Settlement Conference Memorandum {171-182}

IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS IN RE THE MARRIAGE OF ) ) ) Petitioner, ) ) ) ) Respondent. ) and Gen. No.: SETTLEMENT CONFERENCE MEMORANDUM Submitted by: Date: Date Action Filed: Prior Settlement Conf.: Date of Trial: The parties have attended mediation: No Yes (date) No Yes (date) Date of Marriage: Date of Separation: Ages of Children: No Yes (date) Parenting Plan has been presented and approved by the court: Husband Name: Residence: (city/state) Attorney: Health: (condition/explain) Wife Age: Name: Residence: (city/state) Attorney: Health: (condition/explain) Age: Employer: Address: Occupation: Gross Income per year: §505 Net Income per year: Other Income: How long: Employer: Address: Occupation: Gross Income per year: §505 Net Income per year: Other Income: How long: Education:_______________________________ Education:_______________________________ Custody issues in dispute: Custody Child Rep: Mediator: 604(b) Advisor: 604.5 Evaluator: Brief description of issues: Date of referral: Report date: Report date: Modification Visitation Removal Other: Page 1 of 3 171-182 (R 04/06) American LegalNet, Inc. www.FormsWorkFlow.com IRMO: Gen. No. Support/Maintenance disputes: Each party must submit an 11.02 Financial Affidavit. Child Support: 513 Claims: Maintenance: Dependency exemption: Payment of collateral expenses: Other: Property disputes: Each party must submit a proposed balance sheet in a form approved by the court. Valuation: Classification: Percentage Division: Dissipation (be specific): Reimbursement to marital estate: Attorney's fees: Debts: Other: Prepared by: Attorney's Name: _ Address: City: Phone: Fax: ARDC: Page 2 of 3 171-182 (R 04/06) American LegalNet, Inc. www.FormsWorkFlow.com State: Zip Code: CASE NAME: GEN. NO. BALANCE SHEET OF ASSETS AND DEBTS ORDINARY ASSETS VALUE HUSBAND WIFE TOTAL PERCENTAGE DEBTS VALUE HUSBAND WIFE TOTAL PERCENTAGE TAX DEFERRED ASSETS VALUE HUSBAND WIFE TOTAL PERCENTAGE SUMMARY OF ALL ASSETS AND DEBTS Total Ordinary Assets Total Debts Total Tax Deferred Assets TOTAL OVERALL PERCENTAGE DISTRIBUTION OF NET ESTATE HUSBAND Value of non marital estates Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com AMOUNT HUSBAND WIFE WIFE 171-182a (R 04-06)