address County City ( Phone number Birth year ) Email address B. Respondent's birth year and present residence: Respondent's present street address County City State ZIP code ( Phone number ) Email address December 2013 Rule 17.200--Form 228 Page 1 of 10 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.200--Form 228: Settlement Agreement for a Dissolution of Marriage with Children, continued 2. Agreements We agree to the following: A. Children Check all that are true (1) (2) We agree to the custody and visitation set out in the Agreed Parenting Plan (229). We do not agree about custody and visitation. We each filed a Proposed Parenting Plan (230). A parenting plan, either form 229 or form 230, must be provided to the court with the Settlement Agreement. Petitioner has taken the children in the middle course. Attach certificate. Respondent has taken the children in the middle course. Attach certificate. (3) (4) B. Breakdown of marriage The marriage is broken down and cannot be saved. C. Counseling Counseling will not save the marriage. D. Waiting period before decree Check all that apply (1) (2) More than 90 days have passed since Respondent accepted service or was served with an Original Notice. Fewer than 90 days have passed since Respondent accepted service or was served with an Original Notice, but we want the court to take action right away without a separate hearing because: This paper explains how we would like to settle all issues in our divorce. E. Financial affidavits Check one (1) Petitioner or Respondent has filed a Financial Affidavit (224). If you check (1), check each that is applicable. a. b. (2) Petitioner has filed a Financial Affidavit. Petitioner certifies that Petitioner has fully disclosed all income and the identity and value of all assets and debts. Respondent has filed a Financial Affidavit. Respondent certifies that Respondent has fully disclosed all income and the identity and value of all assets and debts. We are asking that the court not require us to file Financial Affidavits because: F. Child Support Check all that are true Note: The amount of child support is determined using the Iowa Child Support Guidelines. The Iowa Department of Human Service provides a child support estimator on its website. Go to: https://childsupport.ia.gov/. (1) (2) December 2013 Petitioner shall pay child support to Respondent in the amount of $ Petitioner shall pay child support to a third party in the amount of $ Rule 17.200--Form 228 per month. per month. Page 2 of 10 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.200--Form 228: Settlement Agreement for a Dissolution of Marriage with Children, continued Third party's full name: first, middle, last Present street address County (3) (4) Respondent shall pay child support to Petitioner in the amount of $ Respondent shall pay child support to a third party in the amount of $ Third party's full name: first, middle, last Present street address County (5) Child support payments shall begin on the for the following children: First, middle, & last initials of each child a. b. c. Birth year First, middle, & last initials of each child d. e. f. Birth year City , State ZIP code per month. per month. City , State ZIP code day of Month , 20 Year , Check this box if you are attaching a separate sheet listing additional children. (6) Check here if you want child support to be higher or lower than the Child Support Guidelines amount. If you check (6), write the amount you want and explain why in b. a. Amount requested:$ per month b. Child support should be different from the Guidelines amount because: G. Tax exemption (1) I ask the court to set the tax deduction as: First, middle, & last initials of each child a. b. c. Birth year Parent who should now claim child for tax deduction Check one for each child Every Year Even Years Odd Years December 2013 Rule 17.200--Form 228 Page 3 of 10 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.200--Form 228: Settlement Agreement for a Dissolution of Marriage with Children, continued d. e. f. Check this box if you are attaching a separate sheet listing additional children. Note: The parent with custody must sign IRS Form 8332 before the non-custodial parent can take the deduction. Tax forms are available from the IRS website: http://www.irs.gov. The earned income tax credit is not the same as the tax exemption. (2) The deduction will start in tax year Year . H. Health care expenses I ask the court to set the health care expenses as follows: Check all that apply Petitioner Respondent (1) (2) will provide medical support (health insurance). will pay the first $ of uncovered medical expenses for the children. After that amount is spent, then uncovered medical expenses shall be paid % by Petitioner and (3) % by Respondent. per month. shall pay cash medical support in the amount of $ I. Division of personal property Check one (1) We have divided our personal property. Petitioner will keep the personal property in Petitioner's possession. Respondent will keep