Judge'S Memorandum Form (Page 2 of 2) in pdf

Protective orders: [ ] applies to [ ] father [ ] mother [ ] both [ ] agreed [ ] default [ ] family violence occurred

[ ] party prohibited from [ ] removing child from other parent [ ] removing child from jurisdiction of Court [ ]

encumbering or disposing of property

[ ] exclusive possession of residence awarded to ____________________ (if family violence occurred)

[ ] complete battering intervention program

[ ] _____________attend and complete counseling with

__________________

[ ] _______________enjoined from [ ] committing family violence [ ] communicating

with the other party or family member [ ] going near the residence or employment of ________________________

or a member of the household [ ] going near a school or child care facility a child normally attends [ ] possessing a

firearm [ ] suspension of license to carry a concealed weapon

[ ] Duration of order: __________________________________________________________

10.

Classes and studies: [ ] Psychological evaluation with _______________ [ ] Counseling with ________________;

persons participating in counseling _______ [ ] Practical parent education classes: ____________ [ ] Social Study

[ ] Drug Test Ordered

[ ] Other _________________________________________________________________________

[ ] Fees split; father ______%; mother _______ %; others ________ %

11.

Mediation with: ___________________________no later than:____________ Costs; father _____ %; mother

_____%; other _______%.

12.

USE OF PROPERTY: [ ] Husband [ ] Wife to have temporary use and possession of [ ] residence and [ ] contents.

Auto/vehicle to Husband: _____________________ Auto/vehicle to Wife: __________________

Other Property Orders: __________________________________________________________________________

_____________________________________________________________________________________________

13.

INVENTORY/PRODUCTION:

Each party to file/exchange Inventory & income information on or before:

____________________________________________________________________________________________

14.

DEBTS FOR WHICH HUSBAND RESPONSIBLE: __________________________________________________

_____________________________________________________________________________________________

15.

DEBTS FOR WHICH WIFE RESPONSIBLE: _____________________________________________________

_____________________________________________________________________________________________

16.

SPOUSAL SUPPORT: Husband [ ] Wife to pay $__________ per ________ beginning ________ to [ }Husband

[ ] Wife through [ ] Child Support Office [ ] direct, [ ] terminating on ______________ [ ] subject to review after

_________________

17.

This memorandum is not a written order.

This memorandum will be reduced to a written order by

___________________ on or before _________________, 200___.

18.

OTHER ORDERS: _________________________________________________________________________

__________________________________________________________________________________________

_________________________________________________________________________________________

____________________________

_____________________________________

Date

Judge

______________________ ____________________ ___________________ __________________

Agreed

[ ] SUBJECT TO PROOF OF SERVICE

Judge'S Memorandum Form Page 2

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