Fill and Sign the Free in the Superior Court for the State of Alaska Case Form

AS 25.24.200-.260 Page 1 of 17 DR-105 ( 10/18)(cs) PETITION FO R DISSOLUTION O F MARRIAGE (WITH CHILDREN) Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Dissolution ) of the Marriage of ) ) ) CASE NO. Party A, ) ) Party B. ) PETITION FOR DISSOLUTION ) OF MARRIAGE (WITH CHILDREN) There is an open Child- in-Need- of-Aid Case. Court Location: . Case number (if known): . We consent to the court’s jurisdiction and request a decree of dissolution of marriage. Our marriage has broken down and we no longer want to be married . We agree this petition is the entire agreement between us. We understand that only the agreements in this petition and attachments are enforceable. I. INFORMATION ABOUT THE PARTIES Has either spouse filed an action for legal separation before filing this action? Yes No If yes, please list the case number, date, and place of filing: A. PARTY A 1. Date of birth: Place of birth: 2. Length of Alaska residence: Driver’s License Number: 3. Home phone: Cell phone: 4. Residence address: (street address) (city) (state) (ZIP) 5. Mailing address: (box or street number) (city) (state) (ZIP) 6. Email Address*: * I authorize the court to email me court documents in this case to the email address above. 7. Occupation: Work phone: 8. Most recent employer: Phone: 9. Employer’s address: B. PARTY B 1. Date of birth: Place of birth: 2. Length of Alaska residence: Driver’s License Number: 3. Home phone: Cell phone: 4. Residence address: (street address) (city) (state) (ZIP) 5. Mailing address: (box or street number) (city) (state) (ZIP) 6. Email Address*: * I authorize the court to email me court documents in this case to the email address above. 7. Occupation: Work phone: 8. Most recent employer: Phone: 9. Employer’s address: Print or Type Party A’s Name Print or Type Party B’s Name Signature of Party A Signature of Party B Signature of Party A Page 2 of 17 DR-105 (10/18)(cs) PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) C. Date and Place of Marriage. Date of marriage: / / (month) (day) (year) Place of marriage: (city) (state) D. Health Care and Health Insurance Does either spouse need medical care or treatment? Yes No If yes, state which spouse and describe the care or treatment needed: Is either spouse covered by health insurance (by an employer or otherwise)? Yes No If yes, state which spouse and the amount paid for the insurance by the spouse or spouses: E. Domestic Violence Has either spouse been involved in any of the following during the marriage: 1. a criminal charge of a crime involving domestic violence, 2. a domestic violence protective order under AS 18.66.100-18.66.180 , 3. injunctive relief against domestic violence under former AS 25.35.010 or 25.35.020, or 4. a domestic violence protective order issued in another jurisdiction and filed with the court in this state under AS 18.66.140? Yes No If yes, describe below: Has there been any domestic violence during the marriage (whether or not the police were involved or anything was filed in court )? Yes No F. Has either spouse received advice from an attorney about dissolution or divorce? Yes No If yes, state which spouse(s): Is either spouse represented by an attorney? Yes No If yes, state which spouse(s): Signature of Party BPrint or Type Party A’s Name Print or Type Party B’s Name AS 25.24.200-.260 Page 3 of 17 DR-105 (10/18)(cs) PETI TION FOR DISSOLUTI ON OF MARRIAGE (WITH CHILDREN) Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) II. FINANCIAL INFORMATION Each party must attach a copy of his or her most recent federal tax return, W2, and at least two recent paystubs. If income is seasonal, show yearly income. If income or deductions will change after the dissolution, file documents showing expected income and deductions. The income and deductions are monthly yearly. A. Gross Income (Do not list ATAP or SSI below.) Party A Party B Gross w ages $ $ Va lue of employer - provided housing/food/etc. 1 $ $ Unemployment c ompensation $ $ Permanent fund dividend (PFD) $ $ Other: $ $ $ $ TOTAL INCOME= $ = $ B. Deductions Allowable Under Civil Rule 90.3 Federal , state and local income tax $ $ Social security tax (FICA) or self - employment tax $ $ Medicare tax $ $ Employment security tax (SUI) $ $ Mandatory retirement contributions $ $ Mandatory union dues $ $ Voluntary retirement contributions if plan earnings are tax - free or deferred , u p to 7.5% of gross wages & self - employ. income when combined with mand. contrib. $ $ Other mandatory deductions (specify): $ $ A limony ordered in other cases and currently paid 2 $ $ Child support ordered for prior children 3 $ $ In - kin d support for prior children 4 $ $ Work - related child care for children in this case $ $ Health insurance for parent (limited to 10% of wages) 5 $ $ TOTAL DEDUCTIONS $ $ C. Net Income TOTAL INCOME from section A $ $ TOTAL DEDUCTIONS from section B $ $ Subtract deductions from income to get NET INCOME $ $ Print or Type Party A’s Name Print or Type Party B’s Name Signature of Party A Signature of Party B 1 This also includes COLA, military BAH, and BAS. 2 Includes spousal support ordered in other cases and currently paid. 3 “Prior children” include children from a different relationship who were born or adopted before the children in this case. 4 For more information, see Prior Child Deduction Chart and Civil Rule 90.3(a)(1)(D). 5 This deduction cannot be more than 10% of gross wages and self-employment income, under 90.3(a)(1)(F). Signature of Party A Page 4 of 17 DR-105 (10/18)(cs) PETITIO N FOR DISSOLUTION OF MARR IAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) D. Adjusted Annual Income Party A Party B 1. If the above figures are based on monthly information, multiply NET INCOME from section C by 12 to get 2. If the above figures are based on yearly information, repeat the NET INCOME amount from section C to show This figure will be used to calculate child support on page 11. E. Monthly Expenses Party A Party B Housing and utilities $ $ Food $ $ Transportation $ $ Medical $ $ Other $ $ $ $ $ $ $ $ I II. PROPERTY AND DEBT INFORMATION, AND AGREEMENT OF PARTIES Below is a list of our asse ts and debts, and ou r agreemen t about dividin g ou r asse ts and debts. We believe the division below is fair and just. A. Assets [Describe all your property and its value. Then check the boxes showing whether it was acquired during the marriage, who possesses it now, and to whom you want it awarded.] 1. Do you have a written community property agreement or a community property trust und er Alaska law (AS 34.77)? Yes No Be sure to include community property in the lists below. Signature of Party B ADJUSTED ANNUAL INCOME $ $ ADJUSTED ANNUAL INCOME $ $ TOTAL EXPENSES $ $ F. Bankruptcy. Party A Party B filed for bankruptcy and that case is pending. Acquired During Marriage Currently Possessed By To Be Awarded To 2. Real Property (land and buildings) provide street address or legal description Value yes no A B JT A B JT * $ $ $ $ $ Print or Type Party A’s Name Print or Type Party B’s Name Page 5 of 17 DR-105 (10/18)(cs) PETITIO N FOR DISSOLUTION OF MARR IAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) * For jointly awarded real property at address : a. We will sell the property and split any profit with % to Party A and % to Party B. Until the property is sold, Party A Party B will make all payments and decisions about the property, and will will not be reimbursed from sale proceeds before any profit is paid. b. One of us will buy the other out . Party A Party B will buy the other party’s interest in the property in an amount equal to % of the fair market value. We also agree that the amount of this payment will be $ or we will have a licensed appraiser or real estate broker determine the property’s fair market value. We will select the appraiser or broker together. c. Other: Use separate sheets for other real property to be awarded jointly. [Note: An award of real property to the parties jointly does not convey a right of survivorship. Consult an attorney with concerns about your right of survivorship. AS 13.12.804(a)(2).] 3. Motor Vehicles (include make, model, a nd license or registration number, and/ or vehicle identification number for each vehicle, mobile home, ATV, boat , snow machine , etc . ) Acquired During Marriage Currently Possessed By To Be Awarded To Value yes no A B JT A B JT $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Signature of Party A Signature of Party B Print or Type Party A’s Name Print or Type Party B’s Name Signa ture of Part y A Page 6 of 17 DR-105 (10/18)(cs) PETITIO N FOR DISSOLUTION OF MARR IAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) 4. Other Property ( furni ture , appliances, jewelry, computers, guns, tools , bank accounts, etc. For ban k or other financial institution accounts, you may list the last 3 digits of the account number and the n ame of the issuing institution.) Acquired During Marriage Currently Possessed By To Be Awarded To Value yes no A B JT A B JT $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 5. Retirement Benefits. We understand that this agreement is only between us and that pension plan provider(s) may require other documents to accept our agreement. We also understand that the court will not draft a waiver document or an order including a qualified domestic relations order (QDRO) that divides the retirement asset(s). Neither of us earned retirement or military pension benefits during the marriage. One or both of us earned retirement or pension benefits during the marriage: Party A earned retirement or military pension benefits during the marriage: Last 3 numbers of account Value of account Being paid now? (Y/N) Party B earned retirement or military pension benefits during the marriage: Last 3 numbers of account Value of account Being paid now? (Y/N) We agree that we will each keep our own retirement and pension benefits. This is fair and equitable because: Signature of Party B Print or Type Party A’s Name Print or Type Party B’s Name Signa ture of Part y A Page 7 of 17 DR-105 (10/18)(cs) PETITIO N FOR DISSOLUTION OF MARR IAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) Our agreement about the distribution of retirement or military pension benefits is attached. If the agreement is not accepted by the retirement plan administrator as a qualified domestic relations order (QDRO), we agree that the court, upon motion by a party, may make any necessary changes. If changes are necessary, we agree that the effective date of the order will remain the date of our original dissolution decree. A copy of the present value statement from the plan administrator for each retirement account is attached. [Note: This is required. An account statement is not the same as a present value statement. You should consult an attorney if you have concerns about the valuation of pension benefits.] 6. Transfer Deadline. All payments from one party to the other party will be made by.All documents necessary to carry out this agreement (including but not limited to signing quit claim deeds, refinancing, transferring title) will be done by . Any property stored by one party for the other will be transferred by . B. Debts [List every debt owed whether or not it is a joint debt. List to whom each debt is owed and the amount owed. Then check the boxes showing whether the debt was incurred during the marriage, who now owes the debt, and who you agree will pay it. Include ALL debts that are currently owed (mortgages, car loans, credit cards, etc.) For credit card, bank card, or debit card accounts, you may list the last 4 digits of the account number and the name of the issuing institution. Note: Even though you agree who is responsible to pay a debt that i s in both of your names, the bank or other cre ditor may still hold the other spouse responsible for the debt if payments are not made.] Incurred During Marriage Currently Owed By To Be Paid By Owed To Amount yes no A B JT A B JT $ $ $ $ $ $ $ $ $ $ $ $ IV. SPOUSAL MAINTENANCE (ALIMONY) AGREEMENT $ per month to be paid by Party A Party B, beginning until or until the recipient dies or remarries. If child support payments will be made through CSSD, you may also have spousal maintenance payments made through CSSD. Do you want spousal maintenance payments to be made through CSSD? Yes No Signature of Party BPrint or Type Party A’s Name Print or Type Party B’s Name AS 25.24.200-.260 Signa ture of Part y A Page 8 of 17 DR-105 (10/18)(cs) PETI TION FOR DISSOLUTI ON OF MARRIAGE (WITH CHILDREN) Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) V. CHILD CUSTODY JURISDICTION INFORMATION A. The following are children under age 19 and born of the marriage or adopted by the parties: CHILD 1 First Name Middle Name Last Name Date of Birth Place of Birth Gender Male Female Curre nt Address (since ____/____/____) Who has custody? Relationship Past Addresses (last 5 years) City and State Who did this child live with then? (name and current address) Relationship From To CHILD 2 First Name Middle Name Last Name Date of Birth Place of Birth Gender Male Female Current Address (since ____/____/____) Who has custody? Relationship Past Addresses (last 5 years) City and State Who did this child live with then? (name and current address) Relationship From To CHILD 3 First Name Middle Name Last Name Date of Birth Place of Birth Gender Male Female Current Address (since ____/____/____) Who has custody? Relationship Past Addresses (last 5 years) City and State Who did this child live with then? (name and current address) Relationship From To Signature of Party B Print or Type Party A’s Name Print or Type Party B’s Name AS 25.24.200-.260 Page 9 of 17 DR-105 (10/18)(cs) PETI TION FOR DISSOLUTI ON OF MARRIAGE (WITH CHILDREN) Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) CHILD 4 )LUVW1DPH  0LGGOH1DPH  /DVW1DPH  'DWHRI%LUWK  3ODFHRI%LUWK  *HQGHU  0DOH  )HPDOH &XUUHQW$GGUHVV (since ____/____/____) Who has custody? Relationship Past Addresses (last 5 years) City and State Who did this child live with then? (name and current address) Relationship From To [Attach extra pages if there are more than four children.] B. Has either Party A or Party B participated as a party, a witness, or in another capacity in another proceeding concerning the custody of any of the above children or visitation with them? Yes No If yes, describe the previous child custody determination: Name of Court Case Number Date Court’s Decision C. Does either Party A or Party B know of a proceeding that could affect this dissolution case (such as a proceeding relating to domestic violence, protective orders, termination of parental rights, adoption or enforcement of a court order)? Yes No If yes, describe: Name of Court Case Number Nature of Proceeding D. Does either Party A or Party B know of any person not a party to this dissolution case who has physical custody of any of the above children or claims to have the right to physica l custody, legal custody, or visitation? Yes No If yes, list each person’s name and address, and what the person claims: E. Is Party A or Party B pregnant? Yes No If yes, include arrangements for this child in the following sections. F. Is paternity disputed regarding any child? Yes No Has paternity been disestablished for any child born during the marriage? Yes No If you answer yes to either of these questions, there may be additional requirements. Print or Type Party A’s Name Print or Type Party B’s Name Signature of Party A Signature of Party B NOTE: You both have a continuing duty to inform the court of any other court proceeding in this state or any other state concerning any of the children listed above. Page 10 of 17 DR-105 (10/18)(cs) PETITIO N FOR DISSOLUTION OF MARR IAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) VI. CHILD CUSTODY AGREEMENT Name of Child Physical Custody Awarded To Legal Custody Awarded To If you agreed to a shared physical custody arrangement, you must specify the custody schedule. You may use the model parenting form (DR-475 ) or describe the schedule below: VII. VISITATION AGREEMENT A. Visitation Rights of Parents We agree will have the following specific visitation rights: summer vacation: holidays: weekends: other: [If you want child support reduced, you must specify dates as explained in section V, page 11, of the Instructions.] Our agreement about parenting and visitation is set forth in the attached parenting agreement (DR-475 or other). We understand that the court must approve a parenting agreement as being in our child(ren)’s best interest. We also understand that this dissolution will not be approved until we have an approved parenting plan. B. Visitation with Other Persons Names of Other Persons: Describe visitation agreement: Signature of Party A Signature of Party B Print or Type Party A’s Name Print or Type Party B’s Name Signa ture of Part y A Page 11 of 17 DR-105 (10/18)(cs) PETITIO N FOR DISSOLUTION OF MARR IAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) V II I. CHILD SUPPOR T (Civil Rule 90.3 ) [Note: You cannot waive child supp ort or agre e to a differen t amoun t than what is calculated under Civil Rule 90.3, unless one of the exceptions in Civil Rule 90.3(c) applies. For example, the obligor’s adjusted annual income is more than $126,000; or the obligor’s annual income is so low tha t the amoun t of support would be less than $600; or you can prove to the cou rt that manife st injustice will resu lt unle ss the support amoun t is varied.] A. Child Support Calculati on Party A Party B 1. a. Adjusted Annual Income (from II.D. on page 4) $ $ b. If line 1.a. is more than $126,000, write $126,000 here. Otherwise, repeat amount on line 1.a.: 2. Multiply line 1.b. by: .20 for one child; .27 for two children; x x .33 for three children; and .03 for each additional child TOTAL 3. Monthly Child Support Payment (before calculating child's health insurance adjustment). Child support will be paid as stated below. The first payment will be made no later than . Payments after that will be made no later than the 1 day of each month thereafter. [See definitions of types of custody in Civil Rule 90.3(f).] a. Primary Custody. One parent has primary physical custody. Divide Annual Child Support amount from line 2 above for the non-custodial parent by 12 = $ to be paid each month by Party A Party B. b. Share d Custody. The child(ren) will reside with each paren t for a perio d specified in writing of at least 30% of the year. [Attach form DR-306 to show calculations.] Monthly child support payment (from line 10 of DR-306) to be paid each month except = $ to be paid by the Party A Party B. c. Divided Custody. Each paren t will have primary physica l custody of one or more of the children and the parents will not share physical custody of any of the children. [Attach form DR-307 to show your calculations.] Month ly child support paymen t (from line 7 of DR-30 7) = $ to be paid by the Party A Party B. d. Hybrid Custody. One paren t has prima ry physical custody of one or more of the children and the parents will share physical custody of at least one child of the relationship. [Attach form DR-308 to show your calculations.] Month ly child support paymen t (from line 8 of DR- 308) = $ t o be paid by the Party A Party B. Signature of Party B ANNUAL CHILD SUPPORT $ $ (amount from “TOTAL” line above or  ZKLFKHYHULVODUJHU  Print or Type Party A’s Name Print or Type Party B’s Name Signa ture of Part y A Page 12 of 17 DR-105 (10/18)(cs) PETITIO N FOR DISSOLUTION OF MARR IAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) 4. Children's Health Care Coverage. a. Health Insurance. I f the children are covered by an insurance company other than the Indian Health Service or Tricare, you should also fill out court form DR-330, Notice to Employer Re: Children’s Medical Insurance. (1) Does Party A have health insurance available for the child(ren) at reasonable cost through Party A’s employer, union, or otherwise? Yes No (2) Does Party B have health insurance available for the child(ren) at reasonable cost through Party B’s employer, un ion, or otherwise? Yes No (3) Are the children eligible for services th rough the Indian Health Service? Yes No (4) Do the children have other health insurance or care available? Yes No Describe: If the answer to (3) and (4) is no, one of the parents must agree to provide insurance for the child(ren) if such insurance is available at a reasonable cost. The cost of the children’s insurance must be divided equally by the parents unless the court orders a different division for good cause. AGREEMENT: Health insurance for the child(ren) will be purchased by: Party A at a monthly cost to Party A of $ * Party B at a monthly cost to Party B of $ * through the above person’s employer union whose name and address are The cost of health insurance for the child(ren) will be divided between the parties equally Explain reason for unequal division: [*List only the cost to insure the children involved in this case. If there is no extra cost to the parent to inclu de the children in the parent’s insurance coverage, you cannot deduct any cost f or the children’s health insurance . The parent must submit documentation from the health insurance provider (employer, union, etc.) showing separately the cost of health insurance for the parent and the parent’s dependents. See Civil Rule 90.3(d) for further explanation. For more information, see Calculating Cost of Child(ren)’s Health Insurance chart on the court’s website.] b. Children's Health Care Expenses Not Covered by Insurance (including medical, dental, vision and mental health counseling expenses). We agree that the children’s reasonable health care expenses not covered by insurance will be paid as follows (unless they are over $5,000 in a calendar year): Party A will pay half and Party B will pay half. Party A will pay and Party B will pay . Explain reason for not sharing these uncovered expenses equally: If the uncovered expenses are over $5,000 in a calendar year, the parties will pay based on their relative financial circumstances when the expense occurs. Signature of Party B Print or Type Party A’s Name Print or Type Party B’s Name Signa ture of Part y A Page 13 of 17 DR-105 (10/18)(cs) PETITIO N FOR DISSOLUTION OF MARR IAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) We agree that each of us will reimburse the other for our share of uncovered health care expenses within 30 days after we are given the bill, proof of payment and, if applicable, a health insurance statement (EOB) showing what part of the cost is uncovered. We understand that the bills and other materials must be sent to the other parent for reimbursement within a reasonable time. 5. Monthly Child Support Payment (including adjustment for children's health insurance). a. Monthly Child Support Payment from paragraph 3 above (on page 1 1) $ b. If obligor is buying health insurance for the child(ren), subtract 50% (or %) of the monthly insurance payment. –$(The “obligor” is the parent paying child support.) c. If obligee is buying health insurance for the child(ren), add 50% (or %) of the monthly insurance payment. + $ (The “obligee” is the parent receiving child support.) 6.We calculated t he Net Monthly Child Support Payment in paragraph 5.d. according to: a. The formula in Civil Rule 90.3(a) or (b). b. Civil Rule 90.3(c)(2). Obligor’s adjusted annual income is more than $126,000. c. Civil Rule 90.3(c)(3). Obligor’s amount of support is less than $600 per year. Obligor’s income is low because obligor is: incarcerated unable to work because other d. Civil Rule 90.3(c)(1). Manifest injustice will result if support is no t varied because: 7. Seasonal Income. Obligor’s income is seasonal and obligee agrees that, as long as the total annual amount remains the same, obligor can make higher payments during high income months and lower payments during low income months as follows: Higher Monthly Amount $ should be paid in (list months) Lower Monthly Amount $ should be paid in (list months) 8. Travel Expenses. Travel expenses necessary for visitation will be paid as follows: Signature of Party B d. Net M onthly Child Support Payment $ Print or Type Party A’s Name Print or Type Party B’s Name Signa ture of Part y A Page 14 of 17 DR-105 (10/18)(cs) PETITIO N FOR DISSOLUTION OF MARR IAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) 9. Native Corporation Dividends. a. The custodian of any Native Corporation dividends paid on behalf of the child(ren)will be b. Except as provided below, the funds will be saved in an account for the child(ren) . Both parents will have access to all statements from the account annually. c. Any taxes owing on any Native Corporation dividends paid on behalf of the child(ren) will be timely paid by (name) d. Any Native Corporation dividends paid on behalf of the children: May be spent for the child(ren)’s health, education, and welfare. May be spent only if both parents provide prior written approval. Other: 10. Extended Visitation Credit. This credit does not apply to us. This credit applies to us because one of us will have primary physical custody and the other (the obligor parent) will have extended visits with the children for periods longer than 27 consecutive days. If and when the obligor parent actually exercises the extended visitation, child support will be reduced for these periods as follows: [Note: This credit may not be more than 75% of the amount owed for the period .] B. We agree that child support will continue while each child is 18 years old as long as the child is (1) unmarried, (2) actively pursuing a high school diploma or equivalent level of technical or vocational training, and (3) living as a dependent with the obligee parent or guardian or a designee of the parent or guardian. We object to continuing child support to the date of graduation because: C. Do you want the assistance of the Child Support Services Division (CSSD) to enforce the support order and keep records of the payments? Yes No If yes, fill out the attached applic ation for CSSD services. [Note: If the parent with custody of the children is receiving assistance from the Alaska Temporary Assistance Program (ATAP), child support payments must be made to CSSD.] D. Immediate Income Withholding Child support will be withheld from the income of the person paying support and paid through the Child Support Services Division (CSSD) unless one of the following exceptions is approved by the court: We made the following alternative arrangement [Note that if you receive ATAP, CSS D must agree to the arrangement]: Also, the person paying support agrees to keep the other party (or CSSD if CSSD is enforcing the order) informed of his/her current employer and the availability of employment-related health insurance coverage for the child(ren) until the support order is satisfied. Signature of Party B Print or Type Party A’s Name Print or Type Party B’s Name Signa ture of Part y A Page 15 of 17 DR-105 (10/18)(cs) PETITIO N FOR DISSOLUTION OF MARR IAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) We believe there is good cause not to require immediate income withholding because it is not in the best interests of the child(ren) for the following reason: Also, the person paying support agrees to keep the other party (or CSSD if CSSD is enforcing the order) informed of his/her current employer and the availability of employment-related health insurance coverage for the child(ren) until the support order is satisfied. The person paying support currently receives social security or other disability compensation that includes regular payments to the child(ren) at least equal to the child support owed each month. Monthly payment to child(ren): $ . Source of the payment: . [Note: To the extent that these payments to the children do not satisfy the monthly amount owed, the court will order that the remaining amount due be withheld from income.] E. Federal Taxes 1. Federal Tax Credit. We agree as follows: will claim the child(ren) every year. Other: The parties also agree to provide each other with a signed IRS Form 8332, if needed, by February 1 so that it may be timely filed with the IRS. This agreement regarding tax benefits may be modified without a court order if both parties agree in writing. As required by AS 25.24.232, we also agree that the parent who has physical custody of the child(ren) for a period less than the other parent may not claim the tax benefits in any tax year if on December 31 of that year the parent was behind in child support payments in an amount more than four times the monthly child support obligation. 2. Federal Tax Considerations. We understand that physical custody of a child may impact whether we can claim tax benefits such as the Earned Income Credit, Head of Household filing status, and Credit for Dependent (Child) Care Expenses. F. Permanent Fund Dividend (PFD) 1. We agree that will timely apply for the Alaska PFD on behalf of the child(ren) while they are minors. The parent who claims the child(ren) for tax purposes also agrees to timely pay the taxes on the children’s PFD. 2. Except as provided below, the child(ren)’s PFD funds will be saved in an account for the child(ren). Both parents will have access to all statements from the account annually. Signature of Party B Every year, Party A will claim the following child(ren) and Party B will claim the following child(ren) Print or Type Party A’s Name Print or Type Party B’s Name The parents will claim the child(ren) in alternating years with Party A Party B claiming the child(ren) for odd-numbered tax years such as 2019 and 2021, and the other parent claiming them for even-numbered tax years such as 2020 and 2022. Signa ture of Part y A Page 16 of 17 DR-105 (10/18)(cs) PETITIO N FOR DISSOLUTION OF MARR IAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) 3. The child(ren)’s PFD funds: May be spent for the child(ren)’s health, education, and welfare. May be spent only if both parents provide prior written approval. Other: IX . RESTORE OR CHANGE NAME Restore Name. Party A and/or B wants to restore a prior name (print full names clearly): From: To: (Party A’s current full name) (Party A’s prior full name) From: To: (Party B’s current full name) (Party B’s prior full name) Change to New Name. [Before checking this box, it is important to read the instructions. Failure to publish notice of your hearing on the court’s website may delay the decree of dissolution or result in denial of the requested name change.] (current legal name) known by a new name, which is The reasons for this request for a change of name are: The party seeks this name change for personal reasons and not to avoid judgments, debts, obligations, or to defraud any person. The reasons stated are consistent with the public interest. X. OTHER AGREEMENTS (IF ANY) Signature of Party B wants to take and be legally Party A B, Print or Type Party A’s Name Print or Type Party B’s Name Page 17 of 17 DR-105 (10/18)(cs) PETITIO N FOR DISSOLUTION OF MARR IAGE (WITH CHILDREN) AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)-(B), (i)(1) XI. SIGNATURES AND VERIFICATIONS After you have both completely filled out this petition, each of you must sign below in front of a notary. Each signature on this page must be separately notarized. You will need to show identification to the notary. Verification I say on oath or affirm under penalty of perjury that I have read this petition and believe that all statements made in th is petition are true. I also certify that I am signing voluntarily and not because of fear, threat, coercion, or restraint. I also state that this petition contains the entire agreement between my spouse and me. Signature of Party A Signature of Party B Date Date Subscribed and sworn to or affirmed before me at , Alaska, . Clerk of Court, Notary Public or other person authorized to administer oaths. My commission expires: (SEAL) Subscribed and sworn to or affirmed before me at , Alaska, on . Clerk of Court, Notary Public or other person authorized to administer oaths. My commission expires: (SEAL)