Case No.______________________________
5.
Name Change: I want the child(ren)’s names to be changed as follows:
__________________________________________________________________________________
__________________________________________________________________________________
6.
Other Issues: Briefly state the other issues that you believe must be resolved to fully settle this
case:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
7.
Settlement: I understand that I am required to personally meet and confer with the opposing party
and their council at least five court days before my court date to resolve as many issues as possible
unless there is a current court order prohibiting contact or a significant history of domestic violence
between us. I verify that the above statements are true based on my best information and belief and I
am willing to settle and resolve this case based upon my positions as provided above. I will be
prepared to show documentation to support my position at the time of the conference or hearing.
_______________________________
___________________________________________
Date
Signature of
Mother
Father
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