Fillable CMSM Self-Represented Plaintiff DISTRICT COURT CLARK COUNTY, NEVADA (Family Law Self Help Center)

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CMSM Self-Represented Plaintiff DISTRICT COURT CLARK COUNTY, NEVADA (Family Law Self Help Center)

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© 2020 Family Law Self-Help Center Complaint for Separate Maintenance (With Children)
* You are responsible for knowing the law about your case. For more information on the law, this form, and free
classes, visit www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road. To find
an attorney, call the State Bar of Nevada at (702) 382-0504.
1
CMSM
Your Name: _________________________
Address: ____________________________
City, State, Zip: ______________________
Phone: _____________________________
Email: ______________________________
Self-Represented Plaintiff
DISTRICT COURT
CLARK COUNTY, NEVADA
_
_____________________________
Plaintiff,
vs.
_
_____________________________
Defendant.
CASE NO.: ____________________
DEPT: ____________________
COMPLAINT FOR SEPARATE MAINTENANCE AND UCCJEA DECLARATION
(With Children)
Plaintiff (your name) _______________________________________, respectfully states:
1. Residency. Which spouse has been a resident of the State of Nevada for at least six
weeks prior to filing this Complaint and intends to make Nevada his/her home for an
indefinite period of time? Me / Defendant.
2. Marriage. The parties were married on (date) ______________________________ in
(city) __________________, (state) _________________.
(☒ check all that apply)
The parties are incompatible, and reconciliation is not possible.
The parties have lived separate and apart for more than one year and there is no
possibility of reconciliation.
The Defendant deserted the Plaintiff at least 90 days prior to filing this case and has
not returned.
Page 2 of 9 - Complaint for Separate Maintenance (With Children)
3. Pregnancy. (☒ check one)
Neither spouse is pregnant.
The following spouse is pregnant: (name of pregnant spouse) __________________.
The other spouse is / is not the parent of the unborn child. The child is due to be
born on (date): ___________________.
It is unknown whether either spouse is currently pregnant.
4. Children. There are (number) _______ minor children in common born to or adopted
by the parties.
Child’s Name
Date of
Birth
State of
Residence
How long child
lived in the state Disability
5. UCCJEA Declaration. Have the children lived in Nevada the last six months, or since
birth? (☒ check all that apply)
Yes, the child(ren) have lived in Nevada for the past six months, or since birth.
No, the child(ren) have NOT lived in Nevada for the past six months.
a. Living Arrangements Last 5 Years. The children have lived with the following
persons in the following places within the last five years:
Time Period
(mo/yr – mo/yr)
Name of Person the
Child(ren) Lived With:
City and State Child’s Name (if
not all children)
______ - present
______ - _____
______ - _____
______ - _____
______ - _____
The names and current addresses of each non-parent the children lived with during the
last five years are:
Page 3 of 9 - Complaint for Separate Maintenance (With Children)
b. Participation in Other Cases. Have you ever participated in any case concerning
these children as a party, witness, or in some other capacity? (☒ check one)
No.
Yes, I have participated in the following cases concerning these children (provide
all specifics including the state, the court name, children involved, the case
number and the date of the child custody order, if any):
c. Knowledge of Other Cases. Do you know of any other case that could affect this
case, such as other custody cases, domestic violence cases, protection order cases, or
adoptions/terminations? (☒ check one)
No.
Yes, the following cases that could affect this case (give all specifics including the
state, the court name, the parties involved, the case number and the type of case):
d. Person(s) Who Claim Custody / Visitation. Is there anyone other than yourself or
other parties to this case who has custody of the children or who can claim a right to
custody or visitation with the children? (☒ check one)
No.
Yes, the following people have custody or can claim custody/visitation of the
children: (list names and addresses of anyone who claims custody/visitation
rights):
6. Legal Custody. Legal custody refers to the ability to make major decisions about the
child, such as medical care, education, and religious upbringing. (☒ check one)
The parties should share joint legal custody of the child(ren).
Plaintiff should have sole legal custody of the child(ren).
Defendant should have sole legal custody of the child(ren).
Nevada is not the “home state” of the child(ren) and cannot enter custody orders.
Page 4 of 9 - Complaint for Separate Maintenance (With Children)
7. Physical Custody. Physical custody refers to the amount of time the child spends with
each parent. (☒ check one)
Joint Custody. The parties should share joint physical custody of the child(ren)
(each parent must have the child(ren) roughly 40% of the time, or 146 days per
year). A proposed parenting timeshare and holiday schedule is attached as Exhibit 1.
Primary Custody. The (☒ check one) Plaintiff / Defendant should have
primary physical custody of the child(ren). A proposed parenting timeshare and
holiday schedule is attached as Exhibit 1.
Sole Custody. The (☒ check one) Plaintiff / Defendant should have sole
physical custody of the child(ren).
Nevada is not the “home state” of the child(ren) and cannot enter custody orders.
8. Other Considerations. The Court should consider the following issues in determining
custody: (☒ check all that apply)
Domestic Violence
CPS Involvement
Military Deployment
State of Residency
Other: _____________________
9. Public Assistance. Has either party ever received public assistance?(☒ check one)
No, the parties in this case have never received public assistance.
Yes, one or more parties now receives or has received public assistance.
10. Parties’ Incomes. The court needs to know both parties’ gross monthly incomes to make
sure child support is set correctly.
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.
My gross monthly income is (insert amount): $_________ / OR unknown.
The other parent’s gross monthly income is (insert amount): $_________ / OR unknown.
Page 5 of 9 - Complaint for Separate Maintenance (With Children)
11. Child Support. Use the attached worksheet to figure out how much child support the court
should order. Complete the worksheet before filling out this section. (☒ check one)
Child support should be paid by (name of parent who should pay child support)
_________________________________ in the amount of $_________ per month.
This is based on: (☒ check one)
The Child Support Worksheet calculation attached.
The amount already established by the District Attorney, Family Support
Division, case (insert case number) R__________________.
No child support is requested. (Explain why not):
I’m not sure how much child support should be paid, and ask the court to set support.
12. Wage Withholding. Should child support be paid through a wage garnishment? (☒ check one)
Yes, a wage withholding order should be entered to secure payment of support.
No, a wage withholding order should not be entered.
13. Back Child Support. Should back child support (“arrears”) be ordered? (☒ check one)
No, no back child support or arrears are requested.
Child support arrears are being handled by the District Attorney, Family Support
Division, case (insert case number) R__________________ and should continue as
ordered in that case.
Yes, back child support should be paid by (name of parent who should pay back child
support) ____________________________________ from (date back child support
should begin) ___________________ to present.
14. Child Care. Are there child care expenses? (☒ check one)
No, there are no child care costs for either parent.
Yes, the monthly child care costs for the child(ren) are: $_________. This amount
should be paid by me only the other parent only both parents equally.
Go to page 12 of this document to calculate child support on the
worksheet, then complete this section.
Page 6 of 9 - Complaint for Separate Maintenance (With Children)
15. Medical Coverage. Medical support (medical, vision, and/or dental) must be provided
for the child(ren). How will the children get medical support/insurance?
Medicaid.
Private / Employer Insurance. The monthly premium should be paid by me only
the other parent only both parents equally.
Other:
16. Unreimbursed Medical Expenses. How will medical expenses get paid if insurance
does not cover a medical cost? (☒ check one)
Any expenses not covered by insurance should be paid equally by both parties.
Any expenses not covered by insurance should be paid by (name of parent)
_____________________________ due to the following extraordinary circumstances:
(explain)
17. “30/30 Rule.” The “30/30 Rule” provides that if a parent pays a medical or dental
expense for a child that is not paid by insurance, that parent must send proof of payment
of the expense to the other parent within 30 days of paying the expense. The other parent
then has 30 days to reimburse the paying parent ½ the cost. Do you want the 30/30 rule
ordered in your case? (☒ check one)
Yes, the Court should order the 30/30 Rule for payment of all unreimbursed medical /
dental expenses.
No, the Court should not order the 30/30 Rule for payment of unreimbursed medical /
dental expenses.
18. Tax Deduction. IRS rules state that the custodial parent usually has the right to claim
the child on their taxes. The custodial parent can waive this right by filling out IRS Form
8332. Talk to a tax professional if you are not sure what to do. (☒ check all that apply)
Plaintiff should claim the following children as dependents for tax purposes every
year: (insert child(ren)’s names): _____________________________________
Defendant should claim the following children as dependents for tax purposes every
year: (insert child(ren)’s names): _____________________________________
The tax deduction should alternate, with Plaintiff claiming the child(ren) in (☒ check
one) even / odd years, and Defendant claiming the child(ren) the other years.
The tax deduction should be allocated per federal law.
Page 7 of 9 - Complaint for Separate Maintenance (With Children)
19. Community Property. (☒ check one)
There is no community property to divide.
Any community property has already been divided.
I do not know the full extent of the community property.
The community property should be divided as follows:
Property to Plaintiff:
1. ______________________________________________________
2. ______________________________________________________
3. ______________________________________________________
4. ______________________________________________________
Property to Defendant:
1. ______________________________________________________
2. ______________________________________________________
3. ______________________________________________________
4. ______________________________________________________
20. Community Debt. (☒ check one)
There is no community debt to divide.
Any community debt has already been divided.
I do not know the full extent of the community debt.
The community debt should be divided as follows:
Debts to Plaintiff:
1. ______________________________________________________
2. ______________________________________________________
3. ______________________________________________________
4. ______________________________________________________
Debts to Defendant:
1. ______________________________________________________
2. ______________________________________________________
3. ______________________________________________________
4. _____________________________________________________
Page 8 of 9 - Complaint for Separate Maintenance (With Children)
21. Alimony. (☒ check one)
No spousal support is requested.
Plaintiff should pay $________ per month in spousal support for the next (number)
_______ years.
Defendant should pay $________ per month in spousal support for the next (number)
_______ years.
22. Name Change. (☒ check one)
Plaintiff does not request a name change.
Plaintiff would like to be restored to his/her former name of (insert former name you
would like to go back to) ____________________________________________.
23. If Plaintiff is able to hire counsel, attorney’s fees and costs are requested.
Plaintiff requests:
1. That Plaintiff be granted an absolute Decree of Separate Maintenance;
2. That the Court grant the relief requested in this Complaint; and
3. For such other relief as the Court finds to be just and proper.
DATED (month) _______________________ (day) _____, 20____.
Submitted By: (your signature) _______________________________
(print your name) _______________________________
Page 9 of 9 - Complaint for Separate Maintenance (With Children)
VERIFICATION
Under penalties of perjury, I declare that I am the Plaintiff in the above-entitled action;
that I have read the foregoing Complaint and UCCJEA Declaration and know the contents
thereof; that the pleading is true of my own knowledge, except for those matters therein
contained stated upon information and belief, and that as to those matters, I believe them to be
true.
I declare under penalty of perjury under the law of the State of Nevada that the
foregoing is true and correct.
DATED (month) _______________________ (day) _____, 20____.
Submitted By: (your signature) _______________________________
(print your name) _______________________________
EXHIBIT 1: Parenting Timeshare and Holiday Schedule
No Visitation Requested Because: (explain) ______________________________
Regular Schedule:
Be very specific. Include
the times and days of the
week for each parent’s
timeshare.
(ex.: Mom: Saturday 7pm –
Wednesday 3pm,
Dad: Wednesday 3pm –
Saturday 7pm)
Summer Schedule:
Same as the regular schedule.
Other: ____________________________________________
Mother’s Day and Mother’s
Birthday:
Mother every year from 9am – 7pm.
Other: ____________________________________________
Father’s Day and Father’s
Birthday:
Father every year from 9am – 7pm.
Other: ____________________________________________
Child’s Birthday:
Even years with (parent) ___________________________.
Odd years with (parent) ____________________________.
*Time shall be from 9am – 7pm.*
Other: ___________________________________________
3 Day Weekends: Even Years: MLK Jr. Day, Memorial Day, Labor Day with
(parent) _________________________________,
President’s Day, Independence Day, Nevada Admissions
Day with the other parent.
Odd Years: MLK Jr. Day, Memorial Day, Labor Day with
(parent) _________________________________,
President’s Day, Independence Day, Nevada Admissions
Day with the other parent.
*Time begins when school lets out the day before the holiday
weekend (or 3pm if no school), and ends the day following
the holiday weekend when school resumes (or 9am).*
**If Independence Day falls on a Tuesday, Wednesday, or
Thursday, the time shall be from July 3 at 9am until July 5
at 9am.**
Other: ____________________________________________
Easter / Spring Break:
Even years with (parent) _____________________________.
Odd years with the other parent.
*Time shall begin the day school lets out until noon the day
before school resumes.*
Other: ____________________________________________
Thanksgiving:
Odd years with (parent) _____________________________.
Even years with the other parent.
*Time shall begin the day school lets out until noon the day
before school resumes.*
Other: ____________________________________________
Winter Break / Christmas:
Segment 1 (Christmas) consists of the day school lets out until
December 26 at noon.
Segment 2 (New Year’s) consists of December 26 at noon
until noon the day before school resumes.
Even years: segment 1 with (parent) ____________________,
segment 2 with the other parent.
Odd years: segment 1 with (parent) ____________________,
segment 2 with the other parent.
Other: ____________________________________________
_________________________________________________
Other Holidays:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Vacation: The parents will not establish a formal vacation plan, and will
instead mutually agree on vacation days and times with the
child(ren).
Each parent may have up to (number) ______ vacation days
per year with the child(ren). The parent shall notify the other
parent of the vacation and provide a general vacation itinerary
at least (number) _____ days before the planned vacation.
Vacation time is not allowed during a holiday allotted to
the other parent.
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© 2020 Family Law Self-Help Center Child Support Worksheet
Joint Custody. Only fill out this section if you are asking for Joint Physical Custody.
Skip to if you are asking for primary custody, sole custody, or visitation only.
Subtract the lower earning parent’s amount of child support from the higher earning parent’s amount.
- = paid by
Adjustments.
If you want primary or sole physical custody, the court uses the number in as the standard
amount of child support the other parent would pay.
If you want the other parent to have primary or sole physical custody, the court uses the number
in as the standard amount of child support you would pay.
If you want both parents to have joint physical custody, the court uses the number in as the
standard amount of child support.
You can ask for more or less child support than the amount in or if you think any of the following
factors apply. ( check all that apply, or skip to if none if these reasons apply)
Special educational needs
A parent’s legal responsibility to support others
The value of services contributed by either
parent
Public assistance paid to support the child
Cost of transportation to and from visitation
The relative income of both households
Any other necessary expenses for the benefit
of the child
The obligor’s ability to pay
Explain:
Final Child Support Amount Requested:
$ ___________ paid by (name) _____________________________________
Higher
$ _______
Lower
$ _______
Child Support Obligation
$____________
Name of higher income parent:
____________________
0.00
© 2020 Family Law Self-Help Center Child Support Worksheet
TO DETERMINE A PARENT’S GROSS MONTHLY INCOME (“GMI”) FROM EMPLOYMENT
Annual Income
$
Biweekly Income
$
÷ by 12 months = GMI
$
X 26 pay periods per year
÷ by 12 months = GMI
$
Weekly Income
$
Hourly Wage
$
X 52 pay periods per year
# of hours worked per week
÷ by 12 months = GMI
$
Subtotal = hourly wage X #
of hours per week
$
X 52 pay periods per year
÷ by 12 months = GMI
$
LOW INCOME CHILD SUPPORT SCHEDULE
FOR PARENTS WHO EARN LESS THAN $1595 PER MONTH
12
0.00
52
0.00
12
0.00
26
0.00
12
0.00
0.00
52
0.00
12
0.00
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CMSM Self-Represented Plaintiff DISTRICT COURT CLARK COUNTY, NEVADA (Family Law Self Help Center)

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Completed 9 February 2021

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