Ind. Porter Cnty. Family Law Rules Apps. A-F

SUPPLEMENT TO THE PORTER COUNT

LOCAL FAMILY LAW RULES

APPENDICES A-F

APPENDIX A

STATE OF INDIANA )

PORTER SUPERIOR COURT ) SS:

IN RE THE MARRIAGE/PATERNITY OF: )

)

Petitioner ) CAUSE #

v, )

)

Respondent )

DOMESTIC RELATIONS CASE MANAGEMENT ORDER

The Court, in the exercise of its discretion under Trial Rule 16 (A), now orders the parties,

including pro se litigants, and their respective attorneys to comply with the following orders:

A. Financial Declaration Forms, complete with supporting exhibits, shall be

exchanged between the parties within forty five (45) days from the date

the Petition for Dissolution of Marriage or Petition for Legal Separation is

filed, and within thirty (30) days from the date that a Petition for

Modification or Petition for Rule to Show Cause is filed, provided said

petitions address the financial obligations of the parties, i.e. child support,

including but not limited to, educational expenses or the payment of

marital debt.

B. Within forty-five (45) days from the date either party filed their petition,

the parties shall be required to appear in person, if they are proceeding pro

se, or by their respective attorneys, for an Initial Pre-Trial Conference.

Said conference is hereby scheduled before this court on the day of

, 201, at m.

Each party shall be prepared to address the following issues:

i. Identification of the issues pending before the court;

ii. Identification of issues which have been amicably resolved

between the parties, together with the terms of said resolution;

iii. Identification of the remaining contested issues;

iv. Estimated time required to complete discovery relative to the

contested issues;

v. If not addressed at the Provisional Hearing, the identification or

appointment of experts who shall assist the parties or the court

in the resolution of the contested issues, including the

appointment of a Guardian-ad-Litem, custodial evaluator or a

property evaluator;

vi. The possibility of settlement on all or a portion of the

contested issues through mediation, settlement conference or

the implementation of another Alternative Dispute Resolution

method;

vii. The estimated time required to present the contested issues

before the court, including the possibility of disposing of

all or a portion of the contested issues in summary fashion;

viii. The parties= attendance and completion of the Trans-

Parenting Class as required by Local Rule;

ix. AT THE CONCLUSION OF THE INITIAL PRE-TRIAL

CONFERENCE, THE COURT SHALL SCHEDULE THE

CASE FOR A FINAL PRE-TRIAL CONFERENCE. NO

FINAL HEARINGS SHALL BE SCHEDULED UNTIL

THE CONCLUSION OF THE FINAL PRE-TRIAL

CONFERENCE.

C. Within ninety (90) days from the conclusion of the Initial Pre-Trial

Conference, the parties shall be required to appear in person, if they are

proceeding pro se, or by their respective attorneys, for a Final Pre-Trial

Conference. Said conference is hereby scheduled before this court on the

day of, 201, at m. Provided, however, the court shall be

permitted schedule the Final Pre-Trial Conference later than ninety (90) days

from the date of the Initial Pre-Trial Conference if it determines that additional

time is required by the parties to complete the discovery identified at the Initial

Pre-Trial Conference or if additional time is required to complete the

Guardian-ad-Litem=s investigation and report, the custodial evaluations, the

real and personal property evaluations and/or mediation, or if the parties intend

to attempt counseling and/or reconciliation.

D That counsel, or party/parties, if pro-se, shall confer in person at a

PreliminaryConference at least ten (10) days before the scheduled Final Pre-Trial Conference. The moving party shall undertake the responsibility of

arranging the aforementioned conference at a time and location which

is mutually agreeable between the parties. In preparation for the Final

Pre-Trial Conference, the parties shall address the following issues at their

Preliminary Conference:

i. The possibility of reaching an agreement regarding the

contested issues;

ii. The possibility of disposing of the cause in summary

fashion as to some or all of the issues;

iii. The identification and exchange of exhibits which the

parties intend to introduce into evidence at the Final

Hearing;

iv. The possibility of stipulating to the authenticity or

admissibility of each parties= exhibits to avoid unnecessary

delays at the Final Hearing;

v. The exchange of each parties= witness lists, including expert

witnesses, and the nature of the testimony that each witness

shall be expected to testify to at the Final Hearing;

vi. The preparation of a master list of the parties= real and personal

property, which list shall be submitted by the parties to the

court as a joint exhibit at the Final Pre-Trial Conference. Said

exhibit shall be presented to the court in the following form and

shall include all assets of the parties subject to division by the

court:

EXAMPLE ASSET FORM

ASSET NUMBER ASSET NAME WIFE=S VALUE HUSBAND=S

VALUE AGREED VALUE COURT=S VALUE

1 Marital Residence $150,000.00 $175,000.00

11 River Drive Valparaiso,

IN Titled: Jointly

2 2002 Jeep Cherokee $ 12,500.00

Titled: Jointly

3 oint Checking Acct. Bank $ 1,500.00 $ 2,500.00

One

Account # 1234

4 Antique Rocker $ 500.00 $ 750.00

vii. The preparation of a master debt list, which shall be submitted by the parties to the court

as a joint exhibit at the Final Pre-Trial Conference. Said exhibit shall be presented to the court in

the following form:

EXAMPLE DEBT FORM

DEBT NUMBER ACCOUNT NAME

AND NUMBER DATE OF SEPARATION

BALANCE CURRENT BALANCE

1 SEARS MASTERCARD

ACCOUNT # 1234 5678-9876 $5,250.00 $5,210.00

TITLED: JOINTLY

2 MBNA VISA

ACCOUNT # 9876 5432-0987$500.00$475.00

TITLED: HUSBAND

E. The parties shall be prepared to address the following issues at their Final

Pre-Trial Conference:

vi. The status of discovery;

vii. The results of mediation or settlement conference;

viii. Identification of the issues resolved by agreement, together

with the terms of said agreement;

ix. Identification of the remaining contested issues;

x. The parties= final witness and exhibit lists, together

with stipulations regarding the admissibility of any

exhibits;

xi. A brief summary regarding the parties= contentions relative to

the contested issues;

xii. The presentation of the parties= joint asset list;

xiii. The presentation of the parties= joint debt list; and

xiv. Anticipated time required to litigate the contested issues.

F. At the conclusion of the Final Pre-Trial Conference, the court shall schedule

the cause of action for final hearing, and shall enter additional orders, if

required, regarding Pre-Trial motions presented by the parties.

G. Pursuant to Trial Rule 16(K) and Trial Rule 41(E), failure to attend the Initial

Pre-Trial Conference or the Final Pre-Trial Conference, may result in the

entry of an order of dismissal or default against the party or parties who fail

to appear. In addition, the court may impose sanctions against any party or

attorney of record who fails to attend the preliminary conference; is

unprepared to participate in either the Initial Pre-Trial Conference or Final

Pre-Trial Conference, or who refuses, in bad faith, to enter into stipulations

regarding the facts, the law, or the exhibits. Said sanctions may include costs

associated with rescheduling any of the three conferences identified herein,

and attorney fees.

No continuances of the Provisional Hearing, Initial Pre-Trial Conference,

Final Pre-Trial Conference, or Final Hearing may be obtained without

strict compliance with the provisions outlined in Trial Rule 53.5 and Local

Rule 3500. If a continuance is requested and granted, said continuance shall

be charged against the party requesting same. The existence of charged

continuances, whether or not in good faith, may be considered by the court in

its ruling regarding the payment of attorney fees or other costs of the action.

ALL OF WHICH IS FOUND AND RECOMMENDED THIS DAY OF,

20.

MAGISTRATE, PORTER SUPERIOR COURT

ALL OF WHICH IS ORDERED, ADJUDGED AND DECREED THIS DAY OF

, 20.

JUDGE, PORTER SUPERIOR COURT

APPENDIX B

FINANCIAL DECLARATION FORM

STATE OF INDIANA: CIRCUIT AND SUPERIOR COURTS OF

PORTER COUNTY

IN RE: THE MARRIAGE OF: Cause No:

Petitioner

and

Respondent

In accordance with Local Rule 2200.1 of the Porter Superior Court and Indiana Trial

Rules 26, 33, 34, 35 and 37, the undersigned, Petitioner or Respondent, hereby submits the

following VERIFIED FINANCIAL DISCLOSURE STATEMENT:

FINANCIAL DECLARATION OF

I. PRELIMINARY INFORMATION

Husband* Wife*

Address: Address:

Soc. Sec. No. Soc. Sec. No.

Badge/Payroll No: Badge/Payroll No:

Occupation: Occupation:

Employer Employer:

Birth Date: Birth Date:

Children:

Date of:

Marriage:

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II. HEALTH INSURANCE INFORMATION

Name and Address of health care insurance

company:

Name all persons covered under Plan(s):

Weekly cost of total health Weekly cost of health insurance premium

insurance premium: for children only:

Name of the children=s= health care providers:

The names of the schools and grade level for each child are:

List any extraordinary health care concerns of any family member:

List any educational concerns of any family member:

III. INCOME INFORMATION

A. EMPLOYMENT HISTORY

Current employer

Address

Telephone No: Length of Employment

Job Description

Gross Income

Per week bi-weekly per month yearly

Net Income

Per week bi-weekly per month yearly

B. EMPLOYMENT HISTORY FOR LAST 5 YEARS

Employer Dates of employment Compensation (per

wk/mo/yr)

C. INCOME SUMMARY

1. GROSS WEEKLY INCOME from: Salary

and wages, including commissions, bonuses,

allowances and over-time $

Note: If paid monthly, determine weekly income by

dividing monthly income by 4.3

Pensions & Retirement

Social Security

Disability and unemployment insurance

Public Assistance (welfare, AFDC payments, etc.)

Food stamps

Child support received for any child(ren) not born

of the parties to this marriage

Dividends and Interest

Rents received

All other sources (specify)

TOTAL GROSS WEEKLY INCOME $

2. ITEMIZED WEEKLY DEDUCTIONS

from gross income:

State and Federal Income taxes:

Social Security

Medical Insurance

Coverage: Health ( )

Dental ( )

Eye Care ( )

Psychiatric ( )

Union or other dues:

Retirement:

Pension fund: Mandatory ( ) Optional ( )

Profit Sharing: Mandatory ( ) Optional ( )

401(k): Mandatory ( ) Optional ( )

SEP: Mandatory ( ) Optional ( )

ESOP: Mandatory ( ) Optional ( )

IRA: Mandatory ( ) Optional ( )

Child support withheld from pay

(not including this case)

Garnishments (itemize on separate sheet)

Credit Union debts

Direct Withdrawals Out of Paychecks:

Car payments

Life insurance

Disability insurance

Thrift plans

Credit union savings

Bonds

Donations

Other (specify)

Other (Specify):

TOTAL WEEKLY DEDUCTIONS

3. WEEKLY DISPOSABLE INCOME

(A minus B: Subtract Total Weekly

Deductions from Total Weekly Gross

Income)

IN ALL CASES INVOLVING CHILD SUPPORT: Prepare and attach an Indiana Child

Support Guideline Worksheet (with documentation verifying your income); or, supplement

with such a Worksheet within ten (10) days of the exchange of this Form.

IV. MONTHLY LIVING EXPENSES:

House

1. Rent(Mortgage)

2. 2nd Mortgage

3. Line of credit

4. Gas/Electric

5. Telephone

6. Water

7. Sewer

8. Sanitation (garbage)

9. Cable

10. Satellite

11. Internet

12. Taxes (Real Estate) (If not part of mortgage payment)

13. Insurance(House) (If not part of mortgage payment)

14. Lawn Care/Snow Removal

Groceries

1. Food

2. Toiletries

3. Cleaning Products

4. Paper Products

Clothing

1. Clothes

2. Shoes

3. Uniforms

Health Care

1. Health insurance not deducted from pay

2. Dental insurance not deducted from pay

3. Doctor Visits (non insurance covered)

4. Dental Visits (non insurance covered)

5. Prescription Pharmaceutical (non insurance covered)

6. Over the counter medicine

7. Glasses/contact lenses

8. Other non-insurance covered health care*

Car & Travel

1. Car Payment

2. Gasoline

3. Oil/Maintenance

4. Insurance (Car)

5. Car Wash

6. Tolls

7. Train/Bus

8. Parking Lot Fees

9. License plates

Beauty Care

1. Hair Dresser/Barber

2. Cosmetics

School Needs

1. Lunches

2. Book

3. Tuition/Registration

4. Uniforms

5. School Supplies

6. Extra curricular activities

Infant Care

1. Diapers

2. Baby Food

Miscellaneous

1. Church Donations

2. Charitable Donations

3. Life Insurance

4. Babysitter

5. Newspapers & Magazines

6. Cigarettes

7. Dry Cleaning

8. Entertainment

9. Cell phone

10. Dues/subscriptions

14. Charge Cards

15. Other *

* Itemize at bottom of page

Sub-Total of Expenses

Average Weekly Expenses (multiply monthly expenses by 12

and divide by 52)

V. PROVISIONAL ARREARAGE COMPUTATIONS. If you allege the existence of a

child support, maintenance, or other arrearage, attach all records or other exhibits

regarding the payment history and compute the child support arrearages.

You must attach a Child Support Guideline Worksheet to your Financial Declaration

Form or one must be exchanged with the opposing party/counsel within 10 days of

receipt of the other parties= Financial Declaration Form.

ASSETS

All property is to be listed regardless of whether it is titled in your name only or jointly or if

property you own is being held for you in the name of a third party.

VI. PROPERTY

A. MARITAL RESIDENCE

Description:

Location:

Date Acquired:

Purchase Price:

Down Payment:

Source of Down Payment:

Current Indebtedness:

Monthly

Payment:

Current Fair Market Value:

B. OTHER REAL PROPERTY (Complete B, on a separate sheet of paper for each

additional parcel of real estate owned, etc).

Description:

Location:

Purchase Price:

Down Payment:

Source of Down Payment:

Current Indebtedness:

Monthly Payment:

Current Fair Market Value:

C. PERSONAL PROPERTY (motor vehicles, boats, motorcycles, furnishings, household

goods, jewelry, firearms, etc. Household furnishings and

household goods such as pots and pans need not be

itemized.)

Current Present

Description Titled Value Indebtedness Payment User

VII. BANK ACCOUNTS

Type of Account

(Checking,

Savings, Account Balance on

Name CDs, etc.) Owner No. Date of Filing

VIII NON-RETIREMENT SECURITIES (stocks, bonds, mutual funds, etc.)

Type of account

(Money mkt,

Stocks, Bonds, Value

Mutual Funds Account on date

Name etc.) Owner No. of filing

IX. LIFE INSURANCE POLICIES (whole life, variable life, annuities, term)

FaceLoanCash

CompanyOwnerPolicy #BeneficiaryValue Amount Value

X. RETIREMENT ACCOUNTS (Pension, Profit Sharing, 401(k), SEP, IRA,

KEOGH, ESOP, etc).

Vested Value as of

Company Type of Plan Owner Account # (Yes/No) Date of Filing

Divorce

I. OTHER PROFESSIONAL OR BUSINESS INTERESTS

Type (Corp.,

Name of Business Part., Sole Owner) % Owned Estimated Value

XII. MARITAL BILLS, DEBTS, AND OBLIGATIONS (list every single bill, debt and

obligation regardless of whether the bill is titled in your name, your spouse=s name, or

jointly. Please include all mortgages, 2nd mortgages, home equity loans, charge cards,

other loans, credit union loans, car payments, and unpaid medical bills, etc. Do

not include monthly expenses such as utilities that are paid in full every month.)

Monthly Balance - Current

Creditor Description Acct # Payment Date of Filing Balance

Example(s):

1st National Bank Mortgage 87612368459 $1,530.00 $145,680.00 $145,100.00

Visa Misc household

expenses 14567865349 $300.00 $3,500.00 $3,250.00

XIII. RECAPITULATION. A summary of the marital estate is as follows:

In Name ofIn Name of

Asset Husband Wife Jointly Held Total

Family Dwelling

Other Real Estate

Personal Property

Bank Accounts

Non-Retirement Securities

Life Insurance Policies

Retirement Accounts

Other Professional/Business

Interests

Total Assets

Liabilities

General Creditors

Mortgage on Family Dwelling

Mortgages on other real estate

Notes to Banks and Others

Loans on Insurance Policies

Other Liabilities

Total Liabilities

ASSETS MINUS LIABILITIES

XIV. PERSONAL STATEMENT REGARDING DIVISION OF PROPERTY

Indiana law presumes that the marital property be split on a 50/50 basis.

However, the Judge may order a division which may differ from an exact 50/50

division of your property. Please provide a brief statement as to your reasons, if

there be any, why the Court should divide your property on anything other than a

50/50 basis.

XV. MANDATORY EXHIBITS

The following exhibits must be attached to your Financial Declaration Form:

1. The last three years of Individual State and Federal income tax returns together

with all W-2 forms, 1099 forms and K-1 forms.

2. The immediate preceding six paycheck stubs showing year-to-date earnings.

3. Documents showing the amount of income received from any other source in the

past three years including irregular income in an amount greater than $500 per

year plus any expenses relating thereto.

4. Child support worksheet, if applicable.

5. Arrearage calculation, if applicable under V of this Financial Declaration Form.

6. With regard to all real estate listed under VI (A) and (B):

a. The title insurance policy, if available,

b. The deed,

c. An amortization schedule from the lending institution, if available,

d. Documents showing the mortgage balance as of the date of the filing of

the Petition for Dissolution of Marriage,

7. As to all bank accounts identified in VII of this Financial Declaration Form:

a. Copy of the bank statement closest to the date of the filing of the petition

for Dissolution of Marriage, and

b. Copies of the bank statements for the five months immediately preceding

the filing of the Petition for Dissolution of Marriage.

8. As to all Non-retirement Securities identified in VIII of this Financial Declaration

Form:

a. Copy of the statement closest to the date of the filing of the petition for

Dissolution of Marriage, and

b. Copies of the statements for the five months immediately preceding the

filing of the Petition for Dissolution of Marriage.

9. As to all Life Insurance policies identified in IX of this Financial Declaration

Form attach statements as of cash value as of the date of the filing of the Petition

for Dissolution of Marriage.

10. As to all Retirement Accounts identified in X of this Financial Declaration Form

attach statements showing the value of the account as of the date of the filing of

the Petition for Dissolution of Marriage and for the preceding five months, if such

statements are available, except for pension accounts and other defined benefit

plans, in which event attach a statement from the employer describing the

benefits.

11. As to all marital bills, debts and obligations identified in XII of this Financial

Declaration Form, attach a statement showing the amount of each bill, debt and

obligation as of the date of the filing of the divorce and for the immediately

preceding five months.

XV. VERIFICATION

I declare, under the pains and penalty of perjury, that the foregoing, including statements

of my income, expenses, assets and liabilities, are true and correct to the best of my

knowledge and that I have made a complete and absolute disclosure of all sources of

income, all assets, and all liabilities. If it is proven to the Court that I have intentionally

failed to disclose all of my income, any asset, or liability, I may lose the asset and may be

required to pay the liability.

Further, this Financial Declaration Form is considered as a Request for Admissions to the

recipient under Trial Rule 35 and should the recipient fail to fully prepare and exchange

this statement then the Court may prohibit the party who did not properly complete the

Financial Declaration Form from introducing any evidence at any hearing to contradict

the evidence of the other party on the issues of income, expenses, assets and liabilities.

Date:

Signature

XVI. ATTORNEY=S CERTIFICATION

I have reviewed with my client the foregoing information, including any valuations and

attachments, and sign this certificate consistent with my obligation under Trial Rule 11 of

the Indiana Rules of Procedure.

Date:

Attorney for the

15 N. Washington Street

Valparaiso, IN 46383

219/464-3246

FINANCIAL DECLARATION FORM

STATE OF INDIANA: CIRCUIT AND SUPERIOR COURTS

OF PORTER COUNTY

(PATERNITY SHORT FORM)

IN RE: THE PATERNITY OF: CAUSE NO:

Petitioner

and

Respondent

In accordance with Local Rule 2200.1 of the Porter Superior Court and Indiana Trial Rules

26, 33, 34, 35 and 37, the undersigned, Petitioner or Respondent, hereby submits the following

VERIFIED FINANCIAL DISCLOSURE STATEMENT:

FINANCIAL DECLARATION OF

I. PRELIMINARY INFORMATION

Mother Father

Address: Address:

Soc. Sec. No. Soc. Sec. No.

Occupation: Occupation:

Employer: Employer:

Birth Date: Birth Date:

Children of this action:

Name Age DOB: SSN:

Name Age DOB: SSN:

Name Age DOB: SSN:

Name Age DOB: SSN:

For each child:

Attached copy of birth certificate: Yes No

Attached copy of signed paternity affidavit Yes No

Date of filing Petition:

Your other children not subject to this proceeding:

Name Date of Birth SSN: Lives with you: YesNoReceives Support: Yes No Amount of

Support Pays Support:Yes No Amount of Support

Name Date of Birth SSN: Lives with you: YesNoReceives Support: Yes No Amount of

Support Pays Support:Yes No Amount of Support

Name Date of Birth SSN: Lives with you: YesNoReceives Support: Yes No Amount of

Support Pays Support:Yes No Amount of Support

Name Date of Birth SSN: Lives with you: YesNoReceives Support: Yes No Amount of

Support Pays Support:Yes No Amount of Support

II. INCOME INFORMATION

A. EMPLOYMENT HISTORY

Current employer:

Address:

Telephone No: Length of employment:

Job description:

Gross Income

Per week Bi-weekly Per month Yearly

B. EMPLOYMENT HISTORY FOR LAST 5 YEARS

(Attach additional sheet if necessary)

Employer Dates of employment Compensation (per wk/mo/yr)

C. INCOME SUMMARY

L. GROSS WEEKLY INCOME FROM: Salary

and wages, including commissions, bonuses,

allowances and over-time $

Note: If paid monthly, determine weekly income by

dividing monthly income by 4.3

Pensions & Retirement

Social Security

Disability and unemployment insurance

Public Assistance (welfare, AFDC payments etc.)

Food stamps

Child support received for any child(ren) not subject

to this action

Dividends and Interest

Rents received

Income from present spouse/relationship

All other sources (specify)

TOTAL GROSS WEEKLY INCOME $

ATTACH COPIES OF:

Last two Federal and State Income Tax Returns

Five of your most recent payroll stubs

III. HEALTH INSURANCE INFORMATION

Name and address of health care insurance company:

Name all persons covered under Plan(s):

Weekly cost of total health Weekly cost of health insurance premium

insurance premium: for children only:

IV. MONTHLY BUDGET OF EXPENSES

A. HOUSING Yourself Children

1. Rent

2. Mortgage-principal & interest

3. Second Mortgage

4. Lot rent

5. Home insurance

6. Other (itemize)

Sub-total

B. UTILITIES

A. Electricity

B. Gas/heating Oil

C. Telephone

D. Water

E. Other (itemize)

Sub-total

C. HOUSEHOLD MAINTENANCE

1. Repairs (normal/on-going)

2. Cable TV

3. Child Support withheld from pay

4. Garnishments

5. Credit cards

6. Legal fines/costs

7. Other (itemize)

D. OTHER EXPENSES

1. Food

2. Clothing

3. Transportation

4. Health/medical/dental

5. Childcare/daycare

6. Personal/entertainment

E. ALL OTHER EXPENSES

V. PROVISIONAL ARREARAGE COMPUTATIONS. If you allege the existence of a child

support, birthing expenses, past medical bills, daycare expenses, maintenance, or other arrearage,

attach all records or other exhibits regarding the payment history and compute the child support

arrearages.

You must attach a Child Support guideline Worksheet to your Financial Declaration From or one

must be exchanged with the opposing party/counsel within 10 days of receipt of the other parties=

Financial Declaration Form.

VI. VERIFICATION

I declare, under the penalties of perjury, that the foregoing, including any valuations and

attachments, is true and correct and that I have made a complete and absolute disclosure of all my

assets and liabilities. Furthermore, I understand that if, in the future, it is proved to this Court that

I have intentionally failed to disclose any asset or liability, I may lose the asset and be required to

pay the liability. Finally, I acknowledge that sanctions may be imposed against me, including

reasonable attorney=s fees and expenses incurred in the investigation, preparation and prosecution

of any claim or action that proves my failure to disclose assets or liabilities.

Date:

PARTY=S SIGNATURE

VII. ATTORNEY CERTIFICATION

I have reviewed with my client, the foregoing information, including any valuations and

attachments, and have signed this certification with my obligation under Trial Rule Eleven (11) of

the Indiana Rules of Procedure.

Date:

ATTORNEY=S SIGNATURE

APPENDIX

D

STATE OF INDIANA ) PORTER SUPERIOR COURT

) SS: Sitting in Valparaiso, Indiana

COUNTY OF PORTER ) CONTINUOUS TERM 20

IN RE THE MARRIAGE/PATERNITY OF:)

)

, Petitioner ) CAUSE #

v )

, Respondent

PETITION FOR THE APPOINTMENT OF A GUARDIAN AD LITEM

The Court now appoints as Guardian ad Litem for the

minor child(ren) of the parties, and Finds, Recommends, and Orders as follows:

1. That the GAL is appointed, pursuant to I.C. 31-15-6-1, et seq., and/or other

appropriate section(s) of the Indiana Code and/or Local Rules, for the following minor

children of the parties:

name date of birth

name date of birth

name date of birth

2. That this appointment of the GAL shall become effective upon payment to the GAL

of the required monetary retainer and the GAL=s acceptance of the same. The issue of the

retainer payment to the GAL shall be set for a review hearing within days. Attorney for

shall coordinate such hearing date and assure that the same occurs if the

GAL has not been paid in a timely manner.

Said monetary retainer shall be in the amount of $ . The GAL is

hereby authorized to bill the parties for services rendered at the GAL=s usual rate, with the

understanding that said usual rate may be reduced to the county=s service rate if any remainder

of the GAL=s bill is later submitted to Porter County for payment.

The Petitioner shall pay $ toward such retainer.

The Respondent shall pay $ toward such

retainer.

The retainer payments shall be made within days of this Order.

Further, as to future billings by the GAL, the parties will divide obligations for the same with

Petitioner paying % and Respondent paying % of such obligations. Payment of

such obligations shall be timely made. All retainer and obligations and/or payments to the

GAL are subject to reallocation and/or further order of the Court.

3. That the GAL is appointed to provide the following services in this cause, with

the understanding that the Court, GAL, or the parties may reasonably expand the scope of

such services upon further motion, order, and/or inquiry:

{check all that apply)

Parenting Time/Visitation Issues

Child=s health issues

Custodial Recommendation

Elicit child=s opinion relevant to pending litigation

Review of home environment(s)

Other:

4. That the parties are hereby directed to provide to the GAL, within ten (10) days of

the payment of the retainer, a written summary of their position on the issues pending before

this court, and their requests of the GAL.

The GAL shall conduct a timely investigation of the issues the GAL deems relevant to the

best interests of the child(ren).

5. That the Parties shall advise the GAL of their current residence and telephone number,

as well as the residence and school (if any) of the child(ren).

6. That upon the presentation of this Order to any agency, hospital, organization, school,

person, or office, including the Department of Public Welfare and mental health agencies,

physicians, psychiatrists, or police departments, the aforementioned shall permit the Guardian

Ad Litem to inspect and/or copy any records, reports, x-rays, photographs or other matters

relevant to this case and the child that is the subject of this dissolution, custody and/or

visitation proceeding. Further, the aforementioned Guardian Ad Litem may obtain any reports

or examine

said reports without the consent of the child(ren), his/her parents, or any other person

responsible for the child=s (children=s) welfare;

The custodial parent(s) shall assure that the GAL is granted access to all such persons

and entities and, as needed, shall sign any release necessary to facilitate the same.

7. That the Parties do hereby acknowledge that, although the GAL-child relationship is

not technically an attorney-client relationship under the statute, the parties do wish to

encourage the child to have open and complete discourse with the GAL. Therefore, the

Guardian ad Litem assigned to this case may, at the GAL=s discretion, maintain any and all

information received from the child as confidential and choose not disclose same except in

reports to the Court, as ordered by the Court, and/or to any party in this case;

If the GAL believes that an attorney-client relationship has been created between the child

and the GAL at any time, the GAL shall promptly notify the court and the parties and set a

status hearing relevant to the same;

8. That the Guardian ad Litem shall appear at all Hearings or proceedings scheduled in

this case and assure proper representation for the child(ren) at said Hearings;

9. That the Guardian Ad Litem is now considered a party to this action and shall therefore

be notified of any hearings, staffings, investigations, depositions, and/or other proceedings in

this cause and shall be notified properly as to any action taken on behalf of the child(ren) by

any party.

The scheduling of hearings requiring the GAL to be present shall be coordinated with the

GAL. Although the GAL shall be notified of all hearings, the appearance of the GAL may be

waived if

the issues relevant to such hearing do not reasonably involve the children.

10. That the GAL shall submit a written report to the Court no later than ten (10) days

prior to any final hearing on issues, as set forth above, relevant to the children.

If such report is not submitted timely, the parties do hereby agree that there shall not be an

automatic continuance of a hearing granted to either party relevant to such late report, and

any party requesting such continuance shall provide notice thereof to the Court and the

GAL and allow the GAL two business days to complete and submit such report.

Ultimately, the Court shall have discretion to rule on the reasonableness of any continuance

request.

APPENDIX E

STATE OF INDIANA ) IN THE COURT

) SS:

COUNTY OF ) Case Number:

(To be supplied by Clerk when case is filed.)

(Caption)

APPEARANCE BY ATTORNEY IN CIVIL CASE

This Appearance Form must be filed on behalf of every party in a civil case.

1. The party on whose behalf this form is being filed is:

Initiating Responding Intervening; and

the undersigned attorney and all attorneys listed on this form now appear in this case for the

following parties:

Name of party

Address of party (see Question # 6 below if this case involves a protection from abuse

order, a workplace violence restraining order, or a no-contact order)

Telephone # of party

FAX:

Email Address:

(List on a continuation page additional parties this attorney represents in this case.)

2. Attorney information for service as required by Trial Rule 5(B)(2)

Name: Atty Number:

Address:

Phone:

FAX:

Email Address:

(List on continuation page additional attorneys appearing for above party)

3. This is a case type as defined in administrative Rule 8(B)(3).

4. I will accept service from other parties by:

FAX at the above noted number: Yes No

Email at the above noted number: Yes No

5. This case involves child support issues. Yes No (If yes, supply social security

numbers for all family members on a separately attached document filed as confidential

information on light green paper. Use Form TCM-TR3.1-4.)

6. This case involves a protection from abuse order, a workplace violence restraining order, or

a no – contact order. Yes No (If Yes, the initiating party must provide an

address for the purpose of legal service but that address should not be one that exposes the

whereabouts of a petitioner.) The party shall use the following address for purposes of

legal service:

Attorney’s address

The Attorney General Confidentiality program address

(contact the Attorney General at 1-800-321-1907 or e-mail address is

confidential@atg.in.gov).

Another address (provide)

7. This case involves a petition for involuntary commitment. Yes No

8. If Yes above, provide the following regarding the individual subject to the petition for

involuntary commitment:

a. Name of the individual subject to the petition for involuntary commitment if it is not

already provided in #1 above:

b. State of Residence of person subject to petition:

c. At least one of the following pieces of identifying information:

(i) Date of Birth

(ii) Driver’s License Number

State where issued Expiration date

(iii) State ID number

State where issued Expiration date

(iv) FBI number

(v) Indiana Department of Corrections Number

(vi) Social Security Number is available and is being provided in an attached

confidential document Yes No

9. There are related cases: Yes No (If yes, list on continuation page.)

10. Additional information required by local rule:

11. There are other party members: Yes No (If yes, list on continuation page.)

12. This form has been served on all other parties and Certificate of Service is attached:

Yes No

Attorney-at-Law

(Attorney information shown above.)