Decree Of Dissolution Of Marriage And Settlement Agreement Page 2
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5Respondent shall have sole physical custody and the parties shall have joint legal custody
of the child(ren).
Other: ___________________________________________________________
7.
The parties have agreed on the following Parenting Time (Visitation) order:
Petitioner shall have reasonable visitation with the minor child(ren) as the parties agree or
according to the Indiana Parenting Time guidelines.
Respondent shall have reasonable visitation with the minor child(ren) as the parties agree
or according to the Indiana Parenting Time guidelines.
Other: ___________________________________________________________
8.
____________________________________________________________ will pay child support
in the amount of _______________ per week, as shown by the attached child support worksheet,
through the County Clerk’s office, or by income withholding order if available from the employer,
beginning on the first Friday following the date of the decree. Said date is _________________.
____________________________________________________________ will be responsible for the
first __________________ of uninsured medical expenses for the minor child(ren). Thereafter, Father
shall be responsible for _______% of uninsured medical expenses, and Mother shall be responsible for
_______% of uninsured medical expenses for the minor child(ren).
9.
The parties have agreed on the following provisions for health insurance maintenance:
____________________________________________________________ shall maintain
medical, dental, and optical insurance as available through employment on the minor child(ren):
______________________________________________________________________________
______________________________________________________________________________
10.
The parties have agreed on the following arrangement for claiming the tax credits, exemptions,
and deductions for the minor child(ren):
Petitioner shall be entitled to claim the minor child(ren) for federal, state, and local
income tax purposes on an annual basis; Respondent shall sign all necessary documents
that will entitle Petitioner to do so.
Respondent shall be entitled to claim the minor child(ren) for federal, state, and local
income tax purposes on an annual basis; Petitioner shall sign all necessary documents
that will entitle Respondent to do so.
Petitioner and Respondent shall each be entitled to claim the minor child(ren) for federal,
state, and local income tax purposes in alternating years; Petitioner shall be entitled to
claim the minor child(ren) in the year ________, and every _______ year thereafter;
Respondent shall be entitled to claim the minor child(ren) in the year ________, and
every _______ year thereafter.
Other: ___________________________________________________________
Form #PS-31152-3
Approved by State Court Administration 02/10
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