In the Fifth Judicial District Court of the 6 State of Nevada, in and for the County of ______

(Your Name) ______1 (Address)______2 (Telephone) ______3 (Email Address)______Self-Represented Plaintiff 4

5 IN THE FIFTH JUDICIAL DISTRICT COURT OF THE 6 STATE OF NEVADA, IN AND FOR THE COUNTY OF ______

9 ______CASE NO.: ______(Plaintiff’s Name), 10 DEPT NO.: ______v. 11 ______12 (Defendant’s Name) ANSWER AND COUNTERCLAIM FOR

13 DIVORCE

15 COMES NOW, Defendant, (your name), ______, in Proper

16 Person and hereby files his/her Answer and Counterclaim to Plaintiff’s Complaint for Divorce as

17 follows:

18 1. Defendant admits the allegations contained in paragraph(s) (write the paragraph number(s) from

19 the Complaint that you agree with) ______

20 ______

21 ______of the

22 Complaint.

23 2. Defendant denies the allegations contained in paragraph(s) (write the paragraph number(s) form 24 the Complaint that you do not agree with)______25 ______26 ______of the 27 Complaint.

3. After reasonable investigation, this Defendant is without sufficient information to form a belief 1 as to the truth or falsity of the matters alleged in paragraph(s) (write the paragraph number(s) that 2 you do not know to be true or false because you do not have enough information)______3 ______4 ______of the Complaint; the allegations 5 are therefore denied with proof demanded at trial. 6

7 COUNTERCLAIM

8 Defendant, as and for a Counterclaim for Divorce against Plaintiff alleges as follows:

9 4. That Plaintiff or Defendant, for more than six (6) weeks immediately before the filing of this 10 action, has/have been and continues to be an actual, bona fide resident of Nye County, 11 Nevada and that Plaintiff or Defendant has been actually physically present and domiciled in 12 Nevada for more than six (6) weeks prior to the filing of this action. 13 5. That Plaintiff and Defendant were married on the (date)______in the city 14 of ______, State of ______and have since remained 15 husband and wife.

16 6. That the wife in this case (check one) is/ is not currently pregnant. 17 I. Child Information 18

19 7. That Plaintiff and Defendant have (number) ______minor children in common who are

20 either biological or adopted.

21 8. The minor children’s names, dates of birth, states and lengths of residence are as follows:

22 Child’s Name Child’s Date of State of Length of time Birth Residence child has lived in 23 the state

9. Child(ren) Residency (check one): 1 The Plaintiff and Defendant do not have minor children in common. 2 The child(ren) are residents of Nevada and have lived here for at least the past six 3 (6) months and, as such, this Court has the necessary UCCJEA jurisdiction to 4 enter orders regarding custody. 5

6 The child(ren) are not residents of Nevada and have not lived here for at least the

7 past six (6) months and, as such, this Court does NOT have the necessary

8 UCCJEA jurisdiction to enter orders regarding custody.

9 10. Legal Custody. Legal Custody involves having basic legal responsibility for a child and 10 making major decisions about the child like the child’s health, education and religious 11 upbringing. (check one) 12 The Plaintiff and Defendant do not have minor children in common. 13 The child(ren) are not residents of the State of Nevada. 14 The Plaintiff and Defendant should be granted joint legal custody of the minor 15 children. 16

17 The Plaintiff should be granted sole legal custody of the minor children.

18 The Defendant should be granted sole legal custody of the minor children.

19 11. Physical Custody. Physical custody refers to the amount of time the child spends in the care 20 of each parent. (check one) 21 Joint physical custody exists when each parent has physical custody of the children at 22 least 40% (146 days) of the time calculated over a one year period.

23 Primary Physical custody exists when one parent has physical custody of the children 24 more than 60% (219 days) of the time calculated over a one year period.

25 The Plaintiff and Defendant do not have minor children in common.

26 The child(ren) are not residents of Nevada.

The Petitioners should be granted joint physical custody of the minor children 1 with a timeshare as outlined in Exhibit 1. 2 The Plaintiff should be awarded primary physical custody of the minor children 3 with the Defendant having visitation as proposed in Exhibit 1. 4

5 The Defendant should be awarded primary physical custody of the minor children

6 with the Plaintiff having visitation as proposed in Exhibit 1.

7 12. Holiday Visitation (check one):

8 The Plaintiff and Defendant do not have minor children in common.

9 The child(ren) are not residents of Nevada.

10 A copy of the proposed holiday visitation schedule is attached as Exhibit 2 and 11 should take precedence when in conflict with the regular visitation schedule. 12 A copy of the proposed holiday visitation schedule is attached as Exhibit 2 and 13 should NOT take precedence when in conflict with the regular visitation 14 schedule. 15 13. Health Insurance (check one): 16 The Plaintiff and Defendant do not have minor children in common. 17 The Plaintiff should maintain medical and dental insurance for the minor 18 child(ren), if available. Any deductibles and expenses not covered by insurance 19 should be paid equally by both parties. 20 The Defendant should maintain medical and dental insurance for the minor 21 child(ren), if available. Any deductibles and expenses not covered by insurance 22 should be paid equally by both parties. 23

24 The Plaintiff and Defendant should both maintain medical and dental insurance

25 for the minor child(ren) if available. Any deductibles and expenses not covered

26 by insurance should be paid equally by both parties.

27 //

28 //

14. Unreimbursed Medical Expenses (check one): 1 30/30 Rule: Any parent incurring an out-of-pocket medical expense relating to the minor child will provide 2 to the other parent a copy of all paperwork relating to that expense within thirty (30) days of incurring said 3 expense, along with a request for contribution for one-half (½) of the out-of-pocket expense actually incurred. Upon receipt of a request for contribution for one-half (½) of an out-of-pocket expense incurred 4 by a parent on behalf of the minor child, the other parent will reimburse the requesting parent in the amount 5 requested within thirty (30) days of receipt of said request for contribution. Upon receipt of reimbursement 6 from any insurance carrier by either parent, and if the other parent previously paid a portion of the payment resulting in that reimbursement, the parent receiving the reimbursement shall equally divide said 7 reimbursement with the other parent within seven (7) days of receipt of same. Both parents have the 8 authority to contact the insurance provider directly in order to determine the status of any individual claim. 9 The Plaintiff and Defendant do not have minor children in common. 10 The Plaintiff and Defendant ask the court to adopt the 30/30 Rule. 11 The Plaintiff and Defendant ask the court to NOT adopt the 30/30 Rule. 12 15. Child Support Amount. Complete the Child Support Worksheet (Worksheet A or Worksheet 13 B) that applies to your custody arrangement BEFORE you complete this question. (check 14 one) 15 The Planitiff and Defendant do not have minor children in common. 16 Based upon the proposed physical custody arrangement the Plaintiff should pay 17 $______dollars per month for support of the parties’ minor children. 18 19 Based upon the proposed physical custody arrangement the

20 Defendant should pay $______dollars per month for support of the parties’ minor children. 21

22 16. Child Support Calculation. The amount of child support requested was calculated based

23 upon the following: (check one)

24 The Plaintiff and Defendant do not have minor children in common.

25 The statutory minimum of $100 per month, per child. 26 The calculation for a primary physical custody arrangement as shown on the 27 attached Worksheet A. 28

The calculation for a joint physical custody arrangement as shown on the attached 1 Worksheet B. 2 Other: ______3

4 17. Wage Withholding Order (check one):

5 The Plaintiff asks that the court order a wage withholding against the obligor

6 parent (parent who owes child/spousal support) to secure payment of child

7 support and spousal support, if any.

8 Good cause exists to postpone the withholding of income from the obligor parent 9 to pay child support and spousal support, if any.

10 18. Child Support Arrears (check one): 11 12 The Plaintiff and Defendant do not have minor children in common.

13 The Defendant is not asking for back child support and waives his/her right to

14 child support arrears.

15 The Defendant is the noncustodial parent and therefore is not entitled to back 16 child support. 17 The Defendant asks the court to award the Plaintiff back child support from 18 (date) ______to (date) ______(max. 4 years) 19 and certifies that during that time period, the Defendant gave the Plaintiff a total 20 of $______for child support. 21 The Defendant asks the court to award the Defendant back child support from 22 (date) ______to (date) ______(max. 4 years) and 23 certifies that during that time period, the Plaintiff gave the Defendant a total of 24 $______for child support. 25 II. Property/Debt Information 26 19. Division of Assets: There may be additional community assets of the parties, the exact 27 amounts and descriptions of which are presently unknown to Plaintiff. Plaintiff asks 28

permission of this Court to amend this Complaint to insert this information when it becomes 1 known to Plaintiff or at the time of trial. (check one) 2 There is no community property to be divided. 3 4 The community property should be divided as follows: Plaintiff shall receive as sole and separate property: 5 1. ______6 2. ______7 3. ______8 4. ______9 Defendant shall receive as sole and separate property: 10 1. ______11 2. ______12 3. ______13 4. ______14

20. Division of Debts: There may be additional community assets of the parties, the exact 15 amounts and descriptions of which are presently unknown to Plaintiff. Plaintiff asks 16 permission of this Court to amend this Complaint to insert this information when it becomes 17 known to Plaintiff or at the time of trial. (check one) 18 There are no community debts to be divided. 19 The community debts should be divided as follows: 20 Plaintiff shall receive as sole and separate debts: 21 1. ______22 2. ______23 3. ______24 4. ______25 Defendant shall receive as sole and separate debts: 26 1. ______27 2. ______28

3. ______1 4. ______2 21. Reason for Divorce: (check one) 3 The husband and wife have become so incompatible in marriage that there is no 4 possibility of reconciliation.

5 The husband and wife have lived separate and apart for more than one year and 6 there is no possibility of reconciliation. 7 22. Spousal Support (check one): 8 Neither party should be awarded spousal support. 9 Spousal support should be awarded to (check one) ⁯ the Plaintiff/ ⁯ the 10 Defendant in the amount of $ ______dollars per month for (number) 11 ______(check one) ⁯ months/⁯ years. The spousal support shall begin 12 on (date) ______and end on (date) ______. 13 23. Name Change for Wife (check one): 14 The wife does not wish to return to her former or maiden name restored. 15 The wife should have her former or maiden name of ______16 restored to her. 17 The wife never changed her name. 18 // 19 // 20 // 21 // 22 // 23 // 24 // 25 // 26 // 27 // 28

WHEREFORE, Defendant prays for a Judgment as follows: 1 1. That the marriage existing between Plaintiff and Defendant be dissolved and that Plaintiff be 2 granted an absolute Decree of Divorce and that each of the parties be restored to the status of 3 a single, unmarried person; 4 2. That the Court grant the relief requested in this Complaint; and 5 3. For such other relief as the Court finds to be just and proper. 6

7 DATED this (day) ______day of (month) ______, 20____. 8

9 Submitted By:______(your signature) 10 ______11 (print your name)

12 13 VERIFICATION

14 STATE OF NEVADA ) ) ss: 15 COUNTY OF NYE )

16 (Your name) ______being first duly sworn 17 under penalties of perjury, deposes and says: 18 That I am the Defendant in the above-entitled action; that I have read the foregoing Answer and 19 Counterclaim for Divorce and know the contents thereof; that the same is true of my own knowledge, 20 except for those matters therein contained stated upon information and belief, and as to those matters, 21 I believe them to be true. 22 Submitted By: ►______23 (your signature)

24 ______(print your name) 25 //

26 //

27 //

28 //

EXHIBIT 1 1 Week Sun. Mon. Tues. Wed. Thurs. Fri. Sat. 2 Sample Mom Mom Dad Dad Dad Mom Mom 3 Pick up at Pick up at 4 3 pm 3 pm Week 5 #1 6

9 Week #2 10

13 Week 14 #3 15

18 Week #4 19

1 EXHIBIT 2

2 Check box Holiday: Time Every Even Odd 3 if this (circle a.m. or Year Years Years holiday p.m.): 4 applies: New Year’s Eve From: Mom Mom Mom 5  ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m. 6 New Year’s Day From: Mom Mom Mom  ______a.m./p.m. Dad Dad Dad 7 To: ______a.m./p.m. Martin Luther From: Mom Mom Mom  8 King, Jr. Day ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m. 9 Presidents’ Day From: Mom Mom Mom  ______a.m./p.m. Dad Dad Dad 10 To: ______a.m./p.m. Passover From: Mom Mom Mom  11 ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m. 12 Easter From: Mom Mom Mom  ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m 13 Memorial Day From: Mom Mom Mom  ______a.m./p.m. Dad Dad Dad 14 To: ______a.m./p.m Mother’s Day From: Mom Mom Mom 15  ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m 16 Father’s Day From: Mom Mom Mom  ______a.m./p.m. Dad Dad Dad 17 To: ______a.m./p.m 4th of July From: Mom Mom Mom 18  ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m. 19 Labor Day From: Mom Mom Mom  ______a.m./p.m. Dad Dad Dad 20 To: ______a.m./p.m. Rosh Hashanah From: Mom Mom Mom 21  ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m. 22 Yom Kippur From: Mom Mom Mom  ______a.m./p.m. Dad Dad Dad 23 To: ______a.m./p.m Nevada Day From: Mom Mom Mom  24 ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m. 25 Halloween From: Mom Mom Mom  ______a.m./p.m. Dad Dad Dad 26 To: ______a.m./p.m. Veterans Day From: Mom Mom Mom  27 ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m. 28

Thanksgiving From: Mom Mom Mom  1 Day ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m. 2 Chanukkah From: Mom Mom Mom  (Days): ______a.m./p.m. Dad Dad Dad 3 ______To: ______a.m./p.m. Chanukkah From: Mom Mom Mom  4 (Days): ______a.m./p.m. Dad Dad Dad ______To: ______a.m./p.m. 5 Christmas Eve From: Mom Mom Mom  ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m. 6 Christmas From: Mom Mom Mom  ______a.m./p.m. Dad Dad Dad 7 To: ______a.m./p.m. Father’s From: Mom Mom Mom 8  Birthday ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m 9 Mother’s From: Mom Mom Mom  Birthday ______a.m./p.m. Dad Dad Dad 10 To: ______a.m./p.m. Child’s Birthday From: Mom Mom Mom 11  ______a.m./p.m. Dad Dad Dad To: ______a.m./p.m. 12 From: Mom Mom Mom  ______a.m./p.m. Dad Dad Dad 13 To: ______a.m./p.m. From: Mom Mom Mom 14  ______a.m./p.m. Dad Dad To: ______a.m./p.m. 15