HO-CHUNK NATION TRIAL COURT (2018)
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IN THE
HO-CHUNK NATION TRIAL COURT
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In re the Custody of Minor Child(ren):
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______________________________,
Petitioner,
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v.
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PETITION FOR CUSTODY AND
PLACEMENT ORDER
Case No.: CPL ___ - _____
[assigned by the Court]
______________________________,
Respondent.
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Pursuant to the DIVORCE AND CUSTODY ORDINANCE, 4 HCC § 9, and CHILD SUPPORT
ENFORCEMENT CODE, 4 HCC § 7, the petitioner requests that the Court issue a custody and
placement order. The petitioner accordingly alleges the following facts:
I. The following information relates to the PETITIONER:
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1.
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I am the petitioner, I am the
Father
Mother
Other: _______________________________
2.
Name: _________________________________________________
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3.
Maiden name (if applicable): __________________________________
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4.
Address: ______________________________________________
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PETITIONER’S INFORMATION
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(state physical address also if P.O. Box is listed)
______________________________________________
City
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Zip Code
Phone: (_____)_________________ (_____)__________________
Home
Work
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Facsimile Number (if available): (_____)_______________________
7.
Date of Birth: ___________________________________________
8.
Social Security Number: ______ - ____ - _______
9.
Occupation: _____________________________________________
Place of employment: _____________________________________
10.
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State
I am a member of the Ho-Chunk Nation:
Yes or
No.
If yes, my enrollment number is: 439A00 __ __ __ __.
(four numbers)
11.
I reside on tribal lands:
Yes or
No.
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Petition for Custody and Placement (03/17)
Page 1 of 6
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II. The following information relates to the RESPONDENT:
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RESPONDENT’S INFORMATION
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Name: ________________________________________________
2.
Respondent is the:
Maiden name (if applicable): ________________________________
4.
Address (last known):
____________________________________
(state physical address also if P.O. Box is listed)
____________________________________
City
4.
State
Zip Code
Phone: (_____)_________________ (_____)_________________
Home
Work
5.
Facsimile Number (if available): _____________________________
6.
Date of Birth: __________________________________________
7.
Social Security Number: ______ - ____ - _______
8.
Occupation: ___________________________________________
Place of Employment: ___________________________________
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Yes or
The respondent is a member of the Ho-Chunk Nation:
(four numbers)
10.
The respondent resides on tribal lands:
Yes or
No.
III. The following information relates to the MINOR CHILDREN (attach additional pages if
necessary):
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1. Name: ________________________________________________
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2. Date of Birth: __________________________________________
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3. Social Security Number: ______ - ____ - _______
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4. The minor child is a member of the Ho-Chunk Nation:
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No.
If yes, the respondent’s enrollment number is: 439A00 __ __ __ __.
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Mother
3.
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Father
Other: _______________________________
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1.
Yes or
No.
If yes, the child’s enrollment number is: 439A00 __ __ __ __.
(four numbers)
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1. Name: ________________________________________________
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2. Date of Birth: __________________________________________
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3. Social Security Number: ______ - ____ - _______
4. The minor child is a member of the Ho-Chunk Nation:
Yes or
No.
If yes, the child’s enrollment number is: 439A00 __ __ __ __.
Petition for Custody and Placement (03/17)
Page 2 of 6
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1. Name: ________________________________________________
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2. Date of Birth: __________________________________________
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3. Social Security Number: ______ - ____ - _______
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4. The minor child is a member of the Ho-Chunk Nation:
Yes or
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If yes, the child’s enrollment number is: 439A00 __ __ __ __.
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four numbers)
No.
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IV. JURISDICTION: By filing this petition, I recognize that I voluntarily submit to the
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personal and subject matter jurisdiction of the Ho-Chunk Nation Judiciary. The below facts
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support the assumption of jurisdiction over the petitioner and/or respondent. In particular, the
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Court may exercise personal jurisdiction over the petitioner and/or respondent due to satisfaction
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of one or more of the following conditions (check all that apply):
the petitioner is enrolled or is eligible to be enrolled with the Ho-Chunk Nation
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the respondent is enrolled or is eligible to be enrolled with the Ho-Chunk Nation
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the petitioner or respondent resides on Nation lands with a child who is enrolled or
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is eligible to be enrolled with the Ho-Chunk Nation
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V. OTHER PROCEEDINGS:
A. Custody was previously decided in a county court:
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No
*If yes, attach a certified copy of the custody order from that court.
B. This Petition for Child Custody is filed in connection with one of the following HoChunk Nation Trial Court cases:
1.
2.
3.
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Yes
4.
☐ Divorce or Nullification of Marriage; Case Number: _______
☐ Paternity; Case Number: ________
☐ Child Support; Case Number: ________
OR
☐ This is a standalone Child Custody action.
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VI. PROHIBITED ACTS: During the pendency of the action, the parties are prohibited
from, and may be held in contempt of court for any of the following:
1) harassing, intimidating, physically abusing or imposing any restraint on the person or
liberty of the other party or a minor child of either party; or
Petition for Custody and Placement (03/17)
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2) Without the consent of the other party or an order of the Court, establishing a residence
with a minor child of the parties outside the state of Wisconsin or more than 150 miles from the
residence of the other party within the state.
3) Removing a minor child of the parties from the state of Wisconsin without consent of
custodial parent.
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VII. ATTACHMENTS: The petitioner must attach any written agreement between the
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parties as to legal custody and physical placement of the children. The document must be notarized.
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NUMBER OF ADDITIONAL PAGES USED: ________
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By affixing my signature below, I swear that I have provided the above information in good
faith and with the belief that each statement represents a true and accurate account of the facts
based upon adequate research and investigation. I recognize that the Ho-Chunk Nation Judiciary
may impose sanctions if it determines that I have made statements in bad faith, including
intentional misstatements or statements made upon inadequate research or investigation. I also
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recognize that the foregoing admonition extends to include the omission of material facts or law,
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which I knew, or should have reasonably known, would impact or prove relevant to the action.
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I file this petition of my own free will and absent threats, intimidation or coercion of any
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kind. I understand that any decision reached by the Ho-Chunk Nation Trial Court is binding and
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that if I disagree with the findings or conclusions or remedies of the Trial Court, I may file an
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appeal with the Ho-Chunk Nation Supreme Court. I further acknowledge that since I am
submitting myself to the jurisdiction of the Ho-Chunk Nation Judiciary, I am subject to its
determinations, including those relating to contempt of court.
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Petition for Custody and Placement (03/17)
Page 4 of 6
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RESPECTFULLY SUBMITTED BY PETITIONER,
Signature: __________________________________________
Date: ______________________, 20 ______
SUBSCRIBED AND SWORN TO before me this ____ day of _____________, 20____
at _________________________________________________________ .
City
State
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Notary Public for _____________________
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State
My commission expires: _______________
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Signature of petitioner’s counsel (if any): ___________________________________
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Name of petitioner’s counsel: ___________________________________
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Mailing address of counsel:
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___________________________________
___________________________________
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E-mail address of counsel:
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Telephone number of counsel: __________________________________
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Ho-Chunk Bar number of counsel: ______________________________
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___________________________________
If not a member of the Ho-Chunk bar, a
Motion to Appear Pro Hac Vice has been
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attached in accordance with Ho-Chunk Nation Rules of Civil Procedure, Rule 16(B), and/or
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have applied for membership in the Ho-Chunk Nation bar in accordance with the Ho-Chunk
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Nation Rules for Admission to Practice.
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Petition for Custody and Placement (03/17)
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RESPECTFULLY SUBMITTED BY RESPONDENT,
Signature: __________________________________________
Date: ______________________, 20 ______
SUBSCRIBED AND SWORN TO before me this ____ day of _____________, 20____
at _________________________________________________________ .
City
State
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____________________________________
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Notary Public for _____________________
State
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My commission expires: _______________
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Signature of respondent’s counsel (if any): ___________________________________
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Name of respondent’s counsel: ___________________________________
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Mailing address of counsel:
___________________________________
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E-mail address of counsel:
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Telephone number of counsel: __________________________________
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Ho-Chunk Bar number of counsel: ______________________________
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If not a member of the Ho-Chunk bar, a
Motion to Appear Pro Hac Vice has been
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attached in accordance with Ho-Chunk Nation Rules of Civil Procedure, Rule 16(B), and/or
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have applied for membership in the Ho-Chunk Nation bar in accordance with the Ho-Chunk
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Nation Rules for Admission to Practice.
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Petition for Custody and Placement (03/17)
Page 6 of 6
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Proposed Parenting Plan
HO-CHUNK NATION TRIAL COURT
First name
Middle name
For Official Use
Last name
Petitioner/Joint Petitioner,
Proposed Parenting Plan
and
Case No.
First name
Middle name
__
Last name
Respondent/Joint Petitioner.
I understand that under Ho-Chunk law, the parties are encouraged to cooperate and agree regarding
the fulfillment of their duties to their children.
The Court may approve any agreement between the parties as to the legal custody and physical
placement and care of minor children if deemed by the Court to be in the best interests of the
children. HCN CHILD SUPPORT CODE 4 HCC § 7.
The parties may file a proposed parenting plan to assist the court with child support and custody.
HCN CHILD SUPPORT CODE 4 HCC § 7.26.a.iii.
In divorce, the Court may approve any agreement between the parties as to the legal custody and
physical placement and care of minor children if deemed by the Court to be in the best interests of
the children. HCN DIVORCE AND CUSTODY ORDINANCE, 4 HCC § 9.8.a.(2).
PROPOSED PARENTING PLAN:
A. Legal Custody - the right and responsibility to make major decisions concerning the child,
except with respect to specific decisions as set forth by the court or the parties in the final
judgment.
1. Legal custody of the minor children shall be as follows:
Name of Child
Date of
Birth
FM-200 HCN Trial Court Proposed Parenting Plan, 12/2017
Joint
Legal
Custody
Sole
Sole Legal
Legal Custody Custody to
to Petitioner Respondent
4 HCC § 7.26a.iii
Page 1 of 8
Proposed Parenting Plan
2. Specific Decision Making Authority
Decisions in the following listed areas will be made as follows:
Decision
a.
b.
c.
d.
e.
Jointly
By Petitioner
By
Respondent
Non-Emergency Health Care
Education/School Activities
Child Care Providers
Non-School Activities
Other:
B. Physical Placement
In allocating the time the minor children spend between the parents, the court should
award the placement on a day-to-day basis as follows:
Primary
Physical
Equal Shared Placement to
Placement
Petitioner
Name of Child
Primary
Physical
Placement to
Respondent
AND the physical placement schedule shall be:
a.
as listed in the attached document.
b.
as proposed below (on a biweekly basis):
Mon.
Tues.
Wed.
Thurs.
Fri.
Sat.
Sun.
Week 1
Week 2
C. Child Care
1.
The children do not require child care.
2.
The child care will be provided by
And the cost of child care will be paid as follows:
a. The petitioner to pay
b. The respondent to pay
FM-200 HCN Trial Court Proposed Parenting Plan, 12/2017
%.
%.
4 HCC § 7.26a.iii
Page 2 of 8
Proposed Parenting Plan
D. Summer and Holiday Placement Schedule: The summer and holiday placement
schedule should be as follows:
1.
According to the attached
2.
See attached
3.
as proposed here:
HOLIDAYS
County standard placement schedule.
With Petitioner the
With Respondent the
following years
following years
Every
Even
Odd
Every
Even
Odd
Year
years
years
year
years
Years
a. Mother’s Day
b. Memorial Day
c. Father’s Day
d. July 4th
e. Labor Day
f. Halloween
g. Thanksgiving
h. Christmas Eve
i. Christmas Day
j. New Year’s Eve
k. New Year’s Day
l. Religious Holiday
m. Religious Holiday
n. Father’s Birthday
o. Mother’s Birthday
p. Children’s Birthday(s)
q. Other:
r. Other:
s. School Spring Break
t. School Teacher Conventions
u. Summer Break to be shared as follows:
E.
Child Support - Note: If the proposal is different from the state guidelines, the reason why it is
different must be given.
The noncustodial parent shall be responsible for child support as follows:
1.
as required by the state support guidelines.
2.
according to the attached proposal.
FM-200 HCN Trial Court Proposed Parenting Plan, 12/2017
4 HCC § 7.26a.iii
Page 3 of 8
Proposed Parenting Plan
F. Transportation Issues
1. The physical transfer of the children for placement should be as follows:
a.
All transportation to and from placements will be provided by the petitioner.
b.
All transportation to and from placements will be provided by the respondent.
c.
Transportation will be shared with:
d.
1.
parent with children shall deliver.
2.
parent without children shall pick up.
Other:
2. Transfers of children shall take place at:
a.
parent’s home.
b.
halfway point:
c.
other location:
d.
Inter-spousal battery/domestic violence is an issue in this relationship and in
order to ensure the safety of the children and/or parent, transfers of the
children between the parents shall be:
1.
supervised by
2.
at a neutral public site
3.
at a home of the following person
4.
Other:
3. Transfers of children shall take place at:
a.
paid by party who incurs the costs.
b.
paid as follows:
G. School
1. The children will attend school at:
Name of Child
School/ School District
2. Education costs will be paid as follows:
a. The petitioner to pay
%.
b. The respondent to pay
%.
FM-200 HCN Trial Court Proposed Parenting Plan, 12/2017
4 HCC § 7.26a.iii
Page 4 of 8
Proposed Parenting Plan
H.
Residence
1. Current
a. The petitioner resides at:
Address
City
State
Zip
This is on Ho-Chunk Nation trust land.
This is not on Ho-Chunk Nation trust lands.
This is an inter-spousal battery/domestic violence case; I decline to give a
specific address, but my general location is currently
.
b. The respondent/joint petitioner currently resides at:
Address
City
State
Zip
This is on Ho-Chunk Nation trust land.
This is not on Ho-Chunk Nation trust lands.
This is an inter-spousal battery/domestic violence case; I decline to give a
specific address, but my general location is currently
.
I. Current Employer
1. The petitioner is currently employed at:
Employer
State
City
Days/Hrs.
This is an inter-spousal battery/domestic violence case; I decline to give my
specific employment, but where I generally work is
.
2. The respondent/joint petitioner is currently employed at:
Employer
State
City
Days/Hrs.
This is an inter-spousal battery/domestic violence case; I decline to give my
specific employment, but where I generally work is
.
J. Health Care
1. Providers: Healthcare services will be provided to the children by the following:
Doctors/Pediatrician/Clinic
FM-200 HCN Trial Court Proposed Parenting Plan, 12/2017
4 HCC § 7.26a.iii
Page 5 of 8
Proposed Parenting Plan
Eye/Optometrist
Dentist/Orthodontist
Insurance/Health Plan (if any)
Other:
2. Expenses
a. Healthcare Insurance for the minor children shall be:
1.
paid by the petitioner
2.
paid by the respondent/joint petitioner
3.
shared equally by both of us.
4.
paid as follows:
5.
See attached plan.
b. Uninsured healthcare expenses shall be:
K.
1.
paid by petitioner
2.
paid by the other respondent/joint petitioner
3.
shared equally by both of us.
4.
paid as follows:
5.
See attached plan.
Upbringing
1.
The minor children will be raised in the following way:
a.
Traditional
b.
Religious
c.
Native American Church
d.
No religious affiliation is planned.
e.
Other
L. Maintaining Contact with Other Parent
I shall assist the children in maintaining contact with the other parent by:
1.
direct contact through periods of placement.
2.
telephone contact.
3.
cards/letters.
4.
e-mail.
5.
providing copies of children’s school projects.
FM-200 HCN Trial Court Proposed Parenting Plan, 12/2017
4 HCC § 7.26a.iii
Page 6 of 8
Proposed Parenting Plan
6.
providing photographs of children participating in activities.
7.
assisting children with gift purchasing for other parent for birthdays and holidays.
8.
assisting children with letter writing to other parent.
9.
creating personal web-site for posting pictures, letters, information, comments.
10.
Other:
(Note: Each parent is expected to take personal responsibility for contacting the schools
to obtain school calendars and report cards and attending parent-teacher meetings.)
M.
Resolving Disagreements
If there are disagreements between the parents on issues that are to be joint decisions,
the way to resolve the disagreements will be:
1.
the parent who has primary physical placement will decide.
2.
the parent who has physical placement at the time of the disagreement will decide.
3.
to allow the parent who generally made this type of decision before these court
proceedings were started to make the same type of decision in the future.
4.
to review the issues from the other parent’s or children’s standpoint and reconsider
my position.
5.
to determine whether my opposition is in good faith and in the best interests of the
children or whether it is an attempt to spite the other parent, if it is not in good faith
or the best interests, reconsider my position.
6.
to determine whether this is a situation in which the children is/are attempting to
manipulate one parent against the other; if it appears to be manipulative, attempt
to consult with the other parent to prevent the children from trapping us in this
position.
7.
to ask for assistance from friends, relatives, clergy, or others who can be neutral
and fair.
8.
I would suggest the following person(s) to serve as a third-party neutral(s):
9.
to contact the tribal court regarding options for mediation.
10.
Other:
FM-200 HCN Trial Court Proposed Parenting Plan, 12/2017
4 HCC § 7.26a.iii
Page 7 of 8
Proposed Parenting Plan
Parties may each
submit a separate
parenting plan. In that
instance they must
provide a certificate of
service for all parties
and the court.
This is an individually filed plan.
OR
This plan is jointly filed as noted by the below information.
Signature of Petitioner
To the extent that
parties agree to submit
one parenting plan, it
should be notarized
and filed with the court.
Print or Type Name
Date
Signature of Respondent/Joint Petitioner
Print or Type Name
Date
FM-200 HCN Trial Court Proposed Parenting Plan, 12/2017
4 HCC § 7.26a.iii
Page 8 of 8
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IN THE
HO-CHUNK NATION TRIAL COURT
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STATEMENT OF INCOME, ASSETS, DEBTS
AND LIVING EXPENSES
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Case No(s).: ___ ____ - ____
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___ ____ - ____
___ ____ - ____
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Under penalty of perjury, I state that the following information on this financial statement is
true, accurate and complete to the best of my knowledge:
Name of Person Completing Form (please print):
I am completing this form as a:
________________________________________
Parent, child, or guardian seeking legal
representation pursuant to the HOCAK NATION
CHILDREN AND FAMILY ACT, 4 HCC § 3.24c.
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Number of Household Members:
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______ Adults
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_____ Children
Employer Information (please print):
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________________________________________
Name
________________________________________
Address
Parent or guardian required to reimburse the HoChunk Nation for child placement assistance or pay
child support to an appointed guardian pursuant to the
HOCAK NATION CHILDREN AND FAMILY ACT, 4 HCC
§ 3.81, 3.114 .
Spouse subject to a divorce proceedings in which
either party seeks a division of assets and debts or
spousal maintenance. DIVORCE AND CUSTODY
ORDINANCE, 4 HCC § 9.8c-d.
Parent, guardian, or adult beneficiary requesting
the release of Children’s/Incompetent’s Trust Fund
(CTF/ITF) monies. PER CAPITA DISTRIBUTION
ORDINANCE, 2 HCC § 12.8c.
________________________________________
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City
State
Zip Code
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(________)_______________________________
Telephone Number
Debtor seeking to establish civil garnishment
exemption pursuant to WIS. STAT. § 812.34(b)-(c).
Other: _________________________________
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Statement of Income, Assets, Debts and Living Expenses (2017)
Page 3 of 3
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STATEMENT OF MONTHLY HOUSEHOLD INCOME
(if there are insufficient columns for all household members, attach additional
schedules)
Salary and wages (if weekly or biweekly, compute as a monthly
figure.)
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Other income (Pensions, retirement, social security, disability, worker’s
compensation, public assistance)
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Child Support and /or maintenance from prior spouse
Dividends, interest, rents, bonuses
Per Capita Payments or Distributions
Other:
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Itemized mandatory monthly deductions (Do not include savings
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Total Monthly Income
or credit union deductions not required by law)
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Federal and state income taxes, social security, Medicare
Union or other dues
Retirement and pension funds
Other mandatory monthly deductions
Total Mandatory Monthly Deductions
Net Monthly Income
STATEMENT OF ASSETS
Asset
Description
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Fair Market /
Cash Value
Real Estate (List kind of property and location)
Other real estate (List kind of property and location)
Vehicle (Give year and make)
Other Vehicles (Give year and make)
Checking account (Give name of financial
institution)
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Savings account (Give name of financial institution)
IRA/Pension/Profit Sharing
Life Insurance with cash value
Stocks/Bonds/Certificates of Deposit
Other assets valued over $200
Total Value of Assets
LONG TERM DEBTS AND MONTHLY EXPENSES
Long Term/Installment Debts
Creditor Name
Balance Owed Monthly Payment
Mortgage Payment (Include property taxes
and insurance if included in payment)
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Credit Cards
Automobile Loans
Other
Other
Total Owed
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Statement of Income, Assets, Debts and Living Expenses (2017)
Page 3 of 3
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Other Monthly Debts/Expenses
Rent (Do not duplicate mortgage payment above.)
Repairs/maintenance on home
Food
Electricity/water/heat
Telephone
Laundry and dry cleaning
Child support (paid for children not in your home)
Maintenance (paid to an ex-spouse)
Clothing and shoes
Health insurance premiums
Medical/dental/drug expenses not covered by insurance
Life insurance premiums
Other insurance premiums (specify):
Child care
Cable TV
Transportation costs (oil/gas/commuting)
School
Entertainment/incidentals/newspapers/books/periodicals
Hobbies
Other:
Other:
Other:
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Total Monthly Payments
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_____________________________________
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Signature
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_____________________________________
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Date Signed
SUBSCRIBED AND SWORN TO before me this
day of
, 20______
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at
.
City
State
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Notary Public for
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My commission expires:
State
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Statement of Income, Assets, Debts and Living Expenses (2017)
Page 3 of 3
This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.