Proposed Settlement of Remaining Issues

This is a private record. My Name

Address

City, State, Zip

I am the [ ] Petitioner [ ] Respondent [ ] Attorney for the [ ] Petitioner [ ] Respondent and my Utah Bar number is ______

In the District Court of Utah

______Judicial District ______County

Court Address ______

Proposed Settlement of Remaining Issues ______Case Number

Proposed Settlement of Remaining Issues Approved Board of District Court Judges December 17, 2010 Page 1 of 5 Revised April 9, 2015 Petitioner ______v. Judge ______Commissioner _ Respondent

Instructions:  You must complete this form before you file it. Court staff cannot complete this form for you.  Keep a copy of all documents for your records.  Attend all court hearings.  Attach additional pages as needed to complete paragraphs that don’t have enough space. Write the paragraph number on the additional page.

[ ] By and through my attorney, (Attorney, check here if you are appearing for your client.)

I propose the following settlement of these remaining issues:

(1) Improvement for and best interest of the child [ ] are not issues. [ ] are issues and my proposal is:

(2) Proposed custody [ ] is not an issue. [ ] is an issue and my proposal is:

(3) Parent-time schedule and terms [ ] are not issues. [ ] are issues and my proposal is:

(4) Exchange of the child [ ] is not an issue. [ ] is an issue and my proposal is:

Proposed Settlement of Remaining Issues Approved Board of District Court Judges December 17, 2010 Page 2 of 5 Revised April 9, 2015 (5) Payment of travel costs [ ] is not an issue. [ ] is an issue and my proposal is:

(6) Relocation [ ] is not an issue. [ ] is an issue and my proposal is:

(7) Child support [ ] is not an issue. [ ] is an issue and my proposal is:

(8) Change in child tax exemption award [ ] is not an issue. [ ] is an issue and my proposal is:

(9) Health insurance and payment of medical expenses [ ] are not issues. [ ] are issues and my proposal is:

(10) Day-care and education expenses [ ] are not issues. [ ] are issues and my proposal is:

Proposed Settlement of Remaining Issues Approved Board of District Court Judges December 17, 2010 Page 3 of 5 Revised April 9, 2015 (11) Costs and attorney fees [ ] are not issues. [ ] are issues and my proposal is:

(12) Other: ______

[ ] is not an issue. [ ] is an issue and my proposal is:

I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true.

Sign here ► Date Typed or Printed Name

Proposed Settlement of Remaining Issues Approved Board of District Court Judges December 17, 2010 Page 4 of 5 Revised April 9, 2015 Certificate of Service I certify that I served a copy of this document on the following people. Served at this Served on Person’s Name Method of Service Address this Date [ ] Mail [ ] Hand Delivery [ ] Fax (Person agreed to service by fax.) [ ] Email (Person agreed to service by email.) [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age (Other Party or Attorney) and discretion residing there.) [ ] Mail [ ] Hand Delivery [ ] Fax (Person agreed to service by fax.) [ ] Email (Person agreed to service by email.) [ ] Left at business (With person in charge or in receptacle for deliveries.) (Child Support Division, [ ] Left at home (With person of suitable age if applicable) and discretion residing there.) [ ] Mail [ ] Hand Delivery [ ] Fax (Person agreed to service by fax.) [ ] Email (Person agreed to service by email.) [ ] Left at business (With person in charge or in receptacle for deliveries.) (Guardian ad Litem, if [ ] Left at home (With person of suitable age applicable) and discretion residing there.) [ ] Mail [ ] Hand Delivery (Clerk of Court) [ ] Electronic File

Sign here ►

Date Typed or Printed Name

Proposed Settlement of Remaining Issues Approved Board of District Court Judges December 17, 2010 Page 5 of 5 Revised April 9, 2015