Many family law matters involve complex and valuable legal rights which cannot adequately be protected without the assistance of an
attorney. The information provided is basic, general information that does not fit all situations. It is the duty of each self-represented
individual to know what rules of court and law apply. For more information on the law, these forms, and free classes, visit
www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road.
About Stipulations: A “stipulation” is an agreement between two parties. The agreement becomes
a legally binding “order” when it is signed by the judge.
This Packet Is For:
Parties who are both representing themselves; AND
The parties have reached an agreement on changing child support. You can also include other
agreements about any other issues that you want the court to approve.
Use black ink and write clearly.
Stipulation and Order. This form tells the judge what you and the other party have agreed to.
You must use the child support worksheets to show what child support would be under
the standard calculation. You can then agree to the amount calculated, or a different
amount. You will also have to indicate whether there should be a wage garnishment
and how the children will get medical insurance.
You can add other agreements if you want. If you do, be very specific about your
agreement. If your agreement is unclear, the judge may not sign the order.
Do not sign page 2 until you are in front of a notary. The person who wrote the order
must sign the last page (after the judge’s signature line).
You can submit the order in one of two ways:
Bring it to the courthouse: Take it to the drop box on the first floor outside the Clerk’s
Office. The box says “Department Drop Box.”
Mail it to the courthouse: Mail it to: Family Court, 601 N. Pecos Rd., Las Vegas, NV 89101
It can take up to 3 weeks for the judge to review your paperwork. After the judge signs the order, the
judge’s staff will either mail the order back to you or will contact you to come pick it up. If there is a
problem with your paperwork, the judge’s staff will let you know what needs to be corrected.
File the Stipulation and Order (if it was not already filed by the court staff)
File the Notice of Entry of Order: This form tells the other party that the judge entered an
order. Filing this form starts the timelines for anyone who wants to appeal or undo the order,
and is required so the judge can enforce the order in the future if needed.
Fill out the form. Be sure to fill out the Certificate of Mailing at the bottom, because
you will have to mail a copy of the form to the other party the same day you file it.
Attach a copy of the filed Stipulation and Order to this form.
File the form.
Mail a copy of the Notice of Entry of Order (with the Stipulation & Order attached) to
the other party. You can mail this by regular mail.
© 2020 Family Law Self-Help Center Stipulation & Order (Child Support)
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COURT CODE: SAO
Name: _________________________
Address: _______________________
City, State, Zip: __________________
Phone: _________________________
Email: _________________________
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
________________________________
Plaintiff,
vs.
________________________________
Defendant.
CASE NO.: ____________________
DEPT: ____________________
STIPULATION AND ORDER
The parties in this matter, (Plaintiff’s name) ____________________________________
and (Defendant’s name) ______________________________________, both self-represented,
hereby stipulate and agree to the following which applies to the following children:
Child’s Full Name Date of Birth
1. The parties’ gross monthly incomes are:
Gross monthly income includes money received from work, social security, unemployment,
pension/retirement, interest/investments, veteran’s benefits, military allowances, etc.
It does not include SSI, SNAP, TANF, cash benefits from the county, or child support
received.
Parent 1 Name: Gross monthly income: $_________.
Parent 2 Name: Gross monthly income: $_________.
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Use the attached worksheet to figure out how much child support would be under the regular
guidelines. If either parent earns over $6000/mo, visit
nvchildsupportguidelinescalculator.azurewebsites.net/getobligation.aspx and print out the calculation
from that worksheet to attach to this stipulation instead.
Complete and attach one of those worksheets before filling out this section. The court
must see how much support would be set under the guidelines.
2. Under the child support guidelines, the child support calculation would require (name of
parent who would pay child support) _________________________________ to pay
$________ per month in child support.
3. Agreed child support: ( check one)
The parties agree to set child support at the amount above in compliance with Nevada
Administrative Code 425.
The parties agree to set child support at a different amount. The parties agree that: (
check one) no one will pay child support / child support will be paid by (name of
parent who will pay) _____________________________________________ in the
amount of $________ per month. Each parent must initial each line below:
_______ _______ The parent who would receive child support is not currently
receiving public assistance and has not applied for assistance.
_______ _______ The basic needs of the child are met or exceeded by the agreed
child support obligation.
_______ _______ Both parents are aware that if either party seeks a review of the
child support obligation for any authorized reason, the court will
calculate the child support obligation in accordance with the
child support guidelines in effect at the time of the review.
This agreement complies with NAC 425.110.
4. Effective Date. The above child support modification will be effective on (date you
want the new amount to start) _______________________.
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5. Wage Withholding. The parties agree that: ( check one)
There is no need for a wage garnishment to pay child support.
There should be a wage withholding ordered to secure payment of child support and
spousal support, if any. The parties will contact the local child support enforcement
agency to arrange for the wage withholding.
6. Medical Coverage. Medical support (medical, vision, and/or dental) must be provided
for the child(ren). The children will get medical support/insurance through the
following ( check one)
Medicaid.
Private / Employer Insurance. The monthly premium will be paid by: both parents
equally one parent only (parent name): __________________________________.
Other: _______________________________________________________________
7. The parties further agree to the following: (list any other agreements you want included
in this Stipulation and Order)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
© 2020 Family Law Self-Help Center Stipulation & Order (Child Support)
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8. ( check one)
No hearing is currently scheduled.
The hearing currently scheduled for (date) _____________________ at
(time) _____________ ( check one) a.m. p.m. should be taken off calendar.
Respectfully Submitted:
Date: _____________________________
________________________________
(Plaintiff’s signature)
________________________________
(Plaintiff’s printed name)
Date: _____________________________
________________________________
(Defendant’s signature)
_________________________________
(Defendant’s printed name)
ACKNOWLEDGMENT (Plaintiff)
STATE OF NEVADA )
)
COUNTY OF CLARK )
On this (day) _______ day of (month) _______________________, 20_____, before me,
the undersigned Notary Public in and for the said County and State, personally appeared
(Plaintiff’s name) _____________________________________, known to me to be the person
described in and who executed the foregoing Stipulation and Order, and who acknowledged to
me that he / she did so freely and voluntarily and for the uses and purposes therein mentioned.
WITNESS my hand and official seal.
_______________________________________
Signature of notarial officer
© 2020 Family Law Self-Help Center Stipulation & Order (Child Support)
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ACKNOWLEDGMENT (Defendant)
STATE OF NEVADA )
)
COUNTY OF CLARK )
On this (day) _______ day of (month) _______________________, 20_____, before me,
the undersigned Notary Public in and for the said County and State, personally appeared
(Defendant’s name) _____________________________________, known to me to be the
person described in and who executed the foregoing Stipulation and Order, and who
acknowledged to me that he / she did so freely and voluntarily and for the uses and purposes
therein mentioned.
WITNESS my hand and official seal.
_______________________________________
Signature of notarial officer
ORDER
UPON A READING of the foregoing Stipulation of the parties and good cause appearing,
IT IS HEREBY ORDERED that the parties’ stipulation is adopted and made an Order of
this Court.
IT IS FURTHER ORDERED that hearing presently scheduled for (date) ______________
at (time) ____________ ( check one) a.m. p.m. shall be taken off calendar.
IT IS FURTHER ORDERED that each party shall submit the information required in
NRS 125B.055, NRS 125.130 and NRS 125.230 on a separate form to the Court and the
Welfare Division of the Department of Human Resources within ten days from the date this
Decree is filed. Such information shall be maintained by the Clerk in a confidential manner and
not part of the public record. The parties shall update the information filed with the Court and
the Welfare Division of the Department of Human Resources within ten days should any of that
information become inaccurate.
© 2020 Family Law Self-Help Center Stipulation & Order (Child Support)
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NOTICE IS HEREBY GIVEN of the following provision of NRS 125C.0045(6):
PENALTY FOR VIOLATION OF ORDER: THE ABDUCTION, CONCEALMENT OR
DETENTION OF A CHILD IN VIOLATION OF THIS ORDER IS PUNISHABLE AS A
CATEGORY D FELONY AS PROVIDED IN NRS 193.130. NRS 200.359 provides that
every person having a limited right of custody to a child or any parent having no right of
custody to the child who willfully detains, conceals or removes the child from a parent,
guardian or other person having lawful custody or a right of visitation of the child in
violation of an order of this court, or removes the child from the jurisdiction of the court
without the consent of either the court or all persons who have the right to custody or
visitation is subject to being punished for a category D felony as provided in NRS 193.130.
NOTICE IS HEREBY GIVEN that the terms of the Hague Convention of October 25,
1980, adopted by the 14th Session of the Hague Conference on Private International Law, apply
if a parent abducts or wrongfully retains a child in a foreign country. The parties are also put on
notice of the following provision of NRS 125C.0045(8):
If a parent of the child lives in a foreign country or has significant commitments in a foreign
country:
(a) The parties may agree, and the court shall include in the order for custody of the
child, that the United States is the country of habitual residence of the child for the purposes
of applying the terms of the Hague Convention as set forth in subsection 7.
(b) Upon motion of one of the parties, the court may order the parent to post a bond if
the court determines that the parent poses an imminent risk of wrongfully removing or
concealing the child outside the country of habitual residence. The bond must be in an
amount determined by the court and may be used only to pay for the cost of locating the
child and returning him to his habitual residence if the child is wrongfully removed from or
concealed outside the country of habitual residence. The fact that a parent has significant
commitments in a foreign country does not create a presumption that the parent poses an
imminent risk of wrongfully removing or concealing the child.
NOTICE IS HEREBY GIVEN that the parties are subject to the relocation requirements
of NRS 125C.006 & NRS 125C.0065. If joint or primary physical custody has been established
pursuant to an order, judgment or decree of a court and one parent intends to relocate his or her
residence to a place outside of this State or to a place within this State that is at such a distance
that would substantially impair the ability of the other parent to maintain a meaningful
relationship with the child, and the relocating parent desires to take the child with him or her,
the relocating parent shall, before relocating: (a) attempt to obtain the written consent of the
non-relocating parent to relocate with the child; and (b) if the non-relocating parent refuses to
give that consent, petition the court for permission to move and/or for primary physical custody
for the purpose of relocating. A parent who desires to relocate with a child has the burden of
proving that relocating with the child is in the best interest of the child. The court may award
reasonable attorney's fees and costs to the relocating parent if the court finds that the non-
relocating parent refused to consent to the relocating parent's relocation with the child without
having reasonable grounds for such refusal, or for the purpose of harassing the relocating
© 2020 Family Law Self-Help Center Stipulation & Order (Child Support)
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parent. A parent who relocates with a child pursuant to this section without the written consent
of the other parent or the permission of the court is subject to the provisions of NRS 200.359.
NOTICE IS HEREBY GIVEN that if you want to adjust the amount of child support
established in this order, you must file a motion to modify the order with or submit a stipulation
to the court. If a motion to modify the order is not filed or a stipulation is not submitted, the
child support obligation established in this order will continue until such time as all children
who are the subject of this order reach 18 years of age or, if the youngest child who is subject to
this order is still in high school when he or she reaches 18 years of age, when the child
graduates from high school or reaches 19 years of age, whichever comes first. Unless the
parties agree otherwise in a stipulation, any modification made pursuant to a motion to modify
the order will be effective as of the date the motion was filed.
NOTICE IS HEREBY GIVEN that the parties are subject to the provisions of NRS
31A and 125.007 regarding the collection of delinquent child support payments.
NOTICE IS HEREBY GIVEN that either party may request a review of child support
every three years pursuant to NRS 125B.145.
DATED: ______________________________________, 20_____.
____________________________________
DISTRICT COURT JUDGE
Respectfully submitted by:
(Your signature)
(Your name)
/s/
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© 2020 Family Law Self-Help Center Child Support Worksheet – Joint Petitions
TODETERMINEAPARENT’SGROSSMONTHLYINCOME(“GMI”)FROMEMPLOYMENT
AnnualIncome $ BiweeklyIncome $
÷by12months=GMI $ X26payperiodsperyear
÷ by12months=GMI $
WeeklyIncome $ HourlyWage $
X52payperiodsperyear #ofhoursworkedperweek
÷by12months=GMI $
Subtotal=hourlywageX#
ofhoursperweek $
X52payperiodsperyear
÷by12months=GMI $
LOWINCOMECHILDSUPPORTSCHEDULE
FORPARENTSWHOEARNLESSTHAN$1595PERMONTH
12
0.00
52
0.00
12
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26
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12
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ATTACH A FILED COPY OF THE COURT’S ORDER TO THIS NOTICE
© 2017 Family Law Self-Help Center Notice of Entry of Order or Judgment
NEJ
Name:
Address:
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Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
________________________________
Plaintiff,
vs.
________________________________
Defendant.
CASE NO.: ____________________
DEPT: ____________________
NOTICE OF ENTRY
OF ORDER / JUDGMENT
PLEASE TAKE NOTICE that an Order and/or Judgment was entered in this matter on
(date order was filed-on the upper right corner of the order) ______________________, 20___,
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