V I R G I N I A



V I R G I N I A :

IN THE CIRCUIT COURT OF FAIRFAX COUNTY

JANE DOE, *

Plaintiff, *

*

v. * CL No. 06-111111

*

JOHN DOE, *

Defendant. *

FINAL DECREE OF DIVORCE

THIS MATTER CAME ON upon the Complaint filed by the Plaintiff; an Answer and Cross-Complaint filed by the Defendant; upon the taking of depositions of the Plaintiff and her witness before a Notary Public; the filing of a transcript of said depositions herein; and

IT APPEARING unto the Court:

1. The parties hereto were lawfully married to each other on August 2, 1987 in Fairfax, Virginia;

2. That there was one child born or adopted of this marriage, to wit: SLOE MOE DOE, born September 1, 1990;

3. That the Plaintiff is a bona fide resident and domiciliary of the Commonwealth of Virginia and has been so continuously for at least six months prior to institution of this suit;

4. That both parties are over the age of eighteen years and neither party is or has been a member of the Armed Forces of the United States on active duty during the pendency of this proceeding;

5. That the parties have lived separate and apart, continuously and uninterrupted, without any cohabitation, for a period of more than one year, that is from September 1, 2005 to the present, and the Plaintiff has maintained for that time the intent to permanently terminate the marital relationship;

6. That the parties have settled all property, custody and support matters, and that settlement is embodied in this Decree.

7. That the Plaintiff is entitled to a divorce a vinculo matrimonii pursuant to §20-91(9) of the Code of Virginia; and

WHEREUPON, pursuant to §20-60.3, Code of Virginia, the parties are hereby notified of the following provisions of Virginia law and the parties hereby represent to this Court that the information provided below is accurate:

NOTICES and INFORMATION:

1. Support payments may be withheld as they become due pursuant to §20-79.1 or §20-79.2, from income as defined in §63.2-1900, without further amendments of this Order or having to file an application for services with the Department of Social Services.

2. Support payments may be withheld pursuant to Chapter 19 (§63.2-1900, et seq.) of Title 63.2 without further amendments to the order upon application for services with the Department of Social Services.

3. A duty of support is owed for the following children of the parties:

Name Date of Birth Resides With

Sloe Moe Doe July 1, 1990 Mother

4. The following is true information regarding the parties who are subject of this Order:

Plaintiff: Jane Doe

Date of Birth: 11/1/60

SSN: (See Private Addendum)

Drivers License #: 123-456-78

State of Issuance: Virginia

Address: 1111 Fair Street

Fairfax, Virginia 22033

Home Phone #: 703-999-9999

Employment: Manny Mo and Jack

Address: 999 East Street

Alexandria, Virginia 22310

Work Phone #: 703-888-8888

Defendant: John Doe

Date of Birth: 6/2/59

SSN: (See Private Addendum)

Drivers License #: 98-87-65-43

State of Issuance: Virginia

Address: 2222 Last Court

Alexandria, Virginia 22319

Home Phone #: 703-999-9999

Employment: Home Depot

Address: 888 This Street

Manassas, Virginia 20999

Work Phone #: 703-111-1111

[Note: Drivers License numbers do not have to be in Private addendum unless they are same as SSN.]

5. A petition may be filed for the suspension of any license, certificate, registration or other authorization to engage in a profession, trade, business or occupation issued by the Commonwealth of Virginia to a person responsible for support as provided in §63.2-1937, upon a delinquency for a period of ninety days or more or in an amount of $5,000 or more.

[ ] Neither party holds any such a license, certificate, registration or other authorization issued by the Commonwealth of Virginia.

6. a. The Order of this Court as to the amount of the child support and spousal support, expressed in fixed sums per monthly period, together with the payment intervals, the dates payments are due, the date the first payment is due, and the amount of each payment are set forth in the support provisions of this Order. By agreement of the parties, payment of child support shall be paid by the ___________________ directly to the ________________________________, and shall NOT be paid by Income Deduction Order.

b. There is no spousal support payable by one party to the other.

7. a. The Order of this Court as to health care insurance for the minor child is as set forth in the health care provisions of this Order.

b. This Order contains a statement whether any unreimbursed medical expenses are to be paid by or reimbursed to a party pursuant to Subsections D and G of §20-108.2, and if such expenses are ordered, then the provisions governing how such payment is to be made.

8. The Order of this Court as to the amount and terms of any arrearages in support is set forth in the arrearage provision of this Order.

9. If child support payments have been ordered, then, unless the Court orders otherwise for good cause shown, the parties shall give each other and this Court at least 30 days advance written notice of any change in address, and shall give notice of any change of telephone number within 30 days after the change. The parties shall give these notices to each other and when payments are to be made through the Department of Social Services (DSS), to the DSS.

10. If child support payments are ordered to be paid through the (DSS), the obligor shall keep the DSS informed of his or her current employer’s name, address and telephone number. If payments are made directly to the obligee then the obligor shall keep this Court informed of his or her current employer’s name, address and telephone number.

11. The separate amounts due to each person under this Order for child support, for spousal support or for a unitary award, or the affirmation of a separation agreement, are set forth in the support provision of this Order.

12. In determination of a support obligation, the support obligation as it becomes due and unpaid creates a judgment by operation of law.

13. The Department of Social Services may, pursuant to Chapter 19 (§63.2-1900, et seq.) of Title 63.2 and in accordance with §20-108.2 and §63.2-1921, initiate a review of the amount of support ordered by any court.

14. If any arrearages for child support, including interest or fees, exist at the time the youngest child included in this order emancipates, payments shall continue in the total amount due (current support plus amount applied toward arrearages) at the time of emancipation until all arrearages are paid.

WHEREFORE, It is:

ADJUDGED, ORDERED and DECREED as follows:

1. Divorce:

That the Plaintiff, JANE DOE, is hereby granted a Final Decree of Divorce, a vinculo matrimonii, from the Defendant, JOHN DOE, pursuant to §20-91(9) of the Code of Virginia, 1950, as amended, based on the parties having lived separate and apart, continuously and uninterrupted, without any cohabitation, for more than one year;

2. Custody:

a. The parties shall share the joint legal custody of the minor child and the primary residence shall be with the Plaintiff, JANE DOE. JOHN DOE shall have liberal and reasonable visitation rights on alternate weekends from 6:00 p.m. on Friday until 8:00 p.m. on Sunday. He shall also have the child for one-half of the Christmas school break and for the Thanksgiving holiday, and for four weeks in the summer. The person who has the child for the weekend shall have any Federal holiday Monday attached to that weekend.

b. That both parties shall notify this Court and each other in writing at least thirty (30) days in advance of any intention to relocate their residence pursuant to §124.5 of the Code of Virginia.

3. Child Support:

a. The Defendant shall pay to the Plaintiff as and for child support and maintenance, the sum of Five Hundred and Seventy Dollars ($570.00) per month, commencing on July 1, 2005 and continuing on the first day of each and every month thereafter until further order of the court.

b. The aforesaid support payment for such minor children shall continue to be paid for each such child until the age of eighteen (18), and thereafter for a child who is (i) a full-time high school student, (ii) not self-supporting and (iii) living in the home of the party receiving child support until such child reaches the age of nineteen (19) or graduates from high school, whichever first occurs.

c. By agreement of the parties, payment of child support shall be paid by the directly to the , and shall NOT be paid by Income Deduction Order.

4. Spousal Support:

That there is no spousal support payable by one party to the other.

5. Health Care Coverage and Medical Expenses:

A. For Minor Child: JOHN DOE shall maintain health insurance coverage for the minor child, through his current medical insurance provider, for as long as it remains available to him at reasonable cost. The current coverage for the parties’ minor child is provided by Aetna Insurance, Policy No. 9900990.

[Note: The policy number of health insurance is NOT an account number required to be in the Private Addendum, AND the policy number need not be in the Decree at all if health coverage is supplied through a party’s employer.]

B. For Spouse or Former Spouse: Health insurance is not required by this Order for a spouse or former spouse.

C. Unreimbursed Medical Expenses: JANE DOE shall pay the first $250 of unreimbursed medical expenses for the minor child in each calendar year, as said expenses are defined in §20-108.2, Code of Virginia. The parties shall share all remaining unreimbursed medical expenses in the calendar year in the same proportion as their respective income shares, currently 62% Defendant and 38% Plaintiff.

6. Arrearages:

There are no child support arrearages as of the date of this Decree.

7. Property Settlement:

A. Debts:

(1) The Plaintiff shall be responsible for the credit card accounts: VISA #1, Mastercard #1, and Lord & Taylor. (See Private Addendum).

(2) The Defendant shall be responsible for the credit card accounts: VISA # 2, Mastercard # 2, and Home Deport. (See Private Addendum).

(3) The Plaintiff shall fully retire VISA #1 by May 1, 2006 and shall fully retire the balance of Mastercard #1 by March 1, 2006. The Defendant shall transfer the balance of Mastercard #2 to VISA #2 and shall close Mastercard #2 by May 1, 2006. (See Private Addendum).

B. Stocks and Securities:

(1) The Plaintiff shall have the following accounts for her sole and separate property: (See Private Addendum).

(2) The Defendant shall have the following accounts for his sole and separate property: (See Private Addendum).

C. Pensions and Retirement Accounts

(1) The Plaintiff shall have the following pension and retirement accounts for her sole and separate property: (See Private Addendum).

(2) The Defendant shall have the following pension and retirement accounts for his sole and separate property: (See Private Addendum).

D. Marital Home

The parties currently have the former marital home listed for sale. They shall continue to market the property. When the property is sold and settled and the mortgage and expenses of sale are paid, the remaining net proceeds shall be divided equally.

E. Life Insurance

The Defendant shall maintain his life insurance with Aetna, Policy #XX: and with U.S Life, Policy #YY, with the child as the sole beneficiary, until the child has reached the age of 23 years, or has sooner graduated from college with a four-year degree. (See Private Addendum).

THIS CAUSE IS FINAL.

ENTERED this ___ day of ____________________, 200_.

______________________________________

JUDGE

WE ASK FOR THIS: SEEN and AGREED:

___________________ __________________

Counsel Counsel

Etc. Etc.

[Private Addendum Follows]

PRIVATE ADDENDUM

Pursuant to Va. Code §20-121.03

V I R G I N I A :

IN THE CIRCUIT COURT OF FAIRFAX COUNTY

JANE DOE, *

Plaintiff, *

*

v. * Cl. No. 06-111111

*

JOHN DOE, *

Defendant. *

PRIVATE ADDENDUM TO FINAL DECREE OF DIVORCE

This document is a Private Addendum, and is an integral part of the Final Decree of Divorce entered in this matter on _______________. This Addendum contains identification numbers which are restricted from being contained in a Public Order of this Court. All references contained herein are to the aforementioned Final Decree of Divorce.

1. Page 2 & 3, Para 4:

The Social Security Number of Plaintiff, Jane Doe is: 1111-11-1111.

The Social Security Number of Defendant, John Doe is: 2222-22-2222.

2. Page 7 & 8, Para 7:

A. Debts:

(1) The Plaintiff is responsible for: VISA #1: VISA Acct #1234-5678-1234, and Mastercard #1: Mastercard Acct #9999-8888-7777 and Lord & Taylor: Acct #73486AZR5.

(2) The Defendant is responsible for: VISA #2: VISA Acct #9812-3245-7474, and Mastercard #2: Mastercard Acct #7855-8674-4346, and Home Depot: Acct #2345-96.

(3) The Plaintiff shall fully retire VISA Acct #1234-5678-1234 by May 1, 2006, and shall fully retire the balance of Mastercard Acct #9999-8888-7777 by March 1, 2006. The Defendant shall transfer the balance of Mastercard Acct #7855-8674-4346 to VISA Acct #9812-3245-7474, and shall close Mastercard Acct #7855-8674-4346 by May 1, 2006.

B. Stocks and Securities:

(1) The Plaintiff shall have the following accounts for her sole and separate property: Schwab Account #97-12345.XY.

(2) The Defendant shall have the following accounts for his sole and separate property: ETRADE Brokerage #8AA-76549-8458, and Schwab Account #97-12345.AB.

C. Pensions and Retirement Accounts:

(1) The Plaintiff shall have the following pension and retirement accounts for her sole and separate property: Fidelity IRA #89-1234, ABC Corp. 401(k) #9876-92, Royce Trust Plan #9254892-88.

(2) The Defendant shall have the following pension and retirement accounts for his sole and separate property: Fidelity IRA #89-1235.

D. Life Insurance:

The Defendant shall maintain his life insurance with Aetna, Policy #23-989: and with U.S Life, Policy #96-9876-XZ, with the child, Sloe Moe Doe, as the sole beneficiary, until the child has reached the age of 23 years, or has sooner graduated from college with a four-year degree.

WE ASK FOR THIS: SEEN and AGREED:

___________________ __________________

Counsel Counsel

Etc. Etc.

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