ࡱ>  bjbjҰҰ W  ``0008h$02  (HHH6Eaceeeeee$:`9|``HHKl¶ `HHcc6HЛdH2Oض0^L&L4L8q>,ۋ$qqqՒ*qqqLqqqqqqqqq &: NameAddressCity, State, ZipPhoneCheck your email. You will receive information and documents at this email address. EmailI am [ ] Petitioner [ ] Respondent [ ] Petitioners Attorney [ ] Respondents Attorney (Utah Bar #:__________) [ ] Petitioners Licensed Paralegal Practitioner [ ] Respondents Licensed Paralegal Practitioner (Utah Bar #:__________) In the District Court of Utah __________ Judicial District ________________ County Court Address ______________________________________________________ _____________________________________ Petitioner v. _____________________________________ RespondentMotion for Temporary Order With Children [ ] Hearing Requested _______________________________ Case Number _______________________________ Judge _______________________________ CommissionerI ask the court to enter temporary orders in the paragraphs I have marked below. 1. [ ] Children (including only unborn, minor and adult incapacitated children) The petitioner and the respondent are the parents of the following children: (Add additional pages if needed.) Childs name (first, middle and last)Month and year of birthType of childExample: Jennie Eliza JonesJanuary 2017[ ] Unborn [x] Minor [ ] Adult incapacitated[ ] Unborn [ ] Minor [ ] Adult incapacitated[ ] Unborn [ ] Minor [ ] Adult incapacitated[ ] Unborn [ ] Minor [ ] Adult incapacitated[ ] Unborn [ ] Minor [ ] Adult incapacitated[ ] Unborn [ ] Minor [ ] Adult incapacitated The children have lived at the addresses listed below and with the persons listed below for the past five years: (Add additional pages if needed.) Childs nameAddress (street, city, state, ZIP)Dates child lived at this addressName(s) of person(s) who lived with child at this addressRelationship(s) to childExample: Jennie Jones123 Maple St Mayberry, UT 844445/15/15 to presentJane Doe, John JonesMother, maternal grandfather2. [ ] Child custody All orders involving children will include two types of custody: physical custody and legal custody. Physical custody deals with where the children live and how many overnights the children spend with each parent. Sole physical custody means that the children live primarily with one parent and have parent time (visitation) with the other parent (see parent-time options in Section 3). Joint physical custody means that the children typically spend at least 30% of overnights with both parents each year and that both parents contribute to the expenses of the child in addition to paying child support. Split physical custody means that where there is more than one child, each parent is awarded sole physical custody of at least one of the children. Legal custody deals with access to information and decision making. Sole legal custody means that one parent has the right to make important decisions about the child. Joint legal custody means that both parents: (1) have the right to information about the child (events, appointments, access to school and medical records, etc.); and (2) that both parents discuss and make major decisions together (education, religion, medical, extra-curricular activities, etc.) but designate a parent to make the final decision if they cannot agree.I ask the court to order temporary custody below (Choose one. If you ask for any joint legal custody or joint physical custody arrangement, you must file or attach a Parenting Plan based on Utah Code 30-3-10.7 to 30-3-10.10.): [ ] Custody arrangement: (Add additional pages if needed.) Childs nameMonth and year of birthOrder physical custody toOrder legal custody toExample: Jennie JonesJanuary 2013[ ] Petitioner [x] Respondent [ ] Joint physical[ ] Petitioner [x] Respondent [ ] Joint legal[ ] Petitioner [ ] Respondent [ ] Joint physical[ ] Petitioner [ ] Respondent [ ] Joint legal[ ] Petitioner [ ] Respondent [ ] Joint physical[ ] Petitioner [ ] Respondent [ ] Joint legal[ ] Petitioner [ ] Respondent [ ] Joint physical[ ] Petitioner [ ] Respondent [ ] Joint legal[ ] Petitioner [ ] Respondent [ ] Joint physical[ ] Petitioner [ ] Respondent [ ] Joint legal[ ] Petitioner [ ] Respondent [ ] Joint physical[ ] Petitioner [ ] Respondent [ ] Joint legal[ ] Other custody arrangement (Describe in detail.): I ask the court to order the custody arrangement I have marked above because: 3. [ ] Parent-time I ask the court to order temporary parent-time below (Choose one.): [ ] Statutory parent-time schedule: (Choose all that apply. You can find the Utah Code at le.utah.gov/xcode/code.html. Print and attach a copy of the statute(s) for the option(s) you choose.) [ ] Children under 5 (Utah Code 30-3-35.5) [ ] Children 5-18 (Utah Code 30-3-35) [ ] Children 5-18 (expanded schedule) (Utah Code 30-3-35.1) [ ] Children 5-18 (equal parent-time) (Utah Code 30-3-35.2) [ ] Parent-time described in the filed or attached Parenting Plan. [ ] Other parent-time schedule: (Describe in detail.) I ask the court to order the parent-time schedule I chose above because: 4. [ ] Parent-time transfers I ask the court to order transfer (pick-up and drop-off) of the children for parent-time described below (Choose one.): [ ] Order transfer of the children for parent-time described in the filed or attached Parenting Plan. [ ] Order transfer at beginning of parent-time with [ ] petitioner [ ] respondent [ ] other adult (Name) _______________________________________ transferring the children at this address: _________________________________________________________ and transfer at end of parent-time with [ ] petitioner [ ] respondent [ ] other adult (Name) _______________________________________ transferring the children at this address: _________________________________________________________ [ ] Order curbside transfers (The parent/person picking up or dropping off the children does not leave the vehicle and the other parent/person does not leave the residence). [ ] Other transfer arrangements (Describe in detail.): I ask the court to order the transfer arrangement I chose above because: 5. [ ] Communication between parties I ask the court to order communication between the parties as described below (Choose as many options as you want.): [ ] In person [ ] Phone Petitioners # ________________ Respondents #________________ [ ] Text Petitioners # ________________ Respondents #________________ [ ] Email Petitioners email address ____________________________________ Respondents email address __________________________________ [ ] Through a third party Name ____________________________ Phone # ________________ [ ] Other method of communication: (Describe in detail.) _________________________________________________________ [ ] Communications between the parties must be civil and respectful and limited to parent-time issues only. [ ] The parties must not make negative or harmful remarks about each other in the presence of the children, must not allow other people to do so and must remove the children if anyone makes negative remarks about the other party. [ ] The parties must not discuss this case in the presence of the minor children, must not allow other people to do so and must remove the children if anyone discusses the case in the presence of the minor children. [ ] The parties must not harm or threaten to harm the other parent or the children and must not allow other people to do so and must remove the children if anyone harms or threatens harm to the other parent or children. 6. [ ] Child support I ask the court to order child support based on the parties incomes or estimate of income based on ability or work history. a. Petitioners total countable gross monthly income for child support purposes is $______________ (Utah Code 78B-12-203). This income is from these sources: ___________________________________________________________ __________________________________________________________. [ ] The court should consider petitioner's income to be $______________ based on (Choose one.): [ ] minimum wage. [ ] historical earnings. [ ] Petitioner does receive or has received public assistance. b. Respondents total countable gross monthly income for child support purposes is $________________ (Utah Code 78B-12-203). This income is from these sources: ___________________________________________________________ __________________________________________________________. [ ] The court should consider respondent's income to be $______________ based on (Choose one.): [ ] minimum wage. [ ] historical earnings. [ ] Respondent does receive or has received public assistance. c. Order [ ] petitioner [ ] respondent to pay $________________ per month for child support. The following child support worksheet is filed or attached (Choose one.): [ ] sole physical custody worksheet [ ] joint physical custody worksheet [ ] split custody worksheet (Choose one.) [ ] This amount is based on the Uniform Child Support Guidelines (Utah Code 78B-12-201 et seq.). [ ] This amount is not based on the Uniform Child Support Guidelines and I am asking for a different amount because (Choose one.): [ ] the guidelines are unjust. [ ] the guidelines are inappropriate. [ ] the guidelines amount is not in the best interest of the children. (Utah Code 78B-12-202 and 210.) Explain your choice: _______________________________________________________ ______________________________________________________. d. Effective date (Choose one.): [ ] The child support is effective upon entry of this order. OR [ ] The child support is effective as of this date: ____________________. e. Child support will be paid as follows (Choose one.): [ ] Mandatory income withholding by the Office of Recovery Services. Unless the Office of Recovery Services gives notice that payments will be sent elsewhere, all child support payments must be made to: Office of Recovery Services, PO Box 45011, Salt Lake City, UT 84145 OR [ ] Direct payments to the parent receiving child support by: [ ] Check [ ] Deposit in bank account [ ] Cashiers check or money order [ ] Other: ________________________________________________ I ask for direct payment because (Utah Code 62A-11-404): ________________________________________________________ ________________________________________________________ f. I ask that child support payments be made (Choose one.): [ ] One-half on or before the 5th day of each month, and one-half on or before the 20th day of each month. OR [ ] Other payment arrangement: ________________________________________________________ g. Child support not paid on or before the due date is delinquent on the day after the due date. h. Child support arrearages will be determined by further judicial or administrative process. Any federal or state tax refund or rebate due to the non-custodial parent will be intercepted by the state of Utah and applied to child support arrearages. 7. [ ] Child care expenses I ask the court to order that both parties share equally the reasonable child care expenses related to the custodial parents work or occupational training. The parent who pays child care expenses must immediately provide to the other parent written verification of the cost of the child care expenses and the identity of the child care provider when hired, within 30 calendar days after a change in the provider or the expense, and anytime upon the request of the other parent. If the parent who pays child care expenses fails to provide written verification of child care above, that parent may be denied the right to recover or receive credit for the other parents one-half share of the child care expense. The other parent must begin paying one-half the child care amount on a monthly basis immediately after receiving proof from the parent that pays the child care expense. [ ] Other request for child care payment: 8. [ ] Health insurance, medical and dental expenses Our minor children currently have health insurance coverage through: [ ] Petitioners insurance [ ] Respondents insurance [ ] Medicaid [ ] CHIP [ ] Other: _______________________________________________ [ ] Not covered by insurance [ ] I ask the court to order that [ ] petitioner [ ] respondent maintain health insurance for our minor children. Both parties must share equally: a. the cost of the premium paid by a parent for the children's portion of the insurance. The children's portion of the premium will be calculated by dividing the premium amount by the number of people covered by the policy and multiplying the result by the number of minor children of the parties; and b. all reasonable and necessary uninsured medical and dental expenses incurred for the children and paid by a parent, including deductibles and co-payments. The parent ordered to maintain insurance must provide written verification of coverage to the other parent or the Office of Recovery Services when the children are first enrolled, on or before January 2nd of each calendar year and upon any change of insurance carrier, premium, or benefits within 30 calendar days after the date that parent knew or should have known of the change. If the parent ordered to maintain insurance fails to provide written verification of coverage to the other parent or to the Office of Recovery Services, or if the parent incurring medical expenses fails to provide written verification of the cost and payment of the expenses to the other parent within 30 days of payment, that parent may be denied the right to receive credit for the expenses or to recover the other parent's share of the expenses. The parent receiving written verification will reimburse the parent who incurred the medical or dental expenses one-half of the amount within 30 days after receiving the written verification. I ask for this order because (Choose all that apply.): [ ] the insurance is available to [ ] petitioner [ ] respondent; [ ] the cost of the insurance is reasonable [ ] the custodial parent prefers this arrangement. [ ] Other reasons: [ ] I ask for these additional orders regarding health insurance and medical and dental expenses: 9. [ ] Pregnancy expenses I ask the court to order that [ ] petitioner [ ] respondent pay 50% of the pregnancy expenses. These expenses were billed for services the mother received after becoming pregnant and before the pregnancy ended. (You must attach all documents supporting the amounts you are requesting.) [ ] One-half of health insurance premiums not paid by an employer or government program from _________ to ________ (dates)$ _______________[ ] One-half of medical costs related to the pregnancy not covered by insurance or government program $ _______________10. [ ] Tax exemptions for dependent children I ask the court to order tax exemptions for the dependent children for tax year _____________, as follows: Childs nameMonth and year of birthParent who may claim exemption[ ] Petitioner [ ] Respondent[ ] Petitioner [ ] Respondent[ ] Petitioner [ ] Respondent[ ] Petitioner [ ] Respondent[ ] Petitioner [ ] Respondent[ ] Other: ________________________________________________________ _____________________________________________________________ 11. [ ] Payment of bills and debts I ask the court to order payment of bills and debts (such as mortgage, rent, credit card, utilities, medical expenses, car payments, insurance, etc.) as follows (File or attach Financial Declaration. Add additional pages if needed.): [ ] Petitioner to pay: Type of debtName of creditorLast 4 digits of account no.Total amount owedMonthly amount owed$$$$$$[ ] Respondent to pay: Type of debtName of creditorLast 4 digits of account no.Total amount owedMonthly amount owed$$$$$$The bills and debts should be paid as requested because: 12. [ ] Property I ask the court to order the temporary use and possession of the following property (File or attach Financial Declaration. File or attach additional pages if needed.): [ ] To petitioner [ ] Residence (Address): ________________________________________ [ ] Vehicle(s) (Make/model/year): __________________________________ [ ] Personal property items: ________________________________________________________ ________________________________________________________ [ ] Other: ___________________________________________________ [ ] To respondent [ ] Residence (Address): ________________________________________ [ ] Vehicle(s) (Make/model/year): __________________________________ [ ] Personal property items: ________________________________________________________ ________________________________________________________ [ ] Other: ___________________________________________________ [ ] I ask the court to order that neither party sell, transfer or dispose of any property without a court order or written agreement signed by both parties. I ask for this property order because: 13. [ ] Temporary alimony (Divorce cases only. (Utah Code 30-3-5(8)).) I am unable to meet my own financial needs, and I ask the court to order temporary alimony as follows (File or attach Financial Declaration.): [ ] petitioner [ ] respondent shall pay to [ ] petitioner [ ] respondent temporary alimony in the amount of $ _______________ per month by: (Choose one.): [ ] Check [ ] Deposit in bank account [ ] Cashiers check or money order [ ] Other: ________________________________________________ [ ] Petitioner [ ] Respondent needs temporary alimony because : [ ] Petitioner [ ] Respondent has the financial ability to pay temporary alimony because: 14. [ ] Attorney fees I ask the court to order the other party to pay $___________ to my attorney. (You can only ask for this if you are paying an attorney to represent you in this case. You must file or attach a Financial Declaration.) I ask for attorney fees because:  15. [ ] Other I ask the court for these additional orders: I ask for these additional orders because: 16. Documents I have filed or attached the following documents in support of this Motion for Temporary Order (Check all that apply. Forms can be found at www.utcourts.gov.): [ ] Parenting Plan (Utah Code 30-3-10.7 to 30-3-10.10) [ ] Parent time Schedule (Utah Code 30-3-35; 30-3-35.5; 30-3-35.1; 30-3-35.2) [ ] Child Support Obligation Worksheet (Utah Code 78B-12) [ ] Financial Declaration (Utah Rule of Civil Procedure 26.1) [ ] Income verification (Most recent tax return and pay stub) [ ] Other supporting documents:_____________________________________ Petitioner or Respondent I declare under criminal penalty under the law of Utah that everything stated in this document is true. Signed at ______________________________________________________ (city, and state or country).Signature %DatePrinted Name Attorney or Licensed Paralegal Practitioner of record (if applicable)Signature %DatePrinted Name Notice to responding party You have a limited amount of time to respond to this motion. In most cases, you must file a written response with the court and provide a copy to the other party: within 14 days of this motion being filed, if the motion will be decided by a judge, or at least 14 days before the hearing, if the motion will be decided by a commissioner. In some situations a statute or court order may specify a different deadline. If you do not respond to this motion or attend the hearing, the person who filed the motion may get what they requested. See the courts Motions page for more information about the motions process, deadlines and forms: utcourts.gov/motionsAviso para la parte que responde Su tiempo para responder a esta mocin es limitado. En la mayora de casos deber presentar una respuesta escrita con el tribunal y darle una copia de la misma a la otra parte: dentro de 14 das del da que se presenta la mocin, si la misma ser resuelta por un juez, o por lo menos 14 das antes de la audiencia, si la misma ser resuelta por un comisionado. En algunos casos debido a un estatuto o a una orden de un juez la fecha lmite podr ser distinta. Si usted no responde a esta mocin ni se presenta a la audiencia, la persona que present la mocin podra recibir lo que pidi. Vea la pgina del tribunal sobre Mociones para encontrar ms informacin sobre el proceso de las mociones, las fechas lmites y los formularios: utcourts.gov/motions-spanFinding help The courts Finding Legal Help web page (utcourts.gov/help) provides information about the ways you can get legal help, including the Self-Help Center, reduced-fee attorneys, limited legal help and free legal clinics. Cmo encontrar ayuda legal La pgina de la internet del tribunal Cmo encontrar ayuda legal (utcourts.gov/help-span) tiene informacin sobre algunas maneras de encontrar ayuda legal, incluyendo el Centro de Ayuda de los Tribunales de Utah, abogados que ofrecen descuentos u ofrecen ayuda legal limitada, y talleres legales gratuitos. Certificate of Service I certify that I filed with the court and am serving a copy of this Motion for Temporary Order With Children on the following people.Persons NameService MethodService AddressService Date[ ] Mail [ ] Hand Delivery [ ] E-filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing there.)[ ] Mail [ ] Hand Delivery [ ] E-filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) 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