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

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COMC 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 Custody
* 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
COMC
Your Name: _________________________
Address: ____________________________
City, State, Zip: ______________________
Phone: _____________________________
Email: ______________________________
Self-Represented Plaintiff
DISTRICT COURT
CLARK COUNTY, NEVADA
_
_______________________________
Plaintiff,
vs.
_
_______________________________
Defendant.
CASE NO.: ____________________
DEPT: ____________________
COMPLAINT FOR CUSTODY AND UCCJEA DECLARATION
Plaintiff (your name) ____________________________________________ is the (☒ check
one) mother / father of the children named below, and respectfully states:
1. Which parent has been a resident of the State of Nevada for at least six weeks prior to
filing this Complaint? (☒ check one) Me / Defendant.
2. Have you ever been married to the other party? (
☒
check one) Yes / No.
3. Children. There are (number) _______ minor children at issue:
Child’s Name
Date of
Birth
State of
Residence
How long child
lived in the state Disability
Page 2 of 8 - Complaint for Custody
4. 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:
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):
Page 3 of 8 - Complaint for Custody
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):
5. Paternity. Paternity is not disputed. Plaintiff believes that the father of the children is
(father’s name) because (☒ check all that
apply):
Birth Certificate. The man named above is the father listed on the birth
certificate(s).
Court Order. Paternity was already established by a court order through (name of
court) _______________________ in case number (case number) _______________
on (date) ____________________.
DNA Test. A DNA test shows who is the biological father; a copy is attached.
Parents Lived Together. The parties lived together at least 6 months before
conception and lived together through the period of conception.
Admission. The man named above openly holds out the child as his own and has
accepted the child into his home.
6. Legal Custody. Legal custody refers to the ability to access information and make
major decisions about the children, 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).
Page 4 of 8 - Complaint for Custody
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).
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 8 - Complaint for Custody
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 11 of this document to calculate child support on the
worksheet, then complete this section.
Page 6 of 8 - Complaint for Custody
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)
The Plaintiff should claim the following children as dependents for tax purposes
every year: (insert child(ren)’s names): _____________________________________
The 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 8 - Complaint for Custody
19. Birth Certificate / Name Change. (☒ check all that apply)
The child’s birth certificate should not be changed.
The child’s birth certificate should be changed to state that the father of the minor
child is (name of father) .
The child’s name should be changed to (write the complete first, middle, and last
name the child should have) _____________________________________________
because (explain why you want to change the child’s name)
The child has not been convicted of a felony. Any child age 14 or older will file a
separate consent agreeing to the requested name change. The other parent’s name is
(name of the other parent) ____________________________________ and I believe
he/she lives at (other parent’s address) _____________________________________
This request is made pursuant to NRS 41.298
20. If Plaintiff is able to hire counsel, attorney’s fees and costs are requested.
Plaintiff requests:
1. That the Court grant the relief requested in this Complaint; and
2. 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 8 of 8 - Complaint for Custody
VERIFICATION
Under penalty 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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COMC Self-Represented Plaintiff DISTRICT COURT CLARK COUNTY, NEVADA (Family Law Self Help Center)

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Completed 15 January 2021

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