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(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 _________________ 7 8 9 _______________________ CASE NO.: ____________________ (Plaintiff’s Name), 10 DEPT NO.: _____________________ v. 11 _______________________ 12 (Defendant’s Name) ANSWER AND COUNTERCLAIM FOR 13 DIVORCE 14 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. 28 1 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 24 25 26 27 28 2 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. 27 28 3 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 // 4 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 5 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.

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