Fill and Sign the Held a Final Hearing in This Matter Now Finds the Following Form

Page 1 of 10 Form PS-31152-9 Revised by State Court Administration 12/2014 STATE OF INDIANA ) SUPERIOR / CIRCUIT COURT 1 ) SS: 2 COUNTY OF ) IN THE CIVIL DIVISION, ROOM CA USE NO. 3 IN RE THE MARRIAGE OF: 4 5 Petitioner, 6 and 7 8 Respondent. 9 DECREE OF DISSOLUTION OF MARRIAGE 10 The Court having reviewed the Verified Petition for Dissolution of Marriage and having 11 held a final hearing in this matter, now finds the following: 12 The parties having submitted this Settlement Agreement and the Court having seen and 13 considered the Verified Petition of Dissolution of Marriage and Verified Waiver of Final Hearing 14 submitted by the parties, now approves the following: 15 1. The parties were married on , and separated on 16 2. has been a continuous resident of County for 17 the last three months, and the State of Indiana for the last six months prior to the filing of the 18 Verified Petition for Dissolution of Marriage. 19 3. pregnant. 20 4. Neither party is a member of the military. 21 5. Children: 22 There are no children of the marriage. 23 There are children of the marriage; namely: 24 Name Date of birth: 25 26 27 28 29 . Page 2 of 10 Form PS-31152-9 Revised by State Court Administration 12/2014 Petitioner Respondent 6. Custody and care of the minor child(ren). It is in the best interest of the child(ren) that: 30 The parties shall have joint legal custody over the minor child(ren) with Petitioner 31 being the primary custodial parent. 32 The parties shall have joint legal custody over the minor child(ren) with 33 Respondent being the primary custodial parent. 34 Petitioner shall have sole legal custody of the minor child(ren) and shall be the 35 primary custodial parent. 36 Respondent shall have sole legal custody of the minor child(ren) and shall be the 37 primary custodial parent. 38 Other: ( please describe in detail ) 39 40 41 42 43 7. Parenting Time with the minor child(ren) shall be as follows: 44 45 shall have reasonable parenting time with the minor child(ren ), at a minimum, as set out by the Indiana Parenting Time Guidelines. 46 47 Other: The parties agree that it is in the best interests of the minor child(ren) 48 to follow a parenting time schedule that does NOT follow the 49 Indiana Parenting Time Guidelines ( please describe the schedule in 50 detail and give reasons why the alternative schedule is justified ): 51 52 53 54 55 56 57 Page 3 of 10 Form PS-31152-9 Revised by State Court Administration 12/2014 Petitioner Respondent Petitioner Respondent Petitioner Respondent Petitioner Respondent Petitioner Respondent Petitioner Respondent 8. Child Support 58 will pay child support in the amount of per 59 week, as shown by the attached child support worksheet, through the 60 County Clerk’s office, or by income withholding order if available 61 from the employer, beginning on the first Friday following the date 62 of the decree. 63 64 65 shall be responsible for payment of all controlled expenses related to the upbringing of the minor child(ren). (For use only in cases when parenting time is equally shared.) 66 will be responsible for the first of uninsured 67 medical expenses for the minor child(ren). Thereafter, Petitioner 68 shall be responsible for % of uninsured medical expenses, and 69 Respondent shall be responsible for % of uninsured medical 70 expenses for the minor child(ren). 71 will be responsible to pay the administrative fee that the Clerk 72 charges annually. 73 9. The provisions for health insurance maintenance shall be as follows: 74 shall maintain medical, dental, and optical insurance as available 75 through employment for the minor children: 76 Health insurance for the child(ren) is not available to either parent at a reasonable 77 cost, therefore, neither party is ordered to provide health insurance at this time. In 78 the event that health insurance for the children becomes available at a reasonable 79 cost to one or both of the parties, the party to whom such coverage is available shall 80 obtain coverage for the children within a reasonable time after such coverage 81 becomes available. 82 10. The arrangement for claiming the tax credits, exemptions, and deductions for the minor 83 child(ren) shall be as follows: 84 shall be entitled to claim the minor child(ren) for federal, state, and 85 local income tax purposes on an annual basis; The parties shall 86 cooperate to sign all necessary documents that will allow the party 87 claiming the exemption to do so. 88 Page 4 of 10 Form PS-31152-9 Revised by State Court Administration 12/2014 Petitioner and Respondent shall each be entitled to claim the minor child(ren) for 89 federal, state, and local income tax purposes in alternating years; Petitioner shall 90 be entitled to claim the minor child(ren) in the year , and every even/odd year 91 thereafter; Respondent shall be entitled to claim the minor child(ren) in the year 92 , and every even/odd year thereafter. The parties shall cooperate to sign all 93 necessary documents that will allow the party claiming the exemption to do so. 94 11. The division of jointly held debts shall be as follows : 95 The parties have no outstanding debt for which they are jointly responsible. 96 Petitioner will be solely responsible for the following debts and shall hold 97 Respondent harmless from liability, expense, attorney’s fees, and loss wh ich may 98 be incurred by Respondent, arising out of Petitioner’s failure to pay such debts. : 99 Name of Creditor Amount of Debt 100 101 102 103 104 Respondent will be solely responsible for the following debts, and shall hold 105 Petitioner harmless from liability, expense, attorney’s fees, and loss wh ich may be 106 incurred by Petitioner, arising out of Respondent ’s failure to pay such debts. : 107 Name of Creditor Amount of Debt 108 109 110 111 112 12. The individual debt division shall be as follows: 113 Debts held in Petiti oner’s name only 114 Petitioner will be solely responsible for the all debts held in his/her individual 115 name, and all debts incurred by him/her in his/her name since the date of final 116 separation. Petitioner agrees to hold Respondent harmless from liability, expense, 117 attorney’s fees, and loss which may be incurred by Respondent, arising out of 118 Petitioner’s failure to pay such debts. 119 Page 5 of 10 Form PS-31152-9 Revised by State Court Administration 12/2014 Other: 120 121 122 123 124 Debts held in Respondent’s name only : 125 Respondent will be solely responsible for the all debts held in his/her individual 126 name, and all debts incurred by him/her in his/her name since the date of final 127 separation. Respondent agrees to hold harmless Petitioner from liability, expense, 128 attorney’s fees, and loss which may be incurred by Petitioner, arising out of 129 Respondent ’s failure to pay such debts. 130 Other: 131 132 133 134 135 13. The vehicle division shall be as follows: 136 There are no vehicles to divide. 137 Petitioner will have sole possession of the following vehicles, and Respondent 138 shall execute all documents necessary to transfer title of said vehicles within a 139 reasonable time following the date of this Order: 140 141 (Vehicle #1, Make, Model, and Year) 142 143 (Vehicle #2, Make, Model and Year) 144 Respondent will have sole possession of the following vehicles, and Petitioner 145 shall execute all documents necessary to transfer title of said vehicles within a 146 reasonable time following the date of this Order: 147 148 (Vehicle #1, Make, Model, and Year) 149 150 (Vehicle #2, Make, Model and Year) 151 Page 6 of 10 Form PS-31152-9 Revised by State Court Administration 12/2014 Petitioner Respondent Petitioner Respondent Petitioner Respondent Petitioner Respondent Petitioner Respondent All outstanding debt related to the above-listed vehicles has been allocated in 152 paragraph 12 of this agreement/Order. 153 14. The parties ’ personal property division shall be as follows: 154 The parties already have divided all items of property. 155 Petitioner will have sole possession of the following items of property: 156 157 158 159 160 Respondent will have sole possession of the following items of property: 161 162 163 164 165 15. Marital Residence: 166 The parties are owners of real estate located at 167 , and the partie s agree that: 168 shall retain/take possession and shall become the sole owner of said 169 real estate 170 shall vacate the marital residence by . 171 shall be responsib le for all payments related property taxes and 172 homeowners insurance and shall receive the deductions for mortgage 173 interest and taxes. 174 shall transfer, by Quitclaim Deed, his/her interest in said real estate 175 to the party retaining possession of the marital residence by 176 . 177 agrees to refinance the mortgage debt related to the marital residence 178 and make a good faith effort to obtain a release of the other party on 179 Page 7 of 10 Form PS-31152-9 Revised by State Court Administration 12/2014 Petitioner Respondent said debt on the earliest possible date. Upon release of the other 180 party from mortgage debt, the other party shall transfer, by 181 Quitclaim Deed, his/her interest in said real estate. The party 182 assuming responsibility for mortgage agrees to hold the other party 183 harmless from all liability, expense, attorney fees, loss or damages 184 which may be a result o f a failure to make payments on said 185 mortgage debt. 186 Other: 187 188 189 190 191 The parties are jointly responsible on a lease for a residence located at 192 , and the parties agree that: 193 194 195 196 197 shall retain possession of the leased premises, be responsible for the remaining rental payment and fees due under said lease, and agrees to hold the other party harmless from all liability, expense, attorney fees, loss or damage which may be a result of the failure to make required payments under said lease. 198 shall vacate the leased residence by . 199 Other: 200 201 202 203 204 16. Change of names: 205 Petitioner would like the following former name restored and shall hereinafter be 206 known as: 207 208 Petitioner Respondent Page 8 of 10 Form PS-31152-9 Revised by State Court Administration 12/2014 Respondent would like the following former name restored and shall hereinafter be 209 known as: 210 211 Neither Petitioner nor Respondent requests a name change. 212 17. The marriage has suffered an irretrievable breakdown and should be dissolved. 213 We affirm under the penalties of perjury that the foregoing representations are true. 214 __________________________________________ 215 Petitioner’s Signature 216 STATE OF INDIANA ) 217 ) SS: 218 COUNTY OF ) 219 220 Before me, __________________________, a notary public in and for ______________ County, State of Indiana, 221 personally appeared ____________________________________, and being first duly sworn upon his/her oath, says 222 that the facts alleged in the foregoing instrument are true. 223 Date: ______________________ ___ 224 _______________________________________________ 225 Notary Public 226 My Commission Expires: __________________________ 227 _____________________________________________ 228 Respondent ’s Signature 229 STATE OF INDIANA ) 230 ) SS: 231 COUNTY OF ) 232 233 Before me, __________________________, a notary public in and for ______________ County, State of Indiana, 234 personally appeared ____________________________________, and being first duly sworn upon his/her oath, says 235 that the facts alleged in the foregoing instrument are true. 236 Date: ______________________ ___ 237 _______________________________________________ 238 Notary Public 239 My Commission Expires: __________________________ 240 Page 9 of 10 Form PS-31152-9 Revised by State Court Administration 12/2014 18. Findings of the Court: 241 The parties have disclosed all relevant documents and exchanged all information 242 on value of property, pensions, real estate, and other assets and debts. This 243 document represents an agreement submitted by the parties for approval by the 244 Court. The parties have submitted a waiver of final hearing and have agreed that 245 the property distribution provisions of this agreement represent a just and 246 reasonable division of the marital estate and debts. 247 The Court, having held a hearing during which both parties appeared and presented 248 evidence, now finds that the property distribution provisions of this order: 249 constitute a presumptive equal division of marital property and is therefore 250 just and reasonable. 251 do not constitute the presumptive equal division of marital property, 252 however are, for the reasons set forth below, just and reasonable: 253 __________________________________________________________________ 254 __________________________________________________________________ 255 __________________________________________________________________ 256 __________________________________________________________________ 257 __________________________________________________________________ 258 __________________________________________________________________ 259 __________________________________________________________________ 260 __________________________________________________________________ 261 __________________________________________________________________ 262 __________________________________________________________________ 263 __________________________________________________________________ 264 __________________________________________________________________ 265 __________________________________________________________________ 266 IT IS THEREFORE ORDERED by the Court that the parties’ marriage is hereby 267 dissolved. 268 Date: ________________ _________________________________________ 269 Judge 270 Page 10 of 10 Form PS-31152-9 Revised by State Court Administration 12/2014 Distribution: 271 Petitioner’s Name and Mailing Address: 272 273 274 275 Respondent’s Name and Mailing Address: 276 277 278 279 280