Fill and Sign the Court Having Been Duly Advised in This Matter Now Finds the Form

Page 1 of 3 Form PS-31152-6 Revised by State Court Administration 09/2014 STATE OF INDIANA ) IN THE SUPERIOR / CIRCUIT COURT 1 ) SS: CIVIL DIVISION, ROOM 2 COUNTY OF ) CASE NO. 3 IN RE THE MARRIAGE OF: 4 5 Petitioner, 6 and 7 8 Respondent. 9 TEMPORARY ORDER 10 Petitioner appears / does not appear, and Respondent appears / does not appear for provisional 11 hearing on _________________. The court having been duly advised in this matter, now finds the 12 following: 13 ______ Petitioner / Respondent is awarded temporary custody of the minor child(ren). 14 ______ Petitioner / Respondent shall pay temporary child support for the minor child(ren) in 15 the amount of $__________________ per week, payable through the ______________ 16 County Clerk, or by income withholding order if available from the employer, 17 beginning on _________________. 18 ______ Petitioner / Respondent shall be responsible for the first $__________________ of 19 uninsured medical expenses for the minor child(ren). Thereafter, Petitioner shall be 20 responsible for ________% and Respondent for ________% of uninsured medical 21 expenses for the minor child(ren). 22 ______ Petitioner / Respondent shall have temporary parenting time with the minor child(ren) 23 as the parties agree or according to the Indiana Parenting Time Guidelines. 24 ______ Petitioner / Respondent shall have temporary possession of the marital residence. 25 ______ Petitioner / Respondent shall temporarily maintain medical, dental, and optical 26 insurance as available through employment for the following persons: 27 __________________________________________ 28 __________________________________________ 29 __________________________________________ 30 31 Page 2 of 3 Form PS-31152-6 Revised by State Court Administration 09/2014 ______ There shall be a temporary division of debts, as follows: 32 a. Petitioner shall be solely responsible for the following debts: 33 ________________________________________________ 34 ________________________________________________ 35 ________________________________________________ 36 b. Respondent shall be solely responsible for the following debts: 37 _________________________________________________ 38 _________________________________________________ 39 _________________________________________________ 40 ______ There shall be a temporary division of property, as follows: 41 a. Petitioner shall have sole possession of the following items of property: 42 _________________________________________________ 43 _________________________________________________ 44 _________________________________________________ 45 b. Respondent shall have sole possession of the following items of property: 46 _________________________________________________ 47 _________________________________________________ 48 _________________________________________________ 49 ______ There shall be a temporary division of motor vehicles, as follows: 50 a. Petitioner shall have temporary possession of the following vehicles: 51 __________________________________________________ 52 (Vehicle #1, Make, Model, and Year) 53 __________________________________________________ 54 (Vehicle #2, Make, Model and Year) 55 56 b. Respondent shall have temporary possession of the following vehicles: 57 __________________________________________________ 58 (Vehicle #1, Make, Model, and Year) 59 __________________________________________________ 60 (Vehicle #2, Make, Model and Year) 61 Page 3 of 3 Form PS-31152-6 Revised by State Court Administration 09/2014 ______ There shall be a temporary restraining order in effect during these proceedings: 62 ______ Restraining the parties from removing the child(ren) from the state without the 63 permission of the court or all parties; 64 ______ Restraining the parties from transferring, encumbering, or concealing, or in 65 any way disposing of any of the property of the parties; 66 ______ Other: 67 _____________________________________________ 68 _____________________________________________ 69 _____________________________________________ 70 _____________________________________________ 71 ALL OF WHICH IS SO ORDERED THIS ______ DAY OF __________________, 20____. 72 73 Judge 74 Distribution: 75 76 77 78 79 80 81 82 83