SUPERIOR COURT OF WASHINGTON,
COUNTY OF SKAGIT
In re / NO. ______
PRETRIAL AFFIDAVIT OF:PETITIONER
RESPONDENT

I. PERSONAL DATA

Name:______, Age______Occupation:______

Marriage/Relationship date:______Employer:______

Separation date:______Gross monthly income:______

Children’s ages:______Net monthly income:______

II. SUGGESTED RESIDENTIAL TIME FOR CHILDREN

With Father:______.

With Mother:______.

III. SUGGESTED CHILD SUPPORT

If child support is at issue, complete and file an updated set of Washington State Child Support Worksheets.

Based on current Worksheets, the presumptive amount of child support for ____ children is $______ per month.

Child support should be set at $______per month, because ______.

IV. SUGGESTED MAINTENANCE

If maintenance is at issue, complete and attach the Monthly Expense schedule, and page 1 of the Washington State Child Support Worksheets (showing income and deductions).

Maintenance of $______ per month should be paid to the husband wife, until ______, because ______.

V. ASSETS AND DEBTS

If the other party has not yet filed a Pretrial Affidavit: fill in and attach four separate schedules, listing each community asset, separate asset, community debt, and separate debt. For each item, insert your figures in the appropriate columns (for “Petitioner’s Pretrial Affidavit” or “Respondent’s Pretrial Affidavit”).

If the other party has filed a Pretrial Affidavit: on their four schedules, add your own figures for each item in the appropriate columns. If the other party omitted any assets or debts, add them to the appropriate schedule. Attach copies of your completed schedules.

Transfer your totals from the Community Assets and Community Debts schedules to this chart, showing your proposed divisions of community property and debt:

To Petitioner / To Respondent
Community Assets:
Community Debts:
Subtract Debts from Assets:
Proposed judgment transfer (+/-):
FINAL TOTALS:

VI. OTHER FACTORS

List any other factors which you believe should be considered at the settlement conference, such as special income situations, physical disabilities, dependent children of other relationships, etc.

______

I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signed this _____ day of ______, at ______, Washington.

Petitioner/Respondent______

DATED ______, by:______

Attorney for ______WSBA No. ______

PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT

MONTHLY EXPENSES OF ______AND ______DEPENDENTS:

Housing:

Rent or house payment ______

Taxes and insurance ______

______

Utilities:

Heat (gas & oil) ______

Electricity ______

Water, sewer, garbage ______

Telephone ______

Cable ______

______

Food and Supplies:

Food for ____ persons ______

Supplies (paper, tobacco, pets) ______

Meals eaten out ______

______

Children:

Day care / babysitting ______

Clothing ______

Tuition (if any) ______

______

______

Transportation:

Vehicle payments or leases ______

Vehicle insurance & license ______

Vehicle gas, oil, ordinary maintenance ______

Parking ______

______

Health Care:

Insurance ______

Uninsured dental, orthodontic, medical, eye care ______

______

Personal Expenses (not including children):

Clothing ______

Hair care / personal care ______

Clubs & recreation ______

Education ______

Books, newspapers, magazines, photos ______

Gifts ______

______

Miscellaneous:

Life insurance (if not deducted from income) ______

______

______

______

______

______

______

______

______

______

TOTAL MONTHLY EXPENSES: ______

PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT

COMMUNITY ASSETS

Asset # / Description of Community Asset / Related Debt # / Petitioner’s Position / Respondent’s Position
Fair Mkt Value / To Petitioner / To Respondent / Fair Mkt Value / To Petitioner / To Respondent
CA-1
CA-2
CA-3
CA-4
CA-5
CA-6
CA-7
CA-8
CA-9
CA-10
CA-11
CA-12
CA-13
CA-14
COMMUNITY ASSET TOTALS:

PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT

SEPARATE ASSETS

Asset # / Description of Separate Asset / Related Debt # / Petitioner’s Position / Respondent’s Position
Fair Mkt Value / To Petitioner / To Respondent / Fair Mkt Value / To Petitioner / To Respondent
SA-1
SA-2
SA-3
SA-4
SA-5
SA-6
SA-7
SA-8
SA-9
SA-10
SA-11
SA-12
SA-13
SA-14
SEPARATE ASSET TOTALS:

PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT

COMMUNITY DEBTS

Debt # / Description of Community Debt / Related Asset # / Petitioner’s Position / Petitioner’s Position
Balance at Separation / To Petitioner / To Respondent / Balance at Separation / To Petitioner / To Respondent
CD-1
CD-2
CD-3
CD-4
CD-5
CD-6
CD-7
CD-8
CD-9
CD-10
CD-11
CD-12
CD-13
CD-14
COMMUNITY DEBT TOTALS:

PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT

SEPARATE DEBTS

Debt # / Description of Separate Debt / Related Asset # / Petitioner’s Position / Respondent’s Position
Balance at Separation / To Petitioner / To Respondent / Balance at Separation / To Petitioner / To Respondent
SD-1
SD-2
SD-3
SD-4
SD-5
SD-6
SD-7
SD-8
SD-9
SD-10
SD-11
SD-12
SD-13
SD-14
SEPARATE DEBT TOTALS:

PRETRIAL AFFIDAVIT OF: PETITIONER RESPONDENT