CIRCUIT COURT FOR MONTGOMERY COUNTY
CONFIDENTIAL ADR STATEMENT
FAMILY
PLEASE COMPLETE AND SEND THIS FORM TO THE MEDIATOR
Case N
umber: Settlement/Pretrial Conference Date:
Plaint
iff: Defendant:
Date of Marriage:
Date of Separation:
Child(re
n) name(s) and dates of birth:
Age of each party: Plaintiff ; Defendant
Health of each party: Plaintiff ; Defendant
Each party's current employment and income:
Plaintiff: employment income $
Defendant employment income $
Contest
ed Issues:
Ground for Divorce
Characterization of Property (marital/nonmarital)
Monetary Award
Specific Property issues:
value or ownership of a business
value or ownership of a pension
value or ownership of bank accounts/IRAs
value or ownership of personal property (furniture, automobiles, etc.)
Child support
Alimony: amount $ duration
Use and possession of the marital home car furnishings
Attorney's fees/court costs
Other:
3. IF EITHER PARTY HAS REQUESTED A MONETARY AWARD, ATTACH A COPY OF A JOINT 9-207
STATEMENT EXECUTED BY BOTH PARTIES AND/OR THEIR COUNSEL.
4. Stat
e the terms of your offer to settle this matter:
Attorney for Plaintiff/Defendant