Parenting Plan Page 10
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10Please r e-read t his document ca refully t o m ake s ure i t accurately r eflects your entire agreement. Items
agreed upon outside of this document may not be enforceable.
Your signature below indicates that you have read, understand, and agree with all terms of th is
agreement. This document should be signed in the presence of a notary public or court clerk.
___________________________________
____________________________________________
Petitioner’s Signature
Date
Co-Petitioner’s
Respondent’s Signature
Date
___________________________________
____________________________________________
Signature of Attorney, if applicable
Date
Signature of Attorney, if applicable
Date
___________________________________
____________________________________________
Petitioner’s Address
Co-Petitioner/Respondent’s Address
___________________________________
____________________________________________
City, State, Zip Code
City, State, Zip Code
___________________________________
____________________________________________
(Area Code) Home Telephone Number
(Area Code) Home Telephone Number
___________________________________
____________________________________________
(Area Code) Work Telephone Number
(Area Code) Work Telephone Number
Subscribed and affirmed, or sworn to before me
Subscribed and affirmed, or sworn to before me
in the County of ________________________,
in the County of _________________________,
State of ____________________, this _______
State of ____________________, this ________
day of ________________, 20 ____.
day of ________________, 20 ____.
My Commission Expires: _________________
My Commission Expires: ___________________
_____________________________________
________________________________________
Notary Public/Clerk
Notary Public/Clerk
IF ONLY ONE PARTY SIGNS THE PARENTING PLAN,
COMPLETE THE CERTIFICATE OF SERVICE BELOW.
I certify that on ________________________ (date) a true and accurate copy of the PARENTING PLAN was
served on the other party by:
Faxed to this number: ___________________, or
Hand Delivery,
E-filed,
by placing it in the United States mail, postage pre-paid, and addressed to the following (include name and
address):
To: _______________________________________
_______________________________________
_______________________________________
______________________________________
Your signature
JDF 1113 R5/10
PARENTING PLAN
Page 10 of 10
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