Professional Documents
Culture Documents
MARRIAGE
FORMS
APPROVED BY
The Missouri Supreme Court
July, 2012
These forms are provided at no cost to you by the Missouri Supreme Court
Committee on Access to Family Courts so that you may have access to the
Missouri Courts. It is a crime for another person to charge you a fee for preparing
these forms for you unless that person is a licensed lawyer. If anyone other than
a lawyer attempts to charge you for preparing these forms, you should notify the
Office of Chief Disciplinary Counsel, 3335 American Avenue, Jefferson City,
Missouri, 65109.
Information that you enter on these forms can be saved on your computer ONLY if
you are using Adobe Acrobat version 8.0 or higher. They can be completed using
the free Adobe Reader, but you will not be able to save the information you enter.
The forms listed below are interactive. You can enter the information on
these forms before you print them. If you fill the forms in on your computer, much
of the information you enter on one form is automatically transferred to other
forms. For example, if you type your first name on the Petition for Dissolution of
Marriage, your first name will also appear on the other forms.
Some forms refer to the husband and wife as the parties, while other forms
refer to the parties as the Petitioner and the Respondent. The Parenting Plan
refers to the Mother and Father. It is assumed that you are the petitioner, or the
person filing the case. Because of this, you must indicate whether you are the
Husband or the Wife so that information from one form can be automatically
transferred to the other forms.
This package also contains bookmarks. These bookmarks help you to
navigate throughout these forms. In addition, there are links embedded in the
forms. These links are usually green, and can take you to a related location in the
forms.
If your spouse signs the Answer so that service of process is not required,
then you only have to file one copy of the Petition for Dissolution of Marriage,
Statement of Income and Expenses, Statement of Property and Debt and
Proposed Separation Agreement, and Parenting Plan. If your spouse does not
sign an Answer, then you must file one additional copy of all of these forms.
You should also keep a copy of these forms for your records.
Some additional forms may be required by some Missouri Courts. You should
check with your local court.
TABLE OF CONTENTS
1. Petition for Dissolution of Marriage (Form CAFC001)
This is the first form you should complete. Information that you enter on this form
will be transferred to all the other forms in the package.
Most courts require that you file two copies of the Certificate of Dissolution of
Marriage.
This form requires that you list income and expenses for both you and your
spouse. A lawyer can assist you in finding out this information.
Your spouse may sign this form if he or she does not want to be personally
served. By signing this form, your spouse is allowing the court to decide your
case. Your spouse may also use this form to disagree with your statements on
your forms.
This form is required by most courts to enter the information about your case into
the Courts computer system.
This form is only required if there are unemancipated children of this marriage. If
there are no unemancipated children of this marriage, then you do not have to
print this form, nor do you have to file this form.
There are two parts to this form, Part A and Part B. Part A deals with custody
issues of the children, and Part B deals with support issues of the children. You
must complete both parts of the Parenting Plan.
If you have different custody or support arrangements for some of the
children, you must complete a separate Parenting Plan for each set of children.
Table of Contents
Print Petition
In re the Marriage of
_________________
_____________
____________________
(First)
(Middle)
(Last)
Petitioner, (Your full name should be entered here)
_________
(Jr./Sr./III)
_________
(Jr./Sr./III)
_________________________________________________________
(Street)
_________________________
(City)
__________________
(State)
___________
(Zip)
_________________________
(Telephone Number)
_____________________________
(E-Mail Address)
4. What are the last four numbers of your social security number?
XXX-XX- _____________
5. What is your spouses mailing address?
_________________________________________________________
(Street)
_________________________
(City)
__________________
(State)
_________________________
(Telephone Number)
_____________________________
(E-Mail Address)
___________
(Zip)
6. What are the last four numbers of your spouses social security
number?
XXX-XX- _____________
________________________________________________________
(Street)
_________________________
(City)
__________________
(State)
___________
(Zip)
__________________
(Hours of Employment)
________________________________________________________
(Street)
_________________________
(City)
__________________
(State)
___________
(Zip)
Other: ______________________________________________
Choose one...
9. In what country do you currently reside? ______________________
(Country)
10. In what state do you currently reside and for what length of
time have your resided in your state of residence?
_________________________
(State of Residence)
11. In what county do you currently reside and for what length of
time have you resided in your county of residence?
_________________________
(Name of County)
__________________
(State)
___________
(Zip)
14. What is your total monthly gross income from all sources?
________________________
(Total Monthly Gross Income)
15. Can you support yourself through the combined income from
your employment and income from property that you will receive
in the dissolution?
Yes
No
16. What is your spouses age? _______________
(Number of Years)
Choose one...
_________________________
(Country)
18. In what state does your spouse currently reside and for what
length of time has your spouse resided in his or her state of
residence?
_________________________
(State of Residence)
19. In what county does your spouse currently reside and for what
length of time has your spouse resided in his or her county of
residence?
_________________________
(Name of County)
20. If your spouse does not live in Missouri, did you and your
spouse live together in Missouri during your marriage?
Yes.
No.
Not Applicable. (My spouse currently resides in Missouri)
________________________________________________________
(Street)
_________________________
(City)
__________________
(State)
___________
(Zip)
23. What is your spouses total monthly gross income from all
sources?
________________________
(Total Gross Monthly Income)
24. Can your spouse support him or herself through the combined
income from his or her employment and income from property that
he or she will receive in the dissolution?
Yes
No
Unknown
a date on this
line.
27. In what country, state and county did you get your marriage
license?
Choose one...
_________________________
(Country)
__________________________
(State)
_________________________
(Name of County)
31. State any arrangements which you and your spouse have
made for the maintenance of the other party or the custody and
support of any children.
____________________________________________________________________
____________________________________________________________________
33. How many living children do you and your spouse have
together that were born after the date of your marriage?
_________________
(Number of Children)
34. How many living children did you and your spouse adopt?
_________________
(Number of Children)
35. How many living children do you and your spouse have
together that were born before the date of your marriage?
_________________
(Number of Children)
36. How many living children did Wife have with someone other
than Husband that were born after the date of their marriage? (This
number includes children born since the parties separated)
_________________
(Number of Children)
The number in Question 37 is automatically calculated for you as you fill in Questions 33 through 36.
37. Enter the total number of children from lines 33, 34, 35, and 36.
_________________
(Number of Children)
NOTE: If line 37 is zero, then you may skip Questions 38 through 49 and go directly to Question
50.
INSTRUCTIONS FOR QUESTIONS 38 THROUGH 41 PERTAINING TO CHILDREN
Questions 38 through 41 each have 10 subparts lettered a through j. These subparts are arranged vertically in two columns on
each page. Each of these two columns represents the information for one child. Question 38 pertains to the first child, Question 39
pertains to the second child, and so on.
If you answered Question 37 with 0, you should skip Questions 38 through 49 and go directly to Question 50.
If you answered Question 37 with 1, you should answer Question 38 for the one child you listed in your answer to
Question 37 and if the child is not emancipated, you should also answer questions 42 through 49 inclusive.
If you answered Question 37 with 2, you should answer Questions 38 and 39 for the two children you listed in your
answer to Question 37. If either of the children is not emancipated, you should also answer questions 42 through 49 inclusive.
If you answered Question 37 with 3, you should answer Questions 38 through 40 for the three children you listed in
your answer to Question 37. If any of the children are not emancipated, you should also answer questions 42 through 49 inclusive.
If you answered Question 37 with 4, you should answer Questions 38 through 41 for the four children you listed in your
answer to Question 37. If any of the children are not emancipated, you should also answer questions 42 through 49 inclusive.
If you answered Question 37 with a number greater than 4, you should answer Questions 38 through 41 for the
four children you listed in your answer to Question 37. Additionally, you should attach additional pages answering all the questions
asked in Question 38 for each child you have in addition to the children you have described in Questions 38 through 41. If any of
the children are not emancipated, you should also answer questions 42 through 49 inclusive.
You must list the children even if they are adults or if they are in someone elses custody. You
must also list each child that was born after the date of the marriage even if Husband is not the
father of the child.
QUESTION 38
CHILD ONE
a.
38b. What are the last four numbers of this childs Social Security Number?
b. XXX-XX-
c.
d.
If you did not check any of the boxes in Question 38e, you must answer the rest of the
information for this child on this page (parts 38f through 38j) and you must also answer
questions 42 through 49 for this child. This child IS NOT emancipated and the court must make
orders with respect to custody and support of this child.
If you checked any of the boxes in Question 38e, you do not need to answer the rest of the
information for this child and questions 42 through 49 do not apply to this child. This child IS
emancipated.
38f. With whom has this child primarily resided during the previous 60 days?
38g. Who should have legal custody of this child?
38j. If this child was born prior to the marriage, is Husband listed as the
father on the birth certificate?
f.
g.
Wife
Husband
Joint Husband/Wife
Third Person
h.
Wife
Husband
Joint Husband/Wife
Third Person
i.
j.
Husband
Other (State Name(s))
____________________
Yes
No
Not Applicable
QUESTION 39
CHILD TWO
a.
39b. What are the last four numbers of this childs Social Security Number?
b. XXX-XX-
c.
d.
If you did not check any of the boxes in Question 39e, you must answer the rest of the
information for this child on this page (parts 39f through 39j) and you must also answer
questions 42 through 49 for this child. This child IS NOT emancipated and the court must make
orders with respect to custody and support of this child.
If you checked any of the boxes in Question 39e, you do not need to answer the rest of the
information for this child and questions 42 through 49 do not apply to this child. This child IS
emancipated.
39f. With whom has this child primarily resided during the previous 60 days?
39g. Who should have legal custody of this child?
39j. If this child was born prior to the marriage, is Husband listed as the
father on the birth certificate?
f.
g.
Wife
Husband
Joint Husband/Wife
Third Person
h.
Wife
Husband
Joint Husband/Wife
Third Person
i.
j.
Husband
Other (State Name(s))
____________________
Yes
No
Not Applicable
QUESTION 40
CHILD THREE
a.
40b. What are the last four numbers of this childs Social Security Number?
b. XXX-XX-
c.
d.
If you did not check any of the boxes in Question 40e, you must answer the rest of the
information for this child on this page (parts 40f through 40j) and you must also answer
questions 42 through 49 for this child. This child IS NOT emancipated and the court must make
orders with respect to custody and support of this child.
If you checked any of the boxes in Question 40e, you do not need to answer the rest of the
information for this child and questions 42 through 49 do not apply to this child. This child IS
emancipated.
40f. With whom has this child primarily resided during the previous 60 days?
40g. Who should have legal custody of this child?
40j. If this child was born prior to the marriage, is Husband listed as the
father on the birth certificate?
f.
g.
Wife
Husband
Joint Husband/Wife
Third Person
h.
Wife
Husband
Joint Husband/Wife
Third Person
i.
j.
Husband
Other (State Name(s))
____________________
Yes
No
Not Applicable
QUESTION 41
CHILD FOUR
a.
41b. What are the last four numbers of this childs Social Security Number?
b. XXX-XX-
c.
d.
If you did not check any of the boxes in Question 41e, you must answer the rest of the
information for this child on this page (parts 41f through 41j) and you must also answer
questions 42 through 49 for this child. This child IS NOT emancipated and the court must make
orders with respect to custody and support of this child.
If you checked any of the boxes in Question 41e, you do not need to answer the rest of the
information for this child and questions 42 through 49 do not apply to this child. This child IS
emancipated.
41f. With whom has this child primarily resided during the previous 60 days?
41g. Who should have legal custody of this child?
41j. If this child was born prior to the marriage, is Husband listed as the
father on the birth certificate?
f.
g.
Wife
Husband
Joint Husband/Wife
Third Person
h.
Wife
Husband
Joint Husband/Wife
Third Person
i.
j.
Husband
Other (State Name(s))
____________________
Yes
No
Not Applicable
____________________________________________________________________
43. Do you know of anyone other than you or your spouse that
has physical custody of any of the unemancipated children or
claims to have custody or visitation rights with respect to any of
the unemancipated children?
Yes
No
44. Do you have any information of any other custody proceeding
concerning any of the unemancipated children pending in a court
of this or any other state?
Yes
No
45. Have you participated in any other litigation concerning the
custody of any of the unemancipated children in this or any other
state?
Yes
No
46. Have any of the unemancipated children been a victim of
abuse or neglect?
Yes
No
47. If you answered Yes to questions 43, 44, 45, or 46 please
explain.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Request for
Relief
Petitioner, of lawful age, being duly sworn on his or her oath states that he or she is the petitioner named
above and that the facts stated in the Petition for Dissolution of Marriage are true according to his or her
best knowledge and belief.
__________________________________
Petitioner SIGN HERE
__________________________________
Petitioner PRINT YOUR NAME HERE
My Commission Expires:
_____________________
ATTORNEY INFORMATION (May be completed by your attorney)
________________________________________
Attorney SIGN HERE
___________________
Missouri Bar Number
_________________________________________________________
Attorney for Petitioner PRINT YOUR NAME HERE
_________________________________________________________
(Street)
_________________________
(City)
_________________
(Telephone Number)
__________________
(State)
_________________
(Fax Number)
___________
(Zip)
______________________
(Email Address)
Country
Choose one...
Choose one...
Country
Choose one...
Choose one...
State or Country of Marriage
Country
Choose one...
Circuit Clerk
Form CAFC065-04/01/2009
Table of Contents
MISSOURI
Case Number
Information
shown in blue
on this form
does not print.
Division Number
Your
Information
______________
(Middle Name)
________________________________
(Last Name)
________
(Jr./Sr./III)
Other Partys
Information
Monthly
Income
Information
Form 14
______________
(Middle Name)
________________________________
(Last Name)
Wife
Husband
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________________
________
(Jr./Sr./III)
Monthly
Income
Information
(Continued)
Wife
Husband
________________
________________
________________
________________
________________
________________
16.
________________
________________
These numbers are automatically calculated for you as you fill in this form.
Line 1)
________________
________________
________________
________________
________________
________________
________________
________________
_______
_______
________________
________________
________________
________________
________________
________________
Monthly
Expense
Information
Form 14
Wife
Husband
________________
________________
________________
________________
________________
________________
30. Health insurance costs for the children who are the
subject of this proceeding (Form 14 Line 6c)
31. Uninsured extraordinary medical costs for the children
who are the subject of this proceeding (Form 14 Line
6d)
32. Other extraordinary child rearing costs for the children
who are the subject of this proceeding (Form 14- Line
6e)
33. All Other Expenses of each person (Include housing
costs, utilities, transportation costs, food, clothing, loan
payments, charitable contributions, entertainment,
insurance other than listed on line 30, etc.)
________________
________________
Paragraph 5
________________
________________
Paragraph 9
________________
________________
Paragraph 14a
________________
________________
I certify under oath that I have given the other party a copy of this Income and Expense Statement pursuant to Supreme
Court Rule 43.01(d) by: (You MUST check at least ONE of the following five boxes)
Serving a copy with the original pleadings herein.
Mailing a copy to the other party or his or her attorney on ____________________ (Date) at the following address:
________________________________________________________________________
(Street)
_________________________
__________________
______________
(City)
(State)
(Zip)
COUNTY OF ________________
STATE OF _________________
)
) ss.
)
Affiant, of lawful age, being duly sworn on his or her oath, states that he or she is the affiant named herein and
that the facts stated in this Income and Expense Statement are true according to his or her best knowledge
and belief.
__________________________________
Affiant SIGN HERE
_______________________________________
Affiant PRINT YOUR NAME HERE
__________________________________
Notary Public
Table of Contents
Yes. You must file Form CAFC040 with either your Petition for Dissolution of Marriage
or your Answer, even if it is not signed by both parties. You should not file these
directions with the court.
What is marital
property?
What is
nonmarital
property?
Can property be
marital and
nonmarital?
Yes. If an item of property is partly marital and partly nonmarital, then it should be
listed under both the marital and nonmarital sections. For example, if one party had
earned pension benefits for five years prior to the marriage and continued to earn the
same pension benefits for five years during the marriage, one-half or 50% of the
pension and retirement benefits are marital and one-half or 50% are nonmarital. In
that situation, the pension and retirement benefits would be listed both under marital
and nonmarital property.
What is fair
market value?
This is the amount someone would pay for this item of property today. It is not what
the property cost when you purchased it. A ten year old automobile has a value far less
than the amount you paid for the automobile.
What if I dont
agree with this
proposed
separation
agreement?
You must take appropriate actions to protect your interests. CONSULT A LAWYER.
Do not fail to respond if you have been served with these papers as the court may
proceed without any further notice to you.
Do we have to
list our property
even if weve
already divided
it?
Yes, all property and all debt must still be included on one of the tables.
Directions and Information for completing Form CAFC040 - Statement of Property and Debt and
Proposed Separation Agreement Page 1 of 3
Form CAFC040-07/01/2012
What property
should I list on
this form?
Do I have to list
property even if
my spouses
name is not on
it?
Yes, you must list all property owned by you alone, by your spouse alone, and by you
and your spouse together. You must list property even if it is not in joint names. Any
property in which either you or your spouse claim ANY interest whatsoever MUST be
listed.
In many instances, you will not be able to sell your property or receive your
retirement unless you prove that these items were listed in your dissolution of marriage
judgment.
Do I have to list
property that
either of us is
buying at the
present time?
YES. You must list all property that either you or your spouse is purchasing by
making monthly payments. So, even if you owe money on your car or home, it still must
be listed. Actually, it must be listed twice: once as an item of property and once as a
debt secured by the property.
Do I have to list
property I owned
before the
marriage?
Yes. This is normally nonmarital property, but under some circumstances it may be
considered marital property.
Do I have to list
property my
spouse owned
before the
marriage?
Yes. Just as you had to list property you owned before the marriage, you should
also list property your spouse owned before the marriage. Once again, this is normally
nonmarital property, but under some circumstances it may be considered marital
property.
Directions and Information for completing Form CAFC040 - Statement of Property and Debt and
Proposed Separation Agreement Page 2 of 3
Form CAFC040-07/01/2012
Do I have to list
property I
Yes. You are still married, so any property or debt that you have acquired since your
acquired after we separation has to be included.
separated?
What happens if I
dont list all the
property and
marital debt?
It would be a VERY BIG mistake not to list all your property and marital debt. Your
dissolution of marriage may not be final, and your spouse will be able to come back in
the future and try and get this item of property. In some cases, you may not be able to
receive your pension or sell your property without proof that your dissolution of
marriage judgment listed the property.
Should I list my
pension even
though I cant
receive any
benefits now?
Yes. It is very important that you list all pension plans in which you or your spouse
participate. They should be listed even if you cant receive any benefits for a long time.
If you dont list a pension plan, you may not be able to receive any benefits in the
future without further legal proceedings.
Do I have to list
every last dish
and towel?
No. You do not need to list property if it is of minimal value. If the item of property
is worth less than $100.00, you may omit it from your list.
What if I acquire
some property or
debt after I file
my case?
If you acquire any additional property or debt during the time this case is pending,
you must notify the court of that fact at the time of your hearing. If you dispose of any
property or pay off any debt during the time this case is pending, you must notify the
court of that fact at the time of your hearing.
What if I need
more space on
the tables?
You may make copies of any of the four tables if you need additional room for more
property or debt. When you have listed all the property and debt, you should number
the pages. Make sure you write Not Applicable or N/A in each box under Item of
Property or Item of Debt that you do not fill. (Someone could fill this in later with
some other information)
IMPORTANT
This document is placed in a court file, which is an open document available to the
public. In listing your bank or other accounts, or your credit card or other debt, do not
include the entire account number. You should include only enough information to
distinguish your account from other accounts owned by you and your spouse. For
example, in listing a credit card number, you should include only the last four digits of
the account, such as xxxx-xxxx-xxxx-1234.
Directions and Information for completing Form CAFC040 - Statement of Property and Debt and
Proposed Separation Agreement Page 3 of 3
Form CAFC040-07/01/2012
Table of Contents
Case Number
shown in blue
on this form
does not print.
MISSOURI
Division Number
Petitioners
Information
The full name of the person that filed this case is:
___________________
(First Name)
______________
(Middle Name)
________________________________
(Last Name)
________
(Jr./Sr./III)
Respondents
Information
The full name of the person that did NOT file this case:
___________________
(First Name)
______________
(Middle Name)
________________________________
(Last Name)
________
(Jr./Sr./III)
There are two parts to this document. Part One is your division of property and debt
and Part Two pertains to spousal support or maintenance. This document does not
have anything to do with child support or custody. Issues addressing child support and
custody are contained in a parenting plan.
What is a
Separation
Agreement?
How do I
complete Part
One of this
Form?
You must list all of your marital and nonmarital property and marital debt on one of
the four tables.
Use a separate row for each item of property or debt. You should draw a line
through all rows that do not contain an item of property. This is very important because
someone could alter this document after you have signed it. Keep a copy of this
document after you have signed it.
Property
Owned by
Wife
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
(You should attach a copy of the deed for each item of real estate to this form)
Property
Owned by
Husband
Yes
No
Yes
No
Does Wife have any life insurance that could be cashed in?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Does Husband have any life insurance that could be cashed in?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
(You should attach a copy of the deed for each item of real estate to this form)
TABLE 1. PROPERTY TO BE AWARDED TO WIFE - The following property is to become the sole and separate property
of WIFE.
Item of Property
Present Fair
Market Value
Is there an
amount owed
on this
property?
Is this marital or
nonmarital
property?
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Party with
Possession of
this Property
TABLE 2. PROPERTY TO BE AWARDED TO HUSBAND - The following property is to become the sole and separate
property of HUSBAND.
Item of Property
Present Fair
Market Value
Is there an
amount owed
on this
property?
Is this marital or
nonmarital
property?
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Marital
Nonmarital
Both
Wife
Husband
Other
Party with
Possession of
this Property
Debts that
Wife Owes
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
(either alone or
with anyone else) Does Wife owe any money to any family or friends?
Debts that
Husband
Owes (either
alone or with
anyone else)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Chapter 13)
You should list all loans from any individual, bank, credit card company, credit
union, savings and loan association or other lending institution. Include all debts owed
by either you or your spouse. Make sure to list all credit cards and any amounts owed
pursuant to any bankruptcy or other repayment plans.
Debts that the Wife should pay are to be listed in Table 3 and Debts that the
Husband should pay are to be listed in Table 4.
What does
security mean?
The mortgage on a home is traditionally secured by the home. When you finance
the purchase of an automobile, the company that loans you the money is listed on the
title to the automobile. They too have a security interest in your car. Usually, a debt is
secured by an item of property if the person to whom you owe the money can take the
item of property if you fail to pay the debt. The schedules of debt ask you to list any
security for that debt. You must also list the property that secures the debt under the
property listings.
This agreement does not affect the rights of the person to whom you or your spouse
owe the money. They can still collect the money from both or your spouse.
Each party is to attempt to refinance or obtain the release of any liability of the
other party as soon as reasonably practicable after the dissolution of marriage.
TABLE 3. DEBTS TO BE PAID BY WIFE - List all loans from any individual, bank, credit card company, credit union,
savings and loan association or other lending institution that are to be paid by WIFE. Wife is to indemnify and hold Husband harmless
for all debts listed on Table 3.
The creditors rights to collect these debts from Husband are NOT affected without the consent of the creditor. Wife is to
refinance or obtain the release of any liability of Husband on all debts listed in Table 3 as soon as reasonably practicable.
Item of Debt
(Who is the money owed to?)
Current
Balance
Monthly
Payment
Marital or Separate
Debt
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
TABLE 4. DEBTS TO BE PAID BY HUSBAND - List all loans from any individual, bank, credit card company, credit
union, savings and loan association or other lending institution that are to be paid by HUSBAND. Husband is to indemnify and hold
Wife harmless for all debts listed on Table 4.
The creditors rights to collect these debts from Wife are NOT affected without the consent of the creditor. Husband is to
refinance or obtain the release of any liability of Wife on all debts listed in Table 4 as soon as reasonably practicable.
Item of Debt
(Who is the money owed to?)
Current
Balance
Monthly
Payment
Marital or Separate
Debt
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Marital
Nonmarital
Both
Maintenance is money paid on a regular schedule by one spouse to the other for
support after the dissolution of marriage. It may be for a set period of time or it may be
for an indefinite period of time. It usually terminates upon the death of either party or
the remarriage of the party receiving maintenance unless the parties agree otherwise.
It may or may not be subject to future modification upon a showing of changed
circumstances. Maintenance used to be referred to as alimony.
Maintenance to
Wife
The court lacks jurisdiction to enter any orders with respect to maintenance of
Wife.
No maintenance is to be paid to Wife by Husband. This agreement is not subject to
modification.
Husband shall pay to Wife the sum of ____________ per month as and for
maintenance. Said maintenance is _______ subject to modification. Said
maintenance shall terminate upon the death of either party, the remarriage of Wife, or
at such earlier time as set forth herein.
________________________________________________________________________
________________________________________________________________________
Maintenance to
Husband
The court lacks jurisdiction to enter any orders with respect to maintenance of
Husband.
No maintenance is to be paid to Husband by Wife. This agreement is not subject to
modification.
Wife shall pay to Husband the sum of ____________ per month as and for
maintenance. Said maintenance is _______ subject to modification. Said
maintenance shall terminate upon the death of either party, the remarriage of
Husband, or at such earlier time as set forth herein.
________________________________________________________________________
________________________________________________________________________
Wage
Withholding for
Maintenance
Additional
Provisions
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Statement of Property and Debt and Proposed Separation Agreement Page 8 of 9
Form CAFC040-07/01/2012
I certify under oath that I have given the other party a copy of this Property and Debt Statement pursuant to Supreme Court
Rule 43.01(d) by: (You MUST check at least ONE of the following five boxes)
Serving a copy with the original pleadings herein.
Mailing a copy to the other party or his or her attorney on ____________________ (Date) at the following address:
________________________________________________________________________
(Street)
_________________________
__________________
______________
(City)
(State)
(Zip)
COUNTY OF ______________ )
) ss.
STATE OF ________________ )
Wife, of lawful age, being duly sworn on her oath, states that she is the Wife named herein and
that the facts stated in this Statement of Property and Debt are true according her best knowledge and
belief, and that she agrees with the terms and conditions set forth herein.
Further, Wife states that she executed this Statement of Property and Debt as her free act and
deed.
__________________________________
WIFE SIGN HERE
__________________________________
WIFE PRINT YOUR NAME HERE
__________________________________
HUSBAND PRINT YOUR NAME HERE
Table of Contents
In re the Marriage of
_________________
_____________
____________________
(First)
(Middle)
(Last)
Petitioner, (Your full name should be entered here)
_________
(Jr./Sr./III)
_________
(Jr./Sr./III)
4. What are the last four numbers of your social security number?
XXX-XX-______________
(Social Security Number)
Instructions: The last four digits of your social security number are required by 452.312.2(6), RSMo.
Request for
Relief
I certify under oath that I have given the other party a copy of this Answer pursuant to Supreme Court Rule 43.01(d) by:
(You MUST check at least ONE of the following five boxes)
Mailing a copy to the other party or his or her attorney on ____________________ (Date) at the following address:
________________________________________________________________________
(Street)
_________________________
__________________
______________
(City)
(State)
(Zip)
NOTICE
Some local rules may also require that you file an income and expense statement and a property statement at the
time you file your answer. Failure to do so could cause your answer to be stricken. Also, if there are any unemancipated
children, you are required to file a proposed parenting plan within 30 days after the date you were served or the date you
filed this answer. You may file a joint parenting plan with your spouse. See 452.310.7, RSMo.
__________________
(State)
___________
(Zip)
_________________________
(Telephone Number)
_____________________________
(E-Mail Address - Optional)
This is the address that the court will use to send information concerning your case to you. If you move during the time this case is pending, you must
send a letter to the court notifying it of your new address. It is your duty to keep the court informed as to your correct address.
This address is not necessarily the same as the address at which you reside. Even if you do not wish to disclose the address at which you
reside, you MUST still provide the court with a mailing address.
Instructions: The following information MUST be filled in before a notary public. Your answer is required
to be verified before a notary public. 452.310.1, RSMo.
COUNTY OF __________
STATE OF ____________
}
} ss.
}
Respondent, of lawful age, being duly sworn on his or her oath, states that he or she is the respondent
named above and that the facts stated in Respondents Answer to Petitioners Petition for Dissolution of
Marriage are true according to his or her best knowledge and belief.
__________________________________
Respondent SIGN HERE
__________________________________
Respondent PRINT YOUR NAME HERE
My Commission Expires:
_____________________
___________________
Missouri Bar Number
_________________________________________________________
Attorney for Respondent PRINT YOUR NAME HERE
_________________________________________________________
(Street)
_________________________
(City)
_________________
(Telephone Number)
__________________
(State)
_________________
(Fax Number)
___________
(Zip)
______________________
(Email Address)
Print Judgment
Table of Contents
_____________
(Middle)
____________________
(Last)
_________
(Jr./Sr./III)
Petitioner,
_____________
(Middle)
____________________
(Last)
_________
(Jr./Sr./III)
Respondent.
Wife appears by
attorney.
Husband appears by
attorney.
Third Party ___________
appears by attorney.
Guardian ad Litem
appears in person.
Cause submitted upon
affidavit of Wife.
Cause submitted upon
affidavit of Husband.
3. The last four digits of Wifes Social Security Number are ___________ and the last four digits of
Husbands Social Security Number are ___________.
4.
Respondent is not on active duty in the armed services of the United States now or any time
since the filing of the petition herein.
Respondent is on active duty in the armed services of the United States, but has waived his
or her rights pursuant to the Servicemembers Civil Relief Act of 2003.
Jurisdiction
5. Thirty (30) days have elapsed since the filing of the petition herein.
6.
7.
Form CAFC070-07/01/2012
Marriage
8. The parties were married on _____________________, and the marriage was registered in
______________________________________________________________________.
9. The parties continued to live together until ________________________, on or about which date
they separated.
10. There is no reasonable likelihood that the marriage of the parties can be preserved, and the
marriage is, therefore, irretrievably broken.
Children
11. Wife is not now pregnant.
12.
Age
As used herein, minor child(ren) refers to the unemancipated living child(ren) listed above.
__________________________________________________________________________________________
__________________________________________________________________________________________
Maintenance
14. Maintenance to Wife
No maintenance is to be paid to Wife by Husband. This order is not subject to modification.
Husband is ordered to pay to Wife the sum of ____________ per month as and for
maintenance. Said maintenance is _______ subject to modification.
__________________________________________________________________________________________
__________________________________________________________________________________________
The court lacks jurisdiction to enter any orders with respect to maintenance of Wife.
The court lacks jurisdiction to enter any orders with respect to maintenance of Husband.
16. Wage Assignment for Maintenance (If maintenance is to be paid by either party)
Income withholding shall be prepared by the obligee and issued by the Circuit Clerk upon the
effective date of this order.
Income withholding shall not issue for the following reason(s):
_________________________________________________________________________________________.
The court does NOT have jurisdiction (as defined in the Uniform Child Custody Jurisdiction
and Enforcement Act, 452.700, RSMo et seq.) over the custody arrangements of the minor
child(ren) and, therefore, enters no further orders with respect to the custodial arrangements of
the minor child(ren).
The court has jurisdiction (as defined in the Uniform Child Custody Jurisdiction and
Enforcement Act, 452.700, RSMo et seq.) over the custody arrangements of the minor
child(ren).
The court approves the provisions of Part A of the parenting plan marked exhibit _________
pertaining to the custodial arrangements of the minor child(ren) and finds that the custodial
arrangements contained in said parenting plan are in the best interests of the minor child(ren).
Therefore, the court orders the provisions of Part A of the said parenting plan pertaining to
the custodial arrangements of the minor child(ren) and incorporates by reference all of the terms
and conditions pertaining to the custodial arrangements of the minor child(ren) set forth in Part A
of said parenting plan as if fully set forth herein.
The sheriff or other law enforcement officers shall enforce the rights of any person to custody
or visitation pursuant to 452.425, RSMo.
__________________________________________________________________________________________
__________________________________________________________________________________________
The court does not have jurisdiction to enter any orders with respect to the support of the
minor child(ren).
The court orders the provisions of Part B of the parenting plan marked exhibit _________ ,
pertaining to the support of the minor child(ren) and incorporates by reference all of the terms
and conditions set forth in Part B of said parenting plan as if fully set forth herein.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Attorneys Fees
24.
Name Change
25.
Other Orders:
26.
Other orders are as per the attached Exhibit Number___________, which is incorporated by
reference as if fully set forth herein.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Court Costs
27.
Court costs are to be paid from the court cost deposit(s) previously posted.
Court costs are waived.
We, the undersigned parties, do hereby acknowledge receipt of the findings and
recommendations of the commissioner and waive the right to file a motion for rehearing in this
case.
(If heard by a Family Court Judge)
___________
Date
__________________________
Commissioner
___________
Date
___________
Date
A certified copy of this judgment is to be mailed to the following person(s): (Check all applicable boxes)
Petitioners Attorney
Respondents Attorney
Guardian ad Litem
____________________________
____________________________
____________________________
____________________________
(Street)
____________ ______ ______
(City)
(State) (Zip)
_________________________
(Telephone Number)
____________________________
(Street)
____________ ______ ______
(City)
(State) (Zip)
_________________________
(Telephone Number)
____________________________
(Street)
____________ ______ ______
(City)
(State) (Zip)
_________________________
(Telephone Number)
Petitioner
Respondent
____________________________
(Signature of Petitioner)
____________________________
(Street)
____________ ______ ______
(City)
(State) (Zip)
_________________________
(Telephone Number)
____________________________
(Signature of Respondent)
____________________________
(Street)
____________ ______ ______
(City)
(State) (Zip)
_________________________
(Telephone Number)
Third Party
____________________________
(Signature of Third Party)
____________________________
(Street)
____________ ______ ______
(City)
(State) (Zip)
_________________________
(Telephone Number)
Table of Contents
Style of Case:
(i.e. Petitioner v. Respondent)
Petitioner/Plaintiff Information:
Party Type Code:
Name: (Last)
(First)
(Middle)
Address:
City:
DOB:
State:
Gender:
Male
Female
Zip:
SSN:
Bar ID:
Respondent/Defendant Information:
Party Type Code:
Name: (Last)
(First)
(Middle)
Address:
City:
DOB:
State:
Gender:
Male
Female
Zip:
SSN:
Bar ID:
(First)
(Middle)
State:
Gender:
Male
Female
SSN:
Zip:
Bar ID:
(First)
(Middle)
State:
Gender:
Male
Female
Zip:
SSN:
Bar ID:
Employer Information
Petitioner/Plaintiff Employer Name:
Employer Address:
City:
State:
Zip:
State:
Zip:
The following information regarding children is required. Complete this section for any child subject to the action of
this case.
*MACSS Missouri Automated Child Support System
This Filing Information Sheet is applicable to how many children?
Children:
Name:
Gender:
SSN:
Male
Female
Name:
Gender:
SSN:
Male
Female
SSN:
Male
Female
SSN:
Male
Female
SSN:
Male
Female
SSN:
Male
Female
SSN:
Male
Female
SSN:
Male
Female
SSN:
Male
Female
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
Name:
Gender:
DOB:
SSN:
Male
Female
DOB:
State:
Zip:
Email Address:
*IMPORTANT: It is the parties responsibility to keep the court informed of any change of address or employment.*
Instructions to Clerk
Maintain the closed portion(s) of the record in a sealed manila envelope within the file. The file can be
maintained with other open records. If a request is made to review the open portion of the file, the
envelope can be removed from the file. Access to the record must be restricted to avoid access to the
closed portion of the record.
OSCA (10-09) FI-10
Table of Contents
EXHIBIT NO. __________
_________________
(First)
_____________
(Middle)
____________________
(Last)
_________
(Jr./Sr./III)
Petitioner/Plaintiff,
_____________
(Middle)
____________________
(Last)
_________
(Jr./Sr./III)
Respondent/Defendant.
PARENTING PLAN
Part A Custody of the Children
1. Identification of the Parties
Check one, and only one, of the following two boxes.
Mother is the Petitioner/Plaintiff. Father is the Respondent/Defendant.
Father is the Petitioner/Plaintiff. Mother is the Respondent/Defendant.
2. Plan Author(s)
Check all applicable boxes.
Court
Mother
Father
Guardian ad Litem
_________________________
Childs Age
4. Duration of Plan
The terms and conditions set forth in this parenting plan shall remain in full force and effect until the
children are emancipated or until this plan is modified by a court of competent jurisdiction.
5. Types of Decisions
The three types of decisions that parents must make concerning their children are major decisions, daily or
everyday decisions, and emergency decisions.
A. Major Decisions
Major decisions are the significant decisions about the children. Major decisions are made by the parent or
parents with legal custody. The following are examples of major decisions:
The choice or change of schools, including college or special tutoring,
The choice or change of physician, surgeon or dentist,
Religious instruction, training or education,
Selection of child care providers,
Major medical care, surgery, or any medical procedure requiring hospitalization or out-patient surgery,
Major dental work and orthodontia,
Psychological or psychiatric treatment or counseling,
The choice or change of camps or other special or extracurricular activities,
The extent of any travel away from home,
Part or full-time employment,
Purchase or operation of a motor vehicle,
Contraception and sex education,
Actual or potential litigation on behalf of the children.
C. Emergency Decisions
Emergency decisions are decisions of an urgent nature. They affect the health and safety of the children
and have to be made before it is possible to contact the other parent.
The parent who is with the minor child requiring emergency care may make the emergency decision. The
parent making the emergency decision shall advise the other parent of the nature and extent of the emergency as
soon as possible.
7. Legal Custody
You must check one and only one of the following four boxes.
Joint Physical Custody Using Fathers Address It is in the best interest of the children that Mother
and Father have joint physical custody of the children. The address of the children for mailing and educational
purposes is the same as that of Father.
Sole Physical Custody to Mother and Visitation to Father It is in the best interests of the children
that Mother has sole physical custody of the children and that Father have visitation as set forth herein.
Sole Physical Custody to Father and Visitation to Mother It is in the best interests of the children
that Father has sole physical custody of the children and that Mother have visitation as set forth herein.
Sole Physical Custody to Mother and Supervised Visitation to Father It is in the best interests of
the children that Mother have sole physical custody of the children and Father have supervised visitation as set
forth herein. Unsupervised visitation would endanger the childrens physical health or impair their emotional
development because: __________________________________________________________________
__________________________________________________________________.
Visitation will be supervised by __________________________________________________________.
Sole Physical Custody to Father and Supervised Visitation to Mother - It is in the best interests of the
children that Father have sole physical custody of the children and Mother have supervised visitation as set
forth herein. Unsupervised visitation would endanger the childrens physical health or impair their emotional
development because: __________________________________________________________________
__________________________________________________________________.
Visitation will be supervised by __________________________________________________________.
Sole Physical Custody to Mother and No Visitation to Father It is in the best interests of the
children that Mother has sole physical custody of the children and Father has no visitation with the children.
Visitation would endanger the childrens physical health or impair their emotional development. Father shall
not have access to records and information pertaining to the children pursuant to 452.376.1, RSMo.
Sole Physical Custody to Father and No Visitation to Mother - It is in the best interests of the children
that Father has sole physical custody of the children and Mother has no visitation with the children. Visitation
would endanger the childrens physical health or impair their emotional development. Mother shall not have
access to records and information pertaining to the children pursuant to 452.376.1, RSMo.
Physical and Legal Custody to a Third Party It is in the best interest of the children that
_____________________ (hereinafter referred to as Third Party) has sole legal and sole physical custody of
the children. Both parents are unfit, unsuitable, or unable to be a custodian of the children or the welfare of the
children requires that neither parent have physical custody. (If this box is checked, the same box MUST be
checked in Part A, Paragraph 7.)
13. Transportation
The parent who has the children takes the children to the exchange location. Each party will pay the
expenses associated with his or her own transportation to and from the exchange location unless otherwise
indicated in this parenting plan.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Parenting Plan Part A - Custody Page 5
Form CAFC501-01/01/2011
____________________________
Father
____________________________
Attorney for Mother
____________________________
Attorney For Father
____________________________
Guardian ad Litem
Residential Schedules
1. Weekend and Weekday Schedule
Each exchange should be written on the Weekend and Weekday Exchange Schedule. A sample entry for
one of the exchanges may be as follows: 5:30 p.m. Father receives children. This means that at 5:30 p.m.,
Father will begin a period of time during which the children will be with him.
The last person to receive custody on the Weekend and Weekday Schedule must be different than the first
person to receive custody on the schedule because after each two week period, the cycle repeats itself. There is
always an even number of exchanges for a two week period.
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
2. Vacation Schedule
You must select one and only one of the following two options.
No specific weeks will be set aside for our vacations.
Each parent may designate ______ week(s) each year during which they will have exclusive physical
custody of the children and the regular or special exchange schedules do not apply. Father shall have first
choice of weeks in odd-numbered years. Mother will have first choice of weeks in even-numbered years.
The parent with the first choice of weeks must designate the vacation weeks by March 31 of each year.
During this period, the holiday schedule still applies. Neither parent can select a week which would deny
the other parent of a holiday to which they are entitled.
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
3. Holidays
A different schedule can apply on holidays. The times each parent will have with the children during the
holidays are set forth on the Holiday Exchange Schedule on page 3 of these Residential Schedules.
Include the name of the parent that will have the holiday and how the holiday will be structured. For
example, Memorial Day is always on a Monday. Should the Memorial Day holiday begin at 6:00 p.m. on
Sunday before Memorial Day? Alternatively, should it include the entire weekend? If the entire weekend is
included, then it is possible that one parent may not have a weekend with the children for several weeks.
Holidays and vacations do not alter the Week One or Week Two designation, but they do apply ahead
of the regular schedule. If the holiday schedule conflicts with any other schedule, the holiday schedule takes
precedence.
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Weekday/Weekend Schedules
Sunday
Monday
WEEK ONE
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
WEEK TWO
Tuesday
Wednesday
Thursday
Friday
Saturday
Even
Numbered
Years
Odd
Numbered
Years
FATHER or
MOTHER
FATHER or
MOTHER
Physical Custody
From
To
Time
Time
Special Occasions
(specify)
Halloween
Mothers Day
Fathers Day
Mothers Birthday
Fathers Birthday
Childs Birthday
Holiday Schedules
1
1
1
1
7
4
2
1
1
8
5
3
2
2
2
9
8
5
3
2
2
9
6
4
3
3
3
10
9
6
4
3
10
10
7
5
4
4
4
11
10
7
5
4
11
11
8
6
5
12
12
12
11
8
6
5
12
12
9
7
6
13
13
13
12
9
7
13
13
13
10
8
7
14
14
14
13
10
8
14
14
14
11
9
15
15
15
15
21
18
16
15
15
22
19
17
16
16
16
23
22
19
17
16
16
23
20
18
17
17
17
24
23
20
18
17
24
24
21
19
18
18
18
25
24
21
19
18
25
25
22
20
19
26
26
26
25
22
20
19
26
26
23
21
20
27
27
27
26
23
21
27
27
27
24
22
21
28
28
28
27
24
22
28
28
28
25
23
29
29
29
29
30
31
30
31
30
29
29
31
30
30
31
31
For purposes of this Parenting Plan, WEEK TWO is defined as a week that has Sunday on one of the
following dates:
January
February
March
April
May
June
July
August
September
October
November
December
8
5
5
2
1
1
1
6
3
1
1
1
9
6
6
3
2
2
9
7
4
2
2
2
10
7
7
4
3
3
10
8
5
3
3
10
11
8
8
5
4
11
11
9
6
4
4
11
12
9
9
6
5
12
12
10
7
5
12
12
13
10
10
7
6
13
13
11
8
6
13
13
14
11
11
8
14
14
14
12
9
7
14
14
22
19
19
16
15
15
15
20
17
15
15
15
23
20
20
17
16
16
23
21
18
16
16
16
24
21
21
18
17
17
24
22
19
17
17
24
25
22
22
19
18
25
25
23
20
18
18
25
26
23
23
20
19
26
26
24
21
19
26
26
27
24
24
21
20
27
27
25
22
20
27
27
28
25
25
22
28
28
28
26
23
21
28
28
30
29
29
29
31
30
30
29
29
29
30
30
30
31
31
Sunday
Monday
WEEK ONE
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
WEEK TWO
Tuesday
Wednesday
Thursday
Friday
Saturday
_________________
(First)
_____________
(Middle)
____________________
(Last)
_________
(Jr./Sr./III)
Petitioner/Plaintiff,
_____________
(Middle)
____________________
(Last)
_________
(Jr./Sr./III)
Respondent/Defendant.
PARENTING PLAN
Part B Support of the Children
1. Identification of Parties
Check one and only one of the following two boxes.
Mother is the Petitioner/Plaintiff. Father is the Respondent/Defendant.
Father is the Petitioner/Plaintiff. Mother is the Respondent/Defendant.
2. Plan Author(s)
Check all applicable boxes.
Court
Mother
Father
Guardian ad Litem
_________________________
Childs Age
Form 14
Form 14 is a form used to calculate a presumed amount of child support. Form 14 is part of this parenting
plan and is found on Part B, Page 8. The court will usually follow Form 14, however, if the court finds that the
child support calculated pursuant to Form 14 is unjust or inappropriate, it will set child support at a different
amount.
Parents must also determine the allocation and amount of other expenses of the children such as medical
and dental insurance, uncovered medical and dental expenses, day care, and other extraordinary expenses.
These expenses constitute part of the child support obligations of each parent. These other expenses may be
included in the Form 14 calculation, or they may be paid independently of the child support payment.
Parents may agree on an amount of child support and the allocation of expenses. The court does not have
to accept this agreement and can set different support amounts. Even if the parents have agreed on an amount
of child support, THEY MUST STILL CALCULATE A FORM 14 FOR THE COURT. As they work through
this parenting plan, they will also be entering the information that is required for Form 14.
Missouri law further provides that An award of joint physical custody does not preclude an award of child
support pursuant to Section 452.340 and applicable supreme court rules in determining an amount reasonable or
necessary for the support of the child. 452.375.12, RSMo. Child support may be appropriate even if both
parties have custody of the children an equal amount of time.
You must check one and only one of the following three boxes.
Neither party is required to maintain medical insurance for the benefit of the children. A health benefit
plan is not available at reasonable cost through either parents employer or union. No support rights have been
assigned to the state of Missouri and the Family Support Division is not providing support enforcement services
to either party.
Father shall maintain and pay the cost of medical insurance for the benefit of the children.
Mother shall maintain and pay the cost of medical insurance for the benefit of the children.
Paid by Father
Form 14
Paid by Mother
Extraordinary medical costs are predictable and recurring, such as expenses for dental treatment,
orthodontic treatment, asthma treatment and physical therapy. These expenses MAY be included in the Form
14 calculation. (If no extraordinary medical costs are to be included on Form 14, you may leave this
information blank.)
Form 14
You must check one and only one of the following five boxes
There are no reasonable work-related child care expenses incurred by the parties.
The reasonable work-related child care costs of the children to be paid by Father are $___________ per
month. This amount has been included in the child support calculation pursuant to Form 14. The reasonable
work-related child care costs of the children to be paid by Mother are $___________ per month. This amount
has also been included in the child support calculation pursuant to Form 14.
(You must include these amounts on Form 14 - Line 6a(1) for the parent receiving support or Line 6b for the
parent paying support.)
Mother will pay all reasonable work-related child care expenses. The cost of reasonable work-related child
care expenses has NOT been included in the child support calculation pursuant to Form 14. Father will
reimburse Mother for _______ percent of all reasonable work-related child care expenses actually paid by
Mother. Mother will not be entitled to reimbursement from Father unless said payments are appropriately
reported to the Internal Revenue Service. No reimbursement of reasonable work-related child care expenses
will be allowed unless Mother submits proof of such expense to Father in writing within 120 days of the date
said expenses were incurred. Except for good cause, no legal proceedings seeking reimbursement will be
allowed unless instituted within 360 days of the date said expenses were incurred.
Father will pay all reasonable work-related child care expenses. The cost of reasonable work-related child
care expenses has NOT been included in the child support calculation pursuant to Form 14. Mother will
reimburse Father for _______ percent of all reasonable work-related child care expenses actually paid by
Father. Father will not be entitled to reimbursement from Mother unless said payments are appropriately
reported to the Internal Revenue Service. No reimbursement of reasonable work-related child care expenses
will be allowed unless Father submits proof of such expense to Mother in writing within 120 days of the date
said expenses were incurred. Except for good cause, no legal proceedings seeking reimbursement will be
allowed unless instituted within 360 days of the date said expenses were incurred.
Each parent will pay his or her own reasonable work-related child care expenses related to his or her
employment. The cost of reasonable work-related child care expenses has NOT been included in the child
support calculation pursuant to Form 14. Neither parent will reimburse the other parent for any portion of the
child care expenses.
Paid by Mother
Percentage to be Paid by
Mother to Father
_______%
_______%
_______%
Mother will reimburse Father for the percentage amount of each of these extraordinary child-rearing costs
of the children so long as they are actually paid by Father. No reimbursement of extraordinary childrearing costs of the children will be allowed unless Father submits proof of such expense to Mother in
writing within 120 days of the date said expenses were incurred. Except for good cause, no legal
proceedings seeking reimbursement will be allowed unless instituted within 360 days of the date said
expenses were incurred.
Extraordinary Child-Rearing Costs Paid by
Mother NOT INCLUDED on Form 14
_______________________________________________________
_______________________________________________________
_______________________________________________________
Percentage to be Paid by
Father to Mother
_______%
_______%
_______%
Father will reimburse Mother for the percentage amount of each of these extraordinary child-rearing costs
of the children so long as they are actually paid by Mother. No reimbursement of extraordinary childrearing costs of the children will be allowed unless Mother submits proof of such expense to Father in
writing within 120 days of the date said expenses were incurred. Except for good cause, no legal
proceedings seeking reimbursement will be allowed unless instituted within 360 days of the date said
expenses were incurred.
Paid by Father
Paid by Mother
Form 14
Paid by Father
FATHER /
PARENT
RECEIVING
SUPPORT
PARENT
PAYING
SUPPORT
COMBINED
Calculated Amount
Calculated Amount
Calculated Amount
Calculated Amount
Calculated Amount
Calculated Amount
0.0%
Calculated Amount
Calculated Amount
0.0%
Calculated Amount
Calculated Amount
Paragraph 10
Calculated Amount
Calculated Amount
6b. Reasonable work-related child care costs of the parent paying support
Paragraph 10
6c. Health insurance costs for children who are the subjects of this proceeding
Paragraph 5
Paragraph 9
Paragraph 14a
7. TOTAL ADDITIONAL CHILD-REARING COSTS (Enter sum of lines 6a, 6b, 6c, 6d
and 6e)
Calculated Amount
Calculated Amount
Calculated Amount
Calculated Amount
Calculated Amount
Calculated Amount
Calculated Amount
Calculated Amount
12. PRESUMED CHILD SUPPORT AMOUNT (Line 9 minus lines 10 and 11)
Calculated Amount
Complete all applicable amounts. The court-ordered support amount is set forth in Part B, Paragraph 17.
The presumed child support amount calculated pursuant to Form 14 for six children is: ____________.
The presumed child support amount calculated pursuant to Form 14 for five children is: ____________.
The presumed child support amount calculated pursuant to Form 14 for four children is: ____________.
The presumed child support amount calculated pursuant to Form 14 for three children is: ____________.
The presumed child support amount calculated pursuant to Form 14 for two children is: ____________.
The presumed child support amount calculated pursuant to Form 14 for one child is:
____________.
16. Should the court order the child support pursuant to Missouri Child Support Guidelines?
You must check one and only one of the following two boxes.
Yes. The court-ordered child support is the same as the presumed children support amount. The presumed
child support amount as calculated herein is not rebutted as being unjust and inappropriate.
No. The court-ordered child support is different than the presumed children support amount. After
consideration of all relevant factors pursuant to 452.340.8, RSMo and Form 14, the child support as calculated
herein is rebutted as being unjust and inappropriate.
NOTE: Court-ordered child support will be set at the time of the court proceeding. The court is not bound by
the suggestions of the parties and may set an amount greater or lesser than the suggested amounts of courtordered child support set forth in this parenting plan. If the court approves and adopts this plan, then the
support provisions herein will become the order of the court.
NOTE: The Form 14 calculation assumes that the person receiving support will claim the children as
dependents. If the person paying support is entitled to claim one or more of the children, then the Form 14
guidelines are unjust and inappropriate and the second box in Paragraph 16 should be checked.
If the person claiming the children is not listed below, then the person receiving support shall be entitled to
claim the omitted children as dependents in all years.
Name of Child
____________________________
Mother
____________________________
Father
____________________________
Attorney for Mother
____________________________
Attorney For Father
____________________________
Guardian ad Litem
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Table of Contents
Case Number
Parties
Information
shown in blue
on this form
does not print.
MISSOURI
Division Number
____________________________________________.
(Full Name of Petitioner/Plaintiff)
Information
about the
Hearing
(Time of Hearing)
The hearing will be held promptly at the Courthouse in the above County and Division.
Party Giving
Notice
_________________________________
SIGN HERE
___________________________
PRINT YOUR NAME HERE
__________
BAR NUMBER
______________________________________________________________________
(Street)
_________________________
(City)
__________________
(Telephone Number)
Proof of
Service
__________________
(State)
_______________
(Fax Number)
______________
(Zip)
_____________________________________
(Email Address)
I certify under oath that I have given _____________________ a copy of this Notice of Hearing
pursuant to Missouri Supreme Court Rule 43.01(d) by: (You MUST check at least ONE of the
following four boxes)
Mailing a copy to the other party or his or her attorney on ____________________ (Date)
at the following address:
______________________________________________________________________
(Street)
_________________________
__________________
______________
(City)
(State)
(Zip)