DIVORCE

Uncontested (Spouses Agree)

With Children

PACKET D

INSTRUCTIONS AND ALL FORMS

If you do not have a lawyer, you must use the forms in this

packet to start and finish your divorce

Rev 01/2015, 11/2015, 12/2016, 07/2019

THIS PACKET IS NOT A SUBSTITUTE FOR PROFESSIONAL LEGAL ADVICE

Inside are fill-in-the-blank forms mandated by the New Mexico State Supreme Court for Self-Represented Litigants. They

do not deal with every situation. Divorce can be complicated and using legal forms without a lawyer’s help can harm your

legal rights. The Court assumes no responsibility and accepts no liability for actions taken by users of these documents,

including reliance on their contents.

In this packet you will find . . .

Eleventh Judicial District Court

San Juan County

—- Introduction (1 page)

—- Information & Rules for Self-Represented (Pro Se)

Litigants (2 pages)

4A-100 Instructions for Stage 1 Forms (5 pages)

4A-101 Domestic Relations Information Sheet (2 pages)

4A-103 Petition for Dissolution of Marriage (with children) (5 pgs)

4A-300 Instructions for Stage 3 Forms (has instructions for

uncontested divorce) (4 pages)

4A-301 Marital Settlement Agreement (11 pages)

4A-302 Custody Plan & Order (8 pages)

—- Child Support Worksheet. Find and complete online at

www.nmcourts.gov

4A-303 Child Support Obligation & Order (6 pages)

OMB 0970-0154 Income Withholding for Support (Federal Form)

with instructions (9 pages)

4A-304 Wage Withholding Order (2 pages)

4A-306 Final Decree of Dissolution of Marriage (with children)

(4 pages)

Packet D

Rev 01/2015, 11/2015, 12/2016, 07/2019

PACKET D

UNCONTESTED DIVORCE - WITH CHILDREN

Since you and your spouse have agreed about everything in this dissolution of

marriage (“divorce”) including the custody and support of your children and the

division of your property and debt, the divorce is uncontested.

Forms included in Packet D:

--- Information & Rules for Self-Represented (Pro Se) Litigants (2 pages)

4A-100 Instructions for Stage 1 Forms (5 pages)

4A-101 Domestic Relations Information Sheet to be filled out by both Petitioner

and Respondent (2 pages)

4A-103 Petition for Dissolution of Marriage (with children) (5 pages)

4A-300 Instructions for Stage 3 forms (4 pages)

•Paragraph (E)(1) pertains to uncontested divorce

4A-301 Marital Settlement Agreement (11 pages)

4A-302 Custody Plan and Order (8 pages)

Online Sample of a Child Support Worksheet. This worksheet is required anytime

you ask the judge to set or change child support. Find an automatic

calculator online at www.nmcourts.gov

. Click on “self-help” then “self-

help guide” then “child support worksheet”. The program walks you

through each step. Print your completed worksheet. See 4A-300 (D)(2)(a)

for more instructions.

4A-303 Child Support Obligation and Order (6 pages)

----- Income Withholding For Support (Federal Form OMB 0970-0154) (3 pgs)

----- Instructions for Federal Form OMB 0970-0154 (6 pages)

4A-304 Wage Withholding Order (2 pages)

4A-306 Final Decree of Dissolution of Marriage (with children) (4 pages)

Forms NOT included in Packet D that you may require, such as the following, are available at

the Courthouse or may be obtained on line at www.nmcompcomm.us. Under the “Public Access

Law” tab, look for “Rules of Practice and Procedure.”

Rule 1-103 Rule on requesting (and cancelling a request for) an interpreter for a court hearing

4-115 Request for court interpreter

4-116 Cancellation of court interpreter

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

Introduction (rev. 01/2015, 12/2017, 07/2019) Page 1 of 1

FOR INFORMATION ONLY

DO NOT COPY ● DO NOT FILE

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

Information & Rules for Pro Se Parties (rev. 01/2015, 12/2017, 07/2019)

Page 1 of 2

INFORMATION AND RULES

FOR SELF-REPRESENTED (PRO SE) LITIGANTS

•

Although we want to be responsive to your needs, the court staff cannot give you any

legal advice.

•

You should attend the Court’s Self-Represented Litigants Legal Advice Clinic. At each

clinic, volunteer attorneys are available to give legal advice and can help you complete

your forms. The clinics are free and are held once a month. Visit our website at

eleventhdistrictcourt.nmcourts.gov

for the date, time and location of the next clinic or

ask court staff for a list of clinics.

•

Your first choice should be to consult with an attorney. There is good reason for anyone

seeking legal remedies to do so, but especially those who have been married a long

time; have children; have significant property (land or retirement plans) and/or

significant debts.

•

If you are unable to afford an attorney, there are several sources available where you

may get help. Please ask the clerk for a Pro Se resource list. If there is domestic

violence in your relationship, you may qualify for assistance at DNA Legal Services.

•

Remember that when you are appearing pro se, you are held to the same standards as

attorneys and are expected to know the rules of evidence and courtroom procedure.

The judges and hearing officer cannot help you present your case.

•

You must provide a complete mailing address in your court case file and you must

update it whenever there are changes. If you do not do so, your case may be decided

without your input.

•

Be timely for Court hearings. If you do not appear on time, your case may be decided

without you or a bench warrant may be issued for your arrest.

•

There are two District Court locations: 851 Andrea Drive, Farmington and 103 South

Oliver, Aztec. Be sure to check the notice carefully for the time and location of the

hearing. Allow yourself adequate travel time to appear for your hearing on time.

•

Hearings are often scheduled on a “trailing docket” which means that many cases are

scheduled for a hearing at the same time. If this happens in your case, please be sure

to arrange to be in Court for several hours or the entire day while the judge or hearing

officer deals with each case one at a time.

FOR INFORMATION ONLY

DO NOT COPY ● DO NOT FILE

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

Information & Rules for Pro Se Parties (rev. 01/2015, 12/2017, 07/2019)

Page 2 of 2

•

Children are not allowed in the courtroom without the judge’s permission. There are

no childcare facilities at the Court. Please make other arrangement for your children

for the time you will be at Court.

•

You are expected to come to your Court hearings in person. Appearing by telephone

is only acceptable if you ask the Court’s permission in writing ahead of time (there is a

form for this) and only if the Court approves your request. (Appearing at a Court

hearing by telephone is called a “telephonic appearance.”)

•

Be courteous. Other than to make appropriate objections, do not interrupt anyone who

is speaking during the hearing. If you are representing yourself and you have an

objection to something a witness says, merely stand and say “Objection,” and the Court

will allow you to state the nature of your objection.

•

Do not make faces or gestures at the opposing party, his or her attorney, witnesses or

the judge while in the courtroom. Speak directly to the judge, not the opposing party

or a witness. You will be given an opportunity to be heard if you wait your turn.

•

Treat all Court personnel with respect, including bailiffs, judicial assistants, clerks,

judges and hearing officers.

•

Show your respect for the Court by wearing clean, neat clothing. Wearing hats,

sunglasses, shorts or pajamas in the courtroom is not allowed.

•

Do not bring any food or beverage into the courtroom and do not chew gum or eat

candy in the courtroom.

•

Cell phones are allowed in the courtroom but only if they are turned off. If your phone

rings while you are in the courtroom, the judge has the authority to fine you or to take

your phone.

•

Bring at least four (4) copies of any documents that you want to offer into evidence.

THANK YOU.

Karen L. Townsend, Chief District Judge

Daylene A. Marsh, District Judge

Bradford J. Dalley, District Judge

Sarah V. Weaver, District Judge

Curtis R. Gurley, District Judge

Kyle M. Finch, Hearing Officer and Commissioner

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

4A-100. Domestic Relations Forms – Instructions for Stage 1 (rev. 01/2015)

Page 1 of

4A-100. Domestic relations forms; INSTRUCTIONS FOR STAGE 1 and cautions regarding

use of forms.

A. Short title. These forms, compiled as Forms 4A-100 through 4A-403 NMRA, shall be

known as the Domestic Relations Forms and shall be cited by their New Mexico Rules Annotated set and

form number, as in “Form 4A- NMRA.”

B. Mandatory acceptance of forms by district court. The New Mexico Supreme Court has

approved these Domestic Relations Forms for use in domestic relations actions by self-represented litigants

and attorneys appearing in the district courts. As provided by Rule 1-120 NMRA, these forms supersede

conflicting local district court domestic relations forms and shall be accepted by the district courts.

C. Responsibility of self-represented parties. A self-represented person shall abide by the

same rules of procedure and rules of evidence as lawyers. It is the responsibility of a self-represented

person to determine what needs to be done and to take the necessary action. A self-represented person

involved in a divorce proceeding may need the advice of an attorney or other appropriate professional

during the process and is responsible for finding an attorney or other appropriate professional for advice or

representation.

(1) All notices from the court will be mailed to you at the last address on file with the

court. If you move, you must file a Notice of change of Address so that you receive your mail from the

court.

(2) Rule 1-005 NMRA requires that you provide a copy of anything you file in the

court to the other party on the same day you file it. This is what the Certificate of Service confirms.

D. Definitions. The following definitions apply to the terms used in the Domestic Relations

Forms:

(1) “contested divorce proceeding” means a divorce proceeding in which the parties

cannot reach an agreement on one or more decisions that must be made to finalize a divorce, including but

not limited to the division of property, debts, spousal support, child custody, time sharing, visitation, or

child support, and therefore are unable to file all of the required forms at the same time;

(2) “creditor” means a person, agency, bank, or business to whom a debt is owed;

(3) “custody plan” means Form 4A-302 NMRA, which sets forth the type of legal

custody and includes a parenting plan, when required by law;

(4) “debt” means separate or community debt as defined in Section 40-3-9 NMSA

1978. Debt is an amount of money owed to a creditor that may include, but is not limited to: loans

(signature, car, school, payday), mortgages, credit card balances, balances owed on bills (utilities, phone,

cell phone, cable television), and federal and state tax bills. The party whose name is on the debt may not

be the only party responsible for payment of the debt;

(5) “default” means the process to get relief from the court in the form of an order

when a party fails to respond or defend a case (either party is subject to a default judgment for failure to

respond). See Rule 1-055 NMRA for more information;

(6) “dissolution of marriage” means a divorce;

(7) “divorce proceeding” means the judicial process used to get a divorce;

(8) “minor child” means a child who is under eighteen (18) years of age and who is

the child of both parties to a divorce. For the purposes of support only, a child who is under the age of

nineteen (19) and attending high school full time may be considered a minor child;

(9) “parenting plan” means a plan as defined by Section 40-4-9.1 NMSA 1978, setting

forth the responsibilities of each parent individually and the parents jointly in a joint custody arrangement.

For an example of a parenting plan, see Form 4A-302(II)(B) NMRA;

(10) “party” means a spouse named in a divorce proceeding;

(11) “petition for dissolution of marriage” means the document that requests a divorce;

(12) “petitioner” means the first party named on a petition for dissolution of marriage.

FOR INFORMATION ONLY

DO NOT COPY ● DO NOT FILE

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

4A-100. Domestic Relations Forms – Instructions for Stage 1 (rev. 01/2015)

Page 2 of

This person is referred to as a “petitioner” solely for purposes of identifying the parties in the court system;

(13) “property” means the types of property the parties to a divorce may own, including

community, separate, or quasi-community as defined in Section 40-3-8 NMSA 1978. Property includes,

but is not limited to: homes, land, livestock, cars/vehicles, furniture, savings and checking accounts,

retirement accounts, jewelry, inheritances, tools, and art. The name of the party on the title to the property

may not be the sole owner of the property. Questions about whether property is separate or community

should be referred to a private attorney or the court, as appropriate;

(14) “respondent” means the second party named on a petition in a domestic relations

proceeding;

(15) “service” or “service of process” means having a person eighteen (18) years or

older, who is not a party to the action, give papers to a named party in a case by personally handing the

paperwork to the person, or having the papers delivered to a named party in a case by some other way as

described in Rule 1-004 NMRA;

(16) “summons” means a notice to the respondent that a lawsuit has started. The

summons notifies the respondent to respond to the divorce petition within the specified deadline.

The summons is a two-part form. On the first part, the summons has information about the court,

names and addresses of the parties, the deadline for a response, and notice that a default may happen for

failure to respond. The second part of the summons is the return. The summons is served on the respondent.

Once the respondent is served, the return must be filled out by the person who did the service of process

and signed by that person with a notarized signature. When the original summons, including the return, is

completely filled out and signed, the petitioner is responsible for filing it with the district court. The

summons form is Form 4-206 NMRA. Filing the completed summons and return lets the court know that

the respondent has been served;

(17) “summons packet” means a copy of the summons (Form 4-206 NMRA), petition

for dissolution of marriage (Form 4A-102 or 4A-103 NMRA), temporary domestic order (Form 4A-201

NMRA), and a blank copy of the Domestic Relations Information Sheet (Form 4A-101 NMRA). See

Paragraph E below for more information. The summons packet is served on the respondent;

(18) “temporary domestic order” means an order issued by the court when a divorce

proceeding is filed that instructs the parties on how to conduct themselves regarding interactions with each

other, finances, children, and property until the divorce is final. The temporary domestic order is Form 4A-

201 NMRA;

(19) “time sharing and order for support and care of children” means one or more orders

of the court to include a parenting plan as defined in Paragraph L of Section 40-4-9.1 NMSA 1978

containing the duties of the parents of minor children relating to child custody, time sharing, visitation, and

support, including support of a child under nineteen (19) years of age who is attending high school;

(20) “uncontested divorce proceeding” means a divorce proceeding in which the parties

are in complete agreement as to all the decisions that must be made to finalize a divorce, including but not

limited to decisions regarding the division of property, debts, spousal support, child custody, timesharing,

visitation, and child support, and present the following required forms, completed and signed by both

parties, for filing at the same time;

(a) Without children. If the parties do not have minor children, the following forms

must be filed in an uncontested divorce proceeding;

(i) Domestic relations information sheet, Form 4A-101 NMRA;

(ii) Petition for dissolution of marriage (without minor children), Form 4A-

102 NMRA;

4A-305 NMRA.

(iii) Marital settlement agreement, Form 4A-301 NMRA; and

(iv) Final decree of dissolution of marriage (without minor children), Form

(b) With children. If the parties have minor children, the following forms must be

filed in an uncontested divorce proceeding;

(i) Domestic relations information sheet, Form 4A-101 NMRA

Eleventh Judicial District Court, San Juan County

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4A-100. Domestic Relations Forms – Instructions for Stage 1 (rev. 01/2015)

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NMRA;

(ii) Petition for dissolution of marriage (with minor children), Form 4A-103

(iii) Marital settlement agreement, Form 4A-301 NMRA;

(iv) Custody plan and order, Form 4A-302 NMRA;

(v) Child support obligation and order, Form 4A-303 NMRA, with attached

child support worksheet as described in Section 40-4-11.1 NMSA 1978; and

(vi) Final decree of dissolution of marriage (with minor children), Form 4A-

306 NMRA.

(21) “wage withholding order” means an order that requires child support to be

withheld from the wages of the named parent.

E. STARTING THE DIVORCE PROCESS; CONTESTED. These are the first forms

that must be filed with the court. When starting this process, each spouse must be named as a party on

the forms. One spouse is the petitioner and the other is the respondent. The spouse starting the lawsuit is

the named petitioner. The other spouse is the respondent. The claims or rights of either party are not

determined on the basis of being named as the petitioner or respondent. See Paragraph F of this rule for

instructions on completing forms and next steps after these forms are filled out. In a divorce proceeding,

the case is started by filing the following completed forms with the court:

(1) Domestic Relations Information Sheet. Form 4A-101 NMRA shall be submitted

to the court in all cases. This form is used to provide the court with essential information about the parties

to the divorce proceeding, such as addresses, social security numbers, dates of birth, and the names and

ages of the children of the parties. Although this form is required to be turned into the court, it is not a

public record and is not part of the court file; and

(2) Divorce Petition (Petition for Dissolution of Marriage). Depending on whether

there are minor children of both parties, one of the following two forms are used to request a divorce:

(a) Form 4A-102 NMRA is used if the parties do not have any minor children

together; or

(b) Form 4A-103 NMRA is used if the parties have minor children together.

(3) Summons. The Summons Form is Form 4-206 NMRA. The petitioner must

complete this form. When the petitioner completes the contact information, the court will fill in additional

information to complete the summons and return the original summons to the petitioner. A copy of the

summons shall be served on the respondent as part of the Summons Packet. See Paragraph J of this rule

for serving the Summons Packet. It is the responsibility of the petitioner to file the original summons with

a completed return with the court.

(4) Temporary Domestic Order (TDO). The TDO is Form 4A-201 NMRA. Each

judicial district has different procedures about who provides the standard form and how a TDO is issued.

Some courts provide the form when the lawsuit is filed and others require the party starting the lawsuit to

complete the form. Check with the court where you are filing your lawsuit to find out if you need to bring

a TDO form with you. The contents of the TDO form shall not be changed by any person. The form

requires only the completion of the court caption on the first page. If the court where you are filing your

lawsuit does not issue its own TDO, bring additional copies of the TDO with you when filing your lawsuit.

F. Completion of forms. When filling out any forms, please do the following:

(1) Type or print. You must type or print all of the information required to be

completed on forms filed with the court. If there is not enough room on the form to provide all of the

information required, add a separate page for the information and include the page with the rest of the form

before making copies and filing the form with the court. Your handwriting should be clear and easy to

read.

(2) Signing the forms and other papers. Your signature on a form or other paper filed

with the court means the following:

(a) you have read and understand the form or paperwork;

(b) the information provided by you on the form is factually correct to the best

of your knowledge; and

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

4A-100. Domestic Relations Forms – Instructions for Stage 1 (rev. 01/2015)

Page 4 of

Some forms may need to be signed in front of a notary public and notarized.

G. Required number of copies to file with the court. After completing and signing any

required forms, take the original and two copies of each form to the court clerk for filing. The clerk will

file the originals and return stamped copies to you. One copy is for you, and you must provide the other

copy to the other party.

H. Pay the filing fee. A filing fee must be paid to the court clerk in cash or money order at

the time the divorce case is opened. A divorce case is opened by filing a domestic relations information

sheet, divorce petition, and summons. If you cannot afford to pay the filing fee, you may ask the court to

allow you to file for free or a reduced rate by filing an application for free process. The application for free

process is Form 4-222 NMRA.

I. Filing the first forms with the court. After completing the Summons Packet, take the

original and two (2) copies of each completed form to file in the district court. The court clerk will sign

and stamp the original summons and give the original and two (2) copies of it back to you with a copy of

your filed divorce petition so that a copy of the summons can be served on the respondent. The clerk may

also give you two (2) copies of the TDO or will endorse (stamp) copies of a TDO provided by you. One

copy of the temporary domestic order must be served on the respondent as part of the summons packet.

J. Serving the summons packet.

(1) After a divorce petition and summons and TDO are filed with the court, copies of

all papers must be served on the respondent. This is known as service of process.

(2) The Summons Packet and any other documents the clerk instructs you to serve

may be served on the respondent by hand-delivery by a person who is over the age of eighteen (18) and is

not a party to the divorce proceeding. The petitioner cannot be the person who serves the respondent. Have

someone deliver the Summons Packet to the respondent as required by Rule 1-004(F) NMRA. It is the sole

responsibility of the petitioner to have the summons packet served on the respondent and to provide proof

that the service was completed. The court is not responsible for serving documents on any party.

(a) If you and respondent are not living together and you know the

respondent’s current mailing address, the summons packet may also be served by certified mail, return

receipt requested. If served by certified mail, the respondent must sign a receipt indicating that he or she

received the Summons Packet for service to be completed. The return receipt from the certified mailing

must be filed with the district court.

(b) There are other ways of serving the Summons Packet on the respondent.

Read Rule 1-004 NMRA to learn more about those methods.

enforcement, or any other person who is over eighteen (18) and not a party to the lawsuit. You may have

to pay a fee to someone to do the service of process for you. Check with your local law enforcement or

look in the phone book for resources for service of process.

(3) If you cannot find the respondent after reasonable attempts to find him or her to

serve the Summons Packet, you may file a motion with the court asking permission to serve the summons

packet by publication in a newspaper. If you need to serve the summons packet by publication in a

newspaper, use Forms 4-209 and 4-209A NMRA.

(4) After successful service on the respondent, the petitioner is responsible for making

sure that the original summons with the completed return is filed with the court to prove that the respondent

was served.

K. Responding to the petition. In a contested divorce proceeding, the respondent must file

a written response to the divorce petition. Form 4A-104 NMRA may be used to respond to the divorce

petition. The response must be filed with the court and a copy mailed to the petitioner within thirty (30)

days after the summons packet was served on the respondent. Failure to file a response to the divorce

petition within the thirty (30) days can result in serious consequences, including the entry of a default

judgment against the respondent.

L. Issues not addressed by the forms. The Domestic Relations Forms may not address all

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

4A-100. Domestic Relations Forms – Instructions for Stage 1 (rev. 01/2015)

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domestic relations issues relevant to you. The forms address only the most common divorce issues. If there

are issues that are not addressed in the forms, you are responsible for bringing those issues to the attention

of the court or you should seek the assistance of an attorney. You may need to get other forms that are not

provided in these rules to finish the transfer of property, businesses, etc. For example, the forms do not

include the following:

(1) federal and state tax treatment of income, expenses, and deductions both before

and after a divorce, or as a result of a child support order, for claiming children as dependents, or for paying

or receiving alimony;

(2) how to transfer title to property or assets;

(3) how to divide a business or retirement income;

(4) how to divide or transfer other complicated assets; or

(5) how to divide or transfer debts.

M. Keeping Records. Any party to an action should make copies of all documents,

paperwork, or forms filed with the court for his or her own records.

N. Paying Creditors. These forms, including the final decree of dissolution of marriage, do

not change the legal responsibility of the parties to pay their creditors.

O. Role of judge, clerk, and court. Court clerks can only help you with filing forms with

the court; they cannot help you complete them. The judge makes decisions in your case, but neither the

judge nor the judge’s staff can give advice to either party, including how to fill out the forms. If you need

assistance or have questions about how to complete the forms, you may seek help from an attorney. The

court clerks may give you information about resources for legal assistance. See Rule 23-113 NMRA, which

provides more guidance on what information and assistance court staff may give to self-represented

litigants. You may also want to use your local library to get information about the forms or legal citations

in these rules, which may include internet searches of New Mexico court websites (www.nmcourts.gov) and

the New Mexico compilation commission (www.nmcc.gov

[Approved by Supreme Court Order No. 13-8300-010, effective for all pleadings and papers filed on or after May 31, 2013, in all

cases pending or filed on or after May 31, 2013; as amended by Supreme Court Order No. 14-8300-011, effective for all pleadings

and papers filed on or after December 31, 2014, in all cases filed or pending on or after December 31, 2014.]

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

4A-101. Domestic Relations Information Sheet (rev. 01/2015)

Page 1 of 2

4A-101. Domestic relations information sheet.

DOMESTIC RELATIONS INFORMATION SHEET

NOTE TO CLERK: DO NOT FILE THE INFORMATION SHEET

Type or print responses. Required in all domestic relations cases.

(Do not use in domestic violence cases.)

Petitioner’s attorney information. (Complete only if Petitioner has an attorney.)

Petitioner’s name:

Attorney’s name:

Attorney’s address:

City: State Zip code:

Telephone:

Information regarding petitioner and respondent. (Do not use an attorney’s mailing address.

Use a separate sheet if necessary.

PETITIONER: RESPONDENT:

NAME: NAME:

Other names (e.g. maiden name): Other names (e.g. maiden name):

Address:

City:

State:

Zip code:

Date of birth:

Social Security number

Address:

City:

State:

Zip code:

Date of birth:

Social Security number

Parties’ minor children. (Provide the date of birth and social security number for each minor child,

if any. Use a separate sheet if necessary.)

1. NAME: 2. NAME:

(Last name, first, middle) (Last name, first, middle)

Date of birth:

Social Security number:

Date of birth:

Social Security number: _

3. NAME: 4. NAME:

(Last name, first, middle) (Last name, first, middle)

Date of birth:

Social Security number:

Date of birth:

Social Security number:

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

4A-101. Domestic Relations Information Sheet (rev. 01/2015)

Page 2 of 2

Request to limit access to information. (Optional - complete only if applicable)

[ ] The [petitioner] [respondent] has reason to fear domestic violence or child abuse.

For this reason, please limit access to information about the [petitioner] [respondent] in

the Child Support & Paternity Case Registry to the extent possible.

The [petitioner]

[respondent] realizes that this request may make it more difficult to assist in collecting

child support. The [petitioner] [respondent] understands that the other party and the

public might still view information about this case under some circumstances.

I affirm that this request is legitimately made and not designed to harass or intimidate the other

party or mislead the court.

Signature of [Petitioner] [Respondent]

USE NOTES

The Domestic Relations Information Sheet is not required in domestic violence, commitment, guardianship,

probate, or adoption actions; or if you are filing a pleading that does not change or add to the first pleading.

In uncontested domestic relations matters, the parties may submit one Information Sheet with the initial pleading, and

the document need not be served.

In all other contested domestic relations cases each attorney representing a petitioner, or the petitioner proceeding pro

se, in a contested case must submit the Information Sheet and serve a blank copy of the Information Sheet on the respondent.

Respondents must submit the completed Information Sheet with their first responsive pleading.

The information submitted on these forms does not replace or supplement the filing and service of pleadings or other

papers required by law. These forms, approved by the Supreme Court of New Mexico, are required to initiate domestic relations

cases and are used by the courts for case management.

Forms are available from the court clerks and the NMRA. Electronic copies may be obtained from the Supreme Court's

internet site (www.supremecourt.nm.org) and New Mexico Law on Disc. If re-keying the form it must appear substantially in the

same format as the Supreme Court approved form. Type or print only. If using a word processing system, please print your

answers in bold.

Unless there are more than four children, the Information Sheet is to be submitted on a single page. The clerk

will key-enter the information on the Information Sheet. The Information Sheet will not be filed in the court file.

If the party has more than one social security number, please include it. Pursuant to Sections 27-1-10 and 27-

1-11 NMSA 1978 and federal law, each party must submit the social security number of each party as well as the name, date of

birth and social security number for each minor child. This information will be provided to the State Case Registry and, upon

request, to child support enforcement agencies. The parties’ addresses and social security numbers are also used to accurately

identify and track court users, obtain feedback from court users on a periodic basis and to issue process in contempt proceedings.

Addresses provided on this page will not be made a part of the public record unless that party is or becomes self- represented.

The Child Support & Paternity Case Registry is a required, nationwide database of child support and

paternity orders. Access to registry information is strictly limited to court and child support administrative personnel. Requesting

that your registry information be “nondisclosed” does not prevent authorized parties from reviewing the information. Rather, it

alerts courts and child support administrative personnel to act with caution when viewing your information. However, be aware

that requesting “nondisclosure” of registry information does not limit access to your official district court case file which is a

public record. If you are concerned about such access, ask your lawyer, or the court clerk if you do not have a lawyer, about

ways in which the court may restrict access to your court file.

[Provisionally approved as 4-211 NMRA, effective November 1, 1999 until November 1, 2000; approved, as amended, effective November 1,

2000; as amended by Supreme Court Order No. 13-8300-010, effective for all pleadings and papers filed on or after May 31, 2013, in all cases

pending or filed on or after May 31, 2013; as amended by Supreme Court Order No. 14-8300-011, effective for all cases filed on or after

December 31, 2014.]

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4A-103. Petition for dissolution of marriage (with children).

STATE OF NEW MEXICO

COUNTY OF SAN JUAN

ELEVENTH JUDICIAL DISTRICT COURT

Petitioner,

No. D-1116-DM

Respondent.

PETITION FOR DISSOLUTION OF MARRIAGE

(WITH CHILDREN)

Petitioner, , asks this Court for a Final Decree of

Dissolution of Marriage, and states:

1. The parties, or at least one party, is a resident of County,

State of New Mexico.

2. At least one party has resided in the state of New Mexico for at least six (6) months

immediately preceding the filing of this Petition and has domicile in New Mexico as

defined by Section 40-4-5 NMSA 1978.

3. The parties were married on (date-mm/dd/yyyy) in

(city), (state), and have remained

spouses since that date.

4. A state of incompatibility and irreconcilable differences exists and the parties are not

likely to reconcile.

5. The parties have child/children:

Name Year of Birth Age

6. Choose only one:

There are no more children expected.

The parties are expecting another child/children.

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7. The minor child/children have been residents of the state of New Mexico for at least the

past six (6) months and jurisdiction to determine custody issues is present in the state of

New Mexico. New Mexico is the home state of the child/children.

8. Petitioner=s current address is:

Respondent=s current address is:

The current address of each child under the age of eighteen (18) is: (list name and

address of each child)

Child’s Name Address

9. For the last five (5) years, list the names of the persons with whom each child under the

age of eighteen (18) named in paragraph 6 above has resided, and the dates at each

residence for each child:

Person’s Name Dates

10. Petitioner has information about custody proceeding(s) involving the minor

child/children either pending or in the past in a court in this state or any other state.

(Choose one)

Yes If yes, provide court information:

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11. Choose only one:

Petitioner has not participated as a party, witness, or in any other capacity

in any other litigation concerning the custody of the minor child/children in New Mexico

or in any other jurisdiction and/or state.

Petitioner has participated as a party, witness, or in some other capacity in

other litigation concerning the custody of the minor child/children. List all case names

including names of parties, name of court, location of the court, and court case number:

12. Someone other than Respondent and me has physical custody of the minor child/children

or claims to have custody or visitation rights with respect to the minor child/children.

(Choose one)

Yes If yes, list the name of any such individual(s):

(Name)

13. Choose only one:

Petitioner and Respondent are fit and proper persons to have joint legal custody

of the minor child/children, with the rights and responsibilities identified in Paragraphs F

and J of Section 40-4-9.1 NMSA 1978, and subject to a parenting plan that is consistent

with the best interests of the child/children.

Petitioner is a fit and proper person to have sole legal custody of the

child/children and is able to show the Court why sole legal custody is appropriate for the

child/children.

14. The parties should be ordered to contribute to the support and maintenance of the parties=

child/children pursuant to the New Mexico Child Support Guidelines.

15. Any sole and separate property or debts of the parties should be confirmed by the Court.

16. Any community property of the parties should be equitably divided.

17. Any community debts of the parties should be equitably allocated.

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18. CIRCLE ONE: My spouse [IS] [IS NOT] a member of the military.

19. OPTIONAL (Cross out if this does not apply to you): Petitioner is in need of spousal

support (alimony) to be paid to him/her by Respondent.

20. OPTIONAL (Cross out if this does not apply to you): Petitioner wishes to be

restored to his/her former name:

(Name)

Petitioner asks that the Court:

A. Enter a Final Decree of Dissolution of Marriage on the grounds of incompatibility;

B. (Choose only one)

Award joint legal custody of the child/children and adopt a parenting plan in

the child/children=s best interests;

Award sole legal custody of the child/children to Petitioner/Respondent

(circle one), with visitation for the other parent that is consistent with the best interests of

the child/children;

C. Order the parties to contribute to the support and maintenance of the parties= minor

child/children pursuant to the New Mexico Child Support Guidelines;

D. Confirm the separate property and separate debts of the parties;

E. Equitably divide the community property and community debt of the parties;

F. Order the Respondent to pay spousal support (cross out if this does not apply);

G. Order that Petitioner=s name be restored to his/her former name of

(cross out if this does not apply); and

H. Provide for such other and further relief as the Court may deem just and proper.

Submitted by:

Name

Street/mailing address

City, State, Zip

Telephone number

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VERIFICATION

I, , affirm under penalty of perjury under the laws of the State of

New Mexico that I am the Petitioner in the above-entitled cause, and I know and understand that the

contents contained in the above Petition are true to the best of my knowledge and belief. I have read and

understand the Temporary Domestic Order as described in Rule 1-121 NMRA. I understand that upon

the filing of this Petition with the Court that I am bound by the contents of the Temporary Domestic

Order.

Signature of Petitioner Date

[Approved by Supreme Court Order No. 13-8300-010, effective for all pleadings and papers filed on or after May 31, 2013, in all

cases pending or filed on or after May 31, 2013; as amended by Supreme Court Order No. 14-8300-011, effective for all

pleadings and papers filed on or after December 31, 2014, in all cases filed or pending on or after December 31, 2014.]

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4A-300. Domestic relations forms; INSTRUCTIONS FOR STAGE THREE (3) FORMS.

A. Stage three (3) forms; scope. The stage three (3) forms are the last forms that you must

complete to dissolve your marriage (i.e., get a Adivorce@). Once approved by the Court, the agreements

and promises that you have made in these forms will settle financial matters between you and the other

party, and will control your rights as a parent. When both parties sign the Marital Settlement Agreement

(Form 4A-301 NMRA), the Custody Plan and Order (Form 4A-302 NMRA), and the Child Support

Obligation and Order (Form 4A-303 NMRA), they may be enforced by either party as contracts. When

the Court signs a Final Decree of Dissolution of Marriage (Form 4A-305 or 4A-306 NMRA), you will be

divorced, and the Marital Settlement Agreement, the Custody Plan and Order, and the Child Support

Obligation and Order will become legally binding on both of you. Any important changes to these

agreements should be in writing and signed by both parties. These changes should be filed with the

Court. You should be careful when filling out these forms, and be as complete as possible. It is highly

recommended that you consult with an attorney.

B. Marital Settlement Agreement. A Marital Settlement Agreement (AMSA@) must be

completed, signed by both parties, and filed with the Court in every dissolution of marriage case. (Use

Form 4A-301 NMRA.) Although the MSA is called an AAgreement,@ if the parties do not agree on its

terms, the Court may use the terms of either party=s proposed MSA in its final order after a hearing. The

MSA describes how you and the other party will divide your property and debts, and how you will settle

any other financial matters, including whether one party will pay spousal support or make a cash payment

to the other. When the parties sign the MSA or the Court signs and files a Final Decree of Dissolution of

Marriage, the MSA is legally binding on both parties. See Paragraph A, above.

If you and the other party cannot agree on some or all of the terms of the MSA, you may request

the assistance of a mediator, if available, by completing and filing a Motion for Referral to Mediation

(child support or other financial issues) (Form 4A-205 NMRA) with the Court. If you do not believe a

mediator will be helpful, you may complete and file a Request for Hearing (Form 4A-206 NMRA), and

the Court will make a decision for you. For more information about how to request a hearing, see

Subparagraph (1) of Paragraph E of Form 4A-200 NMRA.

The MSA includes the following sections:

(1) Property we are dividing. This is where you describe how you will divide your

property, including personal property, real property, bank and investment accounts, retirement plans,

vehicles, and any other property. Examples of each type of property are included on the form. Complete

the Personal Property List (Attachment A) to identify any personal property you own that is valuable to

you and to show how you will divide it. If you have real property other than the home you lived in while

you were married, complete the Real Property List (Attachment B) to identify the property and to show

how you will divide it;

(2) Debts we are dividing. This is where you describe how you will divide your

debts (e.g., credit cards, loans, etc.), cancel joint credit cards, file your taxes, and handle any issues that

may come up with tax returns that were filed while you were married. Complete the Debt List

(Attachment C) to identify each of your debts and to show how you will divide them;

(3) Cash payment. This is where you show any dollar amount that you have agreed

one party should pay the other to settle the division of your property and debts. This amount will be

included in the Final Decree of Dissolution of Marriage as a judgment in favor of the party who is to

receive the cash payment. This judgment may be enforced as provided by law;

FOR INFORMATION ONLY

DO NOT COPY ● DO NOT FILE

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(4) Spousal support. This is where you show any dollar amount that you have

agreed one party should pay the other as monthly spousal support. If the Court approves this section, the

amount and timing of spousal support can be modified only by a court order. For more information on

spousal support, see Section 40-4-7 NMSA 1978;

(5) Other statements by parties. This is where you promise to do what is necessary

to carry out your agreements in the MSA and how you will resolve any arguments you may have about

the MSA in the future; and

(6) Verification. This is where you affirm the truth of the statements in the MSA

and sign it under penalty of perjury.

C. Custody plan and order. A Custody Plan and Order must be completed and filed with

the Court in every dissolution of marriage case when the parties are the parents of one or more children

under eighteen (18) years of age or under the age of nineteen (19) and attending high school. (Use Form

4A-302 NMRA.) This document describes decisions that have been made and how decisions will be

made in the future about the children. When the Court signs and files a Final Decree of Dissolution of

Marriage, the Custody Plan and Order is legally binding on both parties. See Paragraph A, above.

If you and the other party cannot agree on the terms of a Custody Plan and Order, you may

request the assistance of a mediator by completing and filing a Motion for Referral to Mediation (child

custody, timesharing, or visitation) (Form 4A-204 NMRA) with the Court. If you do not believe that a

mediator will be helpful, you may complete and file a Request for Hearing (Form 4A-206 NMRA), and

the Court will make a decision for you. For more information about how to request a hearing, see Form

4A-200(E)(1) NMRA. Some courts will not set a hearing on custody matters until the parties have tried

mediation but failed to reach an agreement. Check with the Court before you request a hearing to find out

if mediation is required.

The Custody Plan and Order includes the following sections:

(1) Identification and contact information. This is where you list the names and

contact information of the parties and the children who are covered by the form;

(2) Custody of the children. This is where you describe the agreement you have

reached about how you will make decisions and who will have custody of your children. If you choose

sole legal custody, you must provide the specific reason why sole legal custody is in the best interests of

the children. Also describe how often, when, and where the non-custodial parent will be allowed to visit

the children, if at all. If you choose joint legal custody, you must complete the parenting plan in

Subparagraphs one (1) through five (5) of Paragraph B to describe how you will share the custody of your

children; and

(3) Verification. This is where you affirm the truth of the statements in the Custody

Plan and Order and sign it under penalty of perjury.

D. Child support obligation and order. A Child Support Obligation and Order must be

completed and filed with the Court in every dissolution of marriage case when the parties are the parents

of one or more children under eighteen (18) years of age or under the age of nineteen (19) and attending

high school. (Use Form 4A-303 NMRA.) This document describes how you will divide the expenses of

raising the children, including child support and health insurance, and tax issues relating to the children.

When the Court signs and files a Final Decree of Dissolution of Marriage, the Child Support Obligation

and Order will become legally binding on both parties. See Paragraph A, above.

If you and the other party cannot agree on the terms of the Child Support Obligation and Order,

you may request the assistance of a mediator by completing and filing a Motion for Referral to Mediation

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(child support or other financial issues) (Form 4A-205 NMRA) with the Court. If you do not believe that

a mediator will be helpful, you may complete and file a Request for Hearing (Form 4A-206 NMRA), and

the Court will make a decision for you. For more information about how to request a hearing, see Form

4A-200(E)(1) NMRA.

The Child Support Obligation and Order includes the following sections:

(1) Identification and contact information. This is where you list the names and

contact information of the parties and the children who are covered by the form;

(2) Child support. This is where you describe how you will share the expenses of

raising your children. This portion of the form refers to these additional documents:

(a) Child support worksheet. To complete Paragraph A of this section, you

must complete and attach a child support worksheet to your Child Support Obligation and Order. The

worksheet will help you figure out the amount of child support required by law. The worksheet is

available at Section 40-4-11.1 NMSA 1978, or you can find an interactive version at www.nmcourts.com

by clicking on the AFamily Law Forms@ link and selecting AChild Support Worksheet.@ The interactive

worksheet will automatically calculate the monthly child support obligation. The amount shown on the

child support worksheet will be awarded by the Court. If the parties need to deviate from the amount

shown on the child support worksheet, they must request a different amount, explain why that amount is

necessary, and the deviation must be approved by the Court; and

(b) Wage withholding order. Under Paragraph D of this section, you must

tell the Court how you will begin wage withholding for child support. Payment of child support by wage

withholding is mandatory unless otherwise agreed by the parties or ordered by the Court. Wage

withholding will not take effect until the parties complete a Wage Withholding Order (Form 4A-304

NMRA) and submit it to the Court for filing, or until the Court signs and files the Child Support

Obligation and Order and the parties open a case with the New Mexico Human Services Department,

Child Support Enforcement Division (ACSED@). CSED can issue a notice of wage withholding for the

parties on full service cases. You may request the Court to order wage withholding by attaching a

completed Wage Withholding Order to the Child Support Obligation and Order; and

(3) Verification. This is where you affirm the truth of the statements in the Child

Support Obligation and Order and sign it under penalty of perjury.

E. Final decree of dissolution of marriage. When the Court signs and files a Final Decree

of Dissolution of Marriage, you and the other party will be divorced. You may request a Final Decree of

Dissolution of Marriage as follows:

(1) Uncontested. If you and the other party agree on the terms of your MSA (and

Custody Plan and Order and Child Support Obligation and Order, if you have children), you may request

a Final Decree of Dissolution of Marriage by doing the following:

(a) Filing your completed MSA (and completed Custody Plan and Order and

Child Support Obligation and Order, if you have children) with the Court Clerk=s Office; and

(b) Submitting a completed Final Decree of Dissolution of Marriage (Form

4A-305 NMRA (without children) or 4A-306 (with children) NMRA) to the judge for approval.

The Court may sign the Final Decree of Dissolution of Marriage without further notice, or it may

order you and the other party to appear for a hearing. WARNING: Once the Court signs and files the

Final Decree of Dissolution of Marriage, your divorce will be final, and the terms of the MSA (and the

Custody Plan and Order and Child Support Obligation and Order, if you have children) will be binding as

a court order on both parties. See Paragraph A, above;

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(2) Contested. If you and the other party do not agree on the terms of your MSA

(and Custody Plan and Order and Child Support Obligation and Order, if you have children) and you

cannot submit completed forms to the Court, you should request a trial in your case by submitting a

Request for Hearing (Form 4A-206 NMRA). For more information about how to request a hearing, see

Form 4A-200(E)(1) NMRA.

The Court will set one or more hearings to resolve the remaining disagreements over the terms of

the MSA (and the Custody Plan and Order and Child Support Obligation and Order, if you have children).

You must complete your own proposed MSA (and Custody Plan and Order and Child Support Obligation

and Order, if you have children) and Final Decree of Dissolution of Marriage (Form 4A-305 (without

children) or Form 4A-306 (with children) NMRA) and bring them with you to the hearing. Once the

Court has decided the terms of the MSA (and the Custody Plan and Order and Child Support Obligation

and Order, if you have children), it will sign and file a Final Decree of Dissolution of Marriage, and you

will be divorced from the other party; or

(3) Default. If more than thirty (30) days have passed since you filed and served the

Petition for Dissolution of Marriage and the other party has not filed an answer or otherwise responded to

your petition, you may be able to request a Final Decree of Dissolution of Marriage without the other

party=s participation. This is called a default judgment. See Form 4A-310 NMRA for instructions on how

to request a default judgment and Final Decree of Dissolution of Marriage.

[Approved by Supreme Court Order No. 13-8300-010, effective for all pleadings and papers filed on or after May 31, 2013, in all

cases pending or filed on or after May 31, 2013; as amended by Supreme Court Order No. 14-8300-011, effective for all

pleadings and papers filed on or after December 31, 2014, in all cases filed or pending on or after December 31, 2014.]

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4A-301. Marital settlement agreement.

STATE OF NEW MEXICO

COUNTY OF SAN JUAN

ELEVENTH JUDICIAL DISTRICT COURT

Petitioner,

v. No. D-1116-DM

Respondent.

MARITAL SETTLEMENT AGREEMENT

(Petitioner’s name) and

(Respondent’s name) are married and agree to follow this agreement beginning on the day we both sign it.

We understand that the judge may make changes to this agreement and that we must comply with any

changes made.

PROPERTY WE ARE DIVIDING

A. Personal property (such as clothing, furniture, jewelry, or artwork). We have agreed how we will

divide our property. We have attached a Personal Property List (Attachment A) showing all our

property and which of us will receive that property.

(Choose 1 or 2)

[ ] 1. Each of us already has possession of all the personal property we each expect to receive.

[ ] 2. We will make sure we each have our own property by

(date).

Real Property

(such as a home, mobile home, condominium, lot, or commercial building).

(Choose all that apply)

[ ] 1. Neither of us owns real property.

[ ] 2. We own a marital home, which is located at (address), and

we agree to do the following: (Complete the correct section: a. Keep the home; b. Sell the

home; or c. Other plan.)

[ ] a. Keep the home. We agree that (Choose i or ii)

[ ] i. Petitioner shall keep the home and be responsible for all debts related to

the home.

[ ] ii. Respondent shall keep the home and be responsible for all debts related to

the home.

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The person who keeps the home is called the “homeowner.” The other person is

called the “moving spouse.”

We further agree to the following: (Choose all that apply)

[ ] iii. The amount owed to the moving spouse to buy out that person’s interest

is $ , which is included in the calculation of the Cash

Payment, Section III, below.

[ ] iv. The homeowner will apply to refinance the debt owed on the home no later

than

(date).

[ ] v. This is our plan for the homeowner to buy out the moving spouse’s interest

in the home or to get the moving spouse off of the loan papers:

[ ] b. Sell the home. We are going to sell the home and divide the money from the sale

as follows:

While the home is being sold, [ ] Petitioner (or) [ ] Respondent (choose one) will

stay in the home.

Until the home sells, we will pay expenses, including mortgage, taxes and

insurance, utility bills, and repairs for the home as follows

(describe who is to pay

and how much each person will pay)

We both will cooperate with the showing of the home and the sale of the home,

including signing all paperwork needed in order to sell it and transfer title. Both

of us will preserve the home in a reasonable way including the following things:

[ ] c. Other plan. We have attached a separate sheet with our plan regarding the home.

[ ] 3. One or both of us has other real property as set forth in the attached Real Property List

(Attachment B), and we have agreed to divide that property as set forth in the attachment.

If one party owes the other money for the division of the other real property, that amount

should be included in the calculation of the Cash Payment, Section III, below.

C. Bank and investment accounts (such as checking accounts, savings accounts, stocks, bonds, certificates

of deposit, mutual funds, or life insurance policies with cash value). (Choose 1 or 2)

[ ] 1. We do not have any bank or investment accounts.

[ ] 2. We have the following bank or investment accounts and will divide them as follows:

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Petitioner will have the following bank or investment accounts:

Name of institution Last four (4) digits of account #

Respondent will have the following bank or investment accounts:

Name of institution Last four (4) digits of account #

D. Retirement Plans (such as IRAs, retirement accounts, pension plans, or 401(k) plans).

(Choose 1 or 2)

[ ] 1. Neither of us has a retirement plan.

[ ] 2. We will be dividing our retirement plan(s) as follows:

Petitioner has the following

retirement plan(s):

(Circle one to show whether Petitioner

will KEEP the entire plan, DIVIDE the

plan with Respondent, or TRANSFER

the entire plan to Respondent)

If plan will be DIVIDED,

the amount or % to be given

to Respondent:

[KEEP]

[DIVIDE] [TRANSFER]

[KEEP]

[DIVIDE] [TRANSFER]

[KEEP]

[DIVIDE] [TRANSFER]

Respondent has the

following retirement

plan(s):

(Circle one to show whether

Respondent will KEEP the entire plan,

DIVIDE the plan with Petitioner, or

TRANSFER the entire plan to

Petitioner)

If plan will be DIVIDED,

the amount or % to be given

to Petitioner:

[KEEP]

[DIVIDE] [TRANSFER]

[KEEP]

[DIVIDE] [TRANSFER]

[KEEP]

[DIVIDE] [TRANSFER]

(Check and complete if retirement plan(s) will be divided)

[ ] For the following retirement plans that will be divided, Petitioner shall prepare a Qualified

Domestic Relations Order (“QDRO”), obtain the signature of the other party, and submit the

QDRO to the Court by

(date).

(List the plans):

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[ ] For the following retirement plans that will be divided, Respondent shall prepare a Qualified

Domestic Relations Order (“QDRO”), obtain the signature of the other party, and submit the

QDRO to the Court by

(date).

(List the plans):

Vehicles

(such as cars, trucks, motorcycles, recreational vehicles, boats, tractors, or trailers).

(Choose 1 or 2)

[ ] 1. We do not have any vehicles.

[ ] 2. We have vehicles and are dividing them as follows:

Petitioner will keep the following vehicles and assume any debt relating to each vehicle

(provide the make, model, and year of each vehicle and list the vehicle identification number):

Vehicle description Vehicle Identification No. (last six digits)

Respondent will keep the following vehicles and assume any debt relating to each vehicle

(provide the make, model, and year of each vehicle and list the vehicle identification

number):

Vehicle description Vehicle Identification No. (last six digits)

Each person listed above as keeping the vehicles will pay for the costs of the vehicles,

including insurance.

The parties will transfer title (choose one):

[ ] by the following date (date).

[ ] when the vehicle is paid off.

[ ] the party who is keeping the vehicle already has the title in his/her name.

F. Other property (such as business interests, patents, trademarks, copyrights, royalties, manuscripts, or any

other property). (Choose 1 or 2)

[ ] 1. Neither party has any other property.

[ ] 2. One or both parties has the other property listed below, and we have agreed to divide it as

follows:

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II.

DEBTS WE ARE DIVIDING

A. Debt. We attach a Debt List (Attachment C) which lists all of our debts, including mortgages,

vehicle payments, taxes, credit cards, student loans, medical debts, judgments, and any other debts

we may have. Any debt not listed is the responsibility of the person who created it. Each of us

will pay debts we created prior to our marriage, unless we state differently here. Unless we state

differently here, a person who takes property (such as a house or car) with a debt associated with

it, will take the debt.

(Choose all that apply)

[ ] We have no debt from our marriage.

[ ] We will pay our debts as listed on Attachment C.

[ ] The amount owed from to for the

division of the debts is $ , which is included in the calculation of the Cash

Payment, Section III, below.

B. Credit cards and charge cards. Each of us will turn in and cancel all joint credit cards, or we will

have the credit card company take the other person’s name off of the account.

C. Taxes. We will share information necessary to correctly file our income tax returns. We will get

the help we need to file our taxes.

D. Problem with tax returns. If any of our returns that we filed together are audited or contested,

we will meet to decide what to do. If we cannot decide who pays the taxes owed or who gets any

refund, we will ask a judge to decide at the time the problem comes up.

E. Legal promise. We understand that if either of us fails to pay the debts we have promised to pay,

the other party may end up making that payment. If that happens, the party who should have paid

promises to repay the other party, including any other extra costs caused by the failure to pay, such

as attorney fees, late fees, and interest charged by the creditor.

III. CASH PAYMENT

(If the parties have agreed that one party should pay money to the other in any of the preceding sections, those

amounts should be included in this section.)

In order to settle the division of property and debts, we agree that (name)

shall pay (name) the amount of $ no later than

(date). We agree that judgment shall enter in this amount for

(name of person owed money). The statutory interest rate shall apply as

provided in Section 56-8-4(A) NMSA 1978.

IV.

SPOUSAL SUPPORT

A. We agree to spousal support as follows: (Choose 1 or 2)

[ ] 1. No spousal support. Each of us can support ourselves and neither will pay spousal support

to the other.

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[ ] 2. Spousal support. [ ] Petitioner (or) [ ] Respondent (choose one) will pay spousal

support to the other spouse.

Spousal support will be paid as follows: (Choose i, ii, or iii)

[ ] i. $ per month on the (date) of each month for

(period of time), which is not modifiable.

[ ] ii. $ per month on the (date) of each month until

modified by the court.

[ ] iii. This is our other plan:

V. OTHER STATEMENTS BY PARTIES

A. Documents. We will each sign the documents we need to divide the property and debts, and each

will deliver to the other party all documents related to property and debt awarded to the other.

Future issues.

1. Either of us may ask the judge for help if

a. one of us does not do what we said in this agreement; or

b. we cannot agree on what this agreement says.

We understand that the judge may make one party pay costs such as attorney fees.

If we forgot or failed to list any property or debt, we will seek the help we need to divide that

property or debt.

C. Final agreement. This is the final and entire agreement of the parties. Neither party is relying on

other promises or statements that are not specifically included in this document.

VERIFICATION

When I sign here, I am telling the judge under oath and penalty of perjury:

I have read this agreement and agree with everything in it; I have read the warnings and cautions listed in

this agreement;

I have disclosed all assets and debts known to me, and I understand that my spouse is relying on my

disclosures;

I have gotten the help I needed before signing this agreement; and this document and the statements in it

are true and correct to the best of my knowledge and belief.

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I understand that I can be punished both civilly and criminally if any information in this agreement is false.

Petitioner’s signature Respondent’s signature

Date: Date:

Mailing address: Mailing address:

Telephone: Telephone:

STATE OF NEW MEXICO }

COUNTY OF } ss.

Acknowledged, signed and sworn before me on (mm/dd/yyyy) by

(name of person making statement), the PETITIONER.

Signature of Judge, Notary or other officer

Authorized to administer oaths

Title or date commission expires

STATE OF NEW MEXICO }

COUNTY OF } ss.

Acknowledged, signed and sworn before me on (mm/dd/yyyy) by

(name of person making statement), the RESPONDENT.

Signature of Judge, Notary or other officer

Authorized to administer oaths

Title or date commission expires

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ATTACHMENT A: PERSONAL PROPERTY LIST

(Attach additional pages if needed)

List all items of value to you, such as furniture, household items, electronics, art, jewelry, and tools.

Item

Dollar

Value

Will belong to (check box for each item):

PetitionerRespondent

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ATTACHMENT B: REAL PROPERTY LIST

(Attach additional pages if needed)

List all homes (other than the marital home), land, or other real property owned by Petitioner or

Respondent.

Other Real Property

1. Address/Description of property:

We agree to do the following with the property after the divorce:

(Choose all that apply)

Petitioner will keep the property;

Respondent will keep the property;

[ ] Petitioner [ ] Respondent shall pay the other party $ .

The property will be sold and the proceeds divided as follows:

Other plan:

2. Address/Description of property:

We agree to do the following with the property after the divorce:

(Choose all that apply)

Petitioner will keep the property;

Respondent will keep the property;

[ ] Petitioner [ ] Respondent shall pay the other party $ .

The property will be sold and the proceeds divided as follows:

Other plan:

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ATTACHMENT C: DEBT LIST

(Attach additional pages if needed)

(NOTE: This document is a public document. DO NOT list the full account number for any credit card or

other loan information that you would not want to make public.)

We understand that this agreement may not bind creditors.

Creditor

Last four (4)

numbers on

account

Amount

owed

Will be paid by (checkbox):

Petitioner Respondent

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USE NOTES

A marital settlement agreement must be filed in every dissolution of marriage cause. See Forms 4A-100, -200,

and -300 NMRA for additional information about completing and filing this form.

It is highly recommended that you consult with an attorney. Whether property is separate or community is a

complicated issue. There can be serious consequences, including tax consequences, for the division of property

and for not properly transferring property, including retirement accounts. You may need separate documents to

transfer divided property.

To transfer land, a building or a home other than a mobile home, the parties must prepare, sign and record a deed

in the real property records where the property is located. To transfer a mobile home, contact the Motor Vehicle

Division.

If both parties are listed on the mortgage, you must seek lender approval to remove the moving spouse from the

mortgage and from responsibility for payment.

If the parties are going to divide a retirement plan, contact the retirement plan before completing and filing this

form. Depending on the plan, a QDRO may be necessary. If the parties cannot agree on the terms of the QDRO,

they should request a hearing.

CAUTION: You may want to consult an attorney about your retirement, pension, deferred compensation, 401k

plans, and/or benefits. If you do not see any attorney regarding these assets, you risk losing any interest you have

in these plans and/or benefits. There are certain documents the plan administrator must have. An attorney can

help you prepare these documents.

To transfer vehicles or a mobile home, contact the Motor Vehicle Division.

This agreement may not affect the rights of creditors even when approved by the Court as part of the final decree.

The creditor may expect payment from you no matter who agrees to pay the debt in this agreement. See an

attorney if you have questions about separate and community debts and separate and community property.

There can be serious consequences resulting from spousal support awards. If your agreement includes spousal

support, you should consult with an attorney.

10.

Consult with an attorney if problems arise later.

11.

To divide property or debts left out of this agreement, see Section 40-4-20(A) NMSA 1978.

[Approved by Supreme Court Order No. 13-8300-010, effective for all pleadings and papers filed on or after May 31, 2013, in all

cases pending or filed on or after May 31, 2013; as amended by Supreme Court Order No. 14-8300-011, effective for all pleadings

and papers filed on or after December 31, 2014, in all cases filed or pending on or after December 31, 2014; as amended by Supreme

Court Order No. 15-8300-024, effective for all pleadings and papers filed after November 18, 2015; as amended by Supreme Court

Order On. 19-8300-006, effective for all pleadings and papers filed on or after July 1, 2019.]

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302. Custody Plan and Order (rev. 01/2015, 11/2015)

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4A-302. Custody plan and order.

STATE OF NEW MEXICO

COUNTY OF SAN JUAN

ELEVENTH JUDICIAL DISTRICT COURT

Petitioner,

v. No. D-1116-DM

Respondent.

CUSTODY PLAN AND ORDER

and are the parents of the children

listed below. This document is the custody plan and is in the best interests of the children.

IDENTIFICATION AND CONTACT INFORMATION

Parent=s name Physical address and Place of employment

phone number and phone number

Child=s name Year of birth Age

[ ] The parties shall advise each other of any change to this contact information within ten

(10) days of new information becoming available.

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II.

CUSTODY OF THE CHILDREN

(Choose either Option A, Sole legal custody, or Option B, Joint legal custody)

[ ] A. Sole legal custody and visitation plan. (Do not fill out Option B if you choose this

option)

(Complete 1, 2, and 3)

(name of parent with sole custody) shall

have sole legal custody of the children. The parent with sole custody shall make

the important decisions regarding the children.

The reason that sole custody is in the best interest of the children is because:

This is the visitation plan:

(Choose a, b, or c)

[ ] a. There shall be no visitation until further order of the Court.

(or)

[ ] b. (name of other parent) shall have unsupervised visitation with the

children as follows: (Fully describe visitation plan to include who shall

transport the children and where and when the visitation shall occur.

Attach additional sheets if necessary.)

(or)

[ ] c. (name of other parent) shall have supervised visitation with the

children as follows: (Fully describe visitation plan to include who shall

supervise the visitation, who shall transport the children and where and

when the visitation shall occur. Attach additional sheets if necessary.)

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[ ] B. Joint legal custody and parenting plan. (Do not fill out Option A if you choose

this option)

Important decisions. The parents shall share joint legal custody of the children

and shall make important decisions about the children together. No change

regarding any of the following shall happen unless the parents both agree to the

change in writing or the court changes it:

City and county of residence:

Religion:

Activities:

Name Address and telephone

Doctor

Dentist

School

Child care

Other

Solving arguments. The parents shall resolve any parenting or time-sharing

dispute regarding the children in this way (steps continue until problem solved):

Talk together; or

Communicate in writing as follows:

parent requests change, and gives reasons for the change; and

ii.

answering parent sends response within days.

If the answering parent does not agree to the change, that parent must say

why, and, if possible, make a new proposal.

Take the following steps:

(check all that apply and number them if there is a particular order)

[ ] . Go to couple, family, or other counseling;

[ ] . Go to mediation with a neutral party;

[ ] . Other: ;

[ ] . Go to court.

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Timesharing schedule.

(Complete

Schedule 1

Schedule 2

below.)

[ ] Schedule 1. Same schedule each week or every two weeks.

(Set out the time that each parent shall have the children for that day.)

Week 1

‘s time

(name of parent)

‘s time

(name of parent)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Week 2

‘s time

(name of parent)

‘s time

(name of parent)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

[ ] Schedule 2. Write your own schedule. (Write your own schedule here or

attach a separate sheet or calendar or make additions to Schedule 1.)

Vacation and holiday plan.

Vacations. The parents shall each have [days] [weeks] (circle one) of

uninterrupted time with the children each year. Each parent shall give the

other parent at least [days] [weeks] (circle one) notice of the vacation

time.

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Holidays. Regardless of the day of the week, the children shall spend

holidays as follows: (Insert name of parent who will have the children on each

holiday)

Holidays:

Even year

Odd year

Times

Mother

s Day

(if split)

From

Father

s Day

From

Child=s Birthday

From

Halloween

From

Thanksgiving

break

From

Winter religious

From

holidays

1st 1/2 winter

break

From

2nd 1/2 winter

break

From

Spring Break

From

July 4th

From

Other religious

holidays

From

Others:

From

The Monday of a 3-day weekend due to a school, federal, or state holiday is

the same as the Sunday schedule unless we agree differently.

Details about the timesharing.

Communication. Each parent may have reasonable communication with the

children at all times. Neither parent shall unreasonably interfere with the

children=s communications with the other parent.

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Transfer of children. Responsibility for transferring the children from one

parent to the other shall be as follows (write what you will do here):

Long-distance transfer of children. Responsibility for transferring the

children from one parent to the other in long-distance arrangements shall be as

follows (write down what you will do here):

Emergencies. If there is a medical emergency, the parent with the children

shall try to call the other parent about the emergency. If the other parent

cannot be reached, any decision for emergency medical treatment shall be

made by the available parent in the best interest of the children.

Changes. Each parent may ask the other for changes to this schedule. The

other parent has the right to say Ano.@ If the other parent says Ano,@ the parent

asking for changes shall not argue or criticize the other parent=s decision.

Review of plan. The parents agree to meet [ ] every year (or) [ ] every

years to make sure this plan continues to work well.

VERIFICATION

I affirm under oath and penalty of perjury under the laws of the State of New Mexico that I have read this

document, that I agree with everything in it, and that the statements in it are true and correct to the best of

my knowledge and belief.

Name of parent (print) Name of parent (print)

Parent=s signature Parent=s signature

Date Date

Mailing address Mailing address

Physical address Physical address

Telephone Telephone

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Recommended by (if one is assigned):

Hearing Officer

APPROVED, ADOPTED AND ORDERED BY THE DISTRICT COURT

Date District Court Judge

STATE OF NEW MEXICO }

COUNTY OF } ss.

Acknowledged, signed and sworn before me on (mm/dd/yyyy) by

(name of person making statement), the PARENT.

Signature of Judge, Notary or other officer

Authorized to administer oaths

Title or date commission expires

STATE OF NEW MEXICO }

COUNTY OF } ss.

Acknowledged, signed and sworn before me on (mm/dd/yyyy) by

(name of person making statement), the PARENT.

Signature of Judge, Notary or other officer

Authorized to administer oaths

Title or date commission expires

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USE NOTE

A custody plan must be filed in every dissolution of marriage case if the parties have minor

children or a child under nineteen years of age who is attending high school. For more information about filling out

this form, see Form 4A-300 NMRA.

The parties should understand the difference between the rights and obligations of joint custodians

and a sole custodian. Descriptions of these terms are set out in NMSA 1978 Section 40-4-9.1 NMSA 1978. See an

attorney with questions you may have. Joint custody does not imply an equal division of the child=s time between

the parents or an equal division of financial responsibility for the child.

[Approved by Supreme Court Order No. 13-8300-010, effective for all pleadings and papers filed on or after May

31, 2013, in all cases pending or filed on or after May 31, 2013; as amended by Supreme court Order No. 14-8300-

011, effective for all pleadings and papers filed on or after December 31, 2014, in all cases filed or pending on or

after December 31, 2014; as amended by Supreme Court Order No. 15-8300-024, effective for all pleadings and

papers filed after November 18, 2015.]

THIS IS A SAMPLE “CHILD SUPPORT WORKSHEET”

THIS WORKSHEET IS REQUIRED ANYTIME YOU ASK THE JUDGE TO SET OR CHANGE

CHILD SUPPORT. EVEN IF YOU WANT TO DO SOMETHING DIFFERENT THAN THE

AMOUNT ON YOUR WORKSHEET, YOU HAVE TO SHOW THE JUDGE YOUR WORK-

SHEET FIRST.

FIND AN AUTOMATIC CALCULATOR AT www.nmcourts.gov. CLICK ON “

SELF-HELP”

THEN “

SELF-HELP GUIDE” THEN “CHILD SUPPORT WORKSHEET”. THE PROGRAM WALKS

YOU THROUGH EACH STEP. PRINT YOUR COMPLETED WORKSHEET.

WORKSHEET A - BASIC VISITATION

STATE OF NEW MEXICO

[ ELEVENTH ] JUDICIAL DISTRICT COURT

COUNTY OF [ SAN JUAN ]

[ PARENT 1 ], Petitioner,

vs. NO. DM-1116-

[ PARENT 2 ], Respondent.

MONTHLY CHILD SUPPORT OBLIGATION

Custodial

Parent

Other Parent

Combined

1. Gross Monthly Income

$ 1000.00

$ 2000.00

2. Percentage of Combined Income

50.00 %

100 %

3. Number of Children

4. Basic Support from Schedule

$ 382.00

5. Children’s Health and Dental Insurance Premium

$ 0.00

6. Work-Related Child Care

$ 0.00

7. Additional Expenses $ 0.00

+ $ 0.00

= $ 0.00

8. Total Support $ 0.00

$ 0.00

$ 382.00

9. Each Parent’s Obligation

$ 191.00

10. Amount for Each Parent from Line 8

- $ 0.00

11. Each Parent’s Net Obligation

$ 191.00

PARENT 2 PAYS PARENT 1 EACH MONTH $ 191.00

Parent 1's Signature:

Parent 2's Signature:

Date: _

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4A-303. Child support obligation and order.

STATE OF NEW MEXICO

COUNTY OF SAN JUAN

ELEVENTH JUDICIAL DISTRICT COURT

Petitioner,

v. No. D-1116-DM

Respondent.

CHILD SUPPORT OBLIGATION AND ORDER

and are the parents of the children

listed below.

IDENTIFICATION AND CONTACT INFORMATION

Parent=s name Physical address and Place of employment

phone number and phone number

Child=s name Year of birth Age

[ ] The parties shall advise each other of any change to this contact information within ten

(10) days of new information becoming available.

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II.

CHILD SUPPORT

Child Support Worksheet.

A signed child support worksheet is attached to this plan.

(Complete and sign a child support worksheet prior to completing this section.)

Child support: pays $ per

month. Payments shall begin on _ (date) and shall be paid in the amount

of $ every [ ] week [ ] two weeks [ ] month. Payments shall continue

each month until the youngest child turns eighteen (18); however, if the youngest child

turns eighteen (18) while still attending high school, payments shall continue until the

month the child graduates or turns nineteen (19), whichever occurs first.

(Choose 1 or 2)

[ ] 1. This amount is the amount shown on the worksheet;

(or)

[ ] 2. This is a deviation from the amount shown on the child support worksheet

because (fill in the reason here)

Health insurance coverage

(Choose 1, 2, or 3)

[ ] 1. (name of parent) shall keep the minor children covered by health and

dental insurance under the policy of insurance available to [him] [her] from [his]

[her] employer or other group health care insurance plan.

(or)

[ ] 2. Neither parent has private health or dental insurance coverage available at a

reasonable cost. If the children are covered under Medicaid, the child support

obligor shall pay a cash medical support payment as determined at a subsequent

hearing in which the State of New Mexico, Child Support Enforcement Division

(ACSED@), has been given sufficient notice, or upon the stipulation of the parties

and with the agreement of CSED. The notification to and agreement of CSED is

required only for cash medical support.

(or)

[ ] 3. Other health insurance coverage shall be provided as follows:

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Additional healthcare expenses to be determined by percentage. The parents shall

split the cost of uncovered necessary healthcare expenses in proportion to their income on

the child support worksheet.

Wage withholding of child support. (Choose and complete 1 or 2)

[ ] 1. Withhold wages for child support. Child support payment shall be withheld

from =s paycheck.

(Choose a or b)

[ ] a. Attached is a completed Form 4A-304 NMRA Wage Withholding Order

which directs all withheld payments to the Child Support Enforcement

Division (ACSED@).

(or)

[ ] b. (name of parent) shall take a copy of this

child support obligation after

it is signed by the Court to CSED to open a case and to request that CSED

issue a notice of wage withholding on [his] [her] behalf.

(or)

[ ] 2. Other plan. Wage withholding is not appropriate at this time as the parents have

made the following alternate arrangements for the payment of support (describe

alternate payment arrangements, subject to approval by the Court):

Health and dental insurance. The parents shall do the following:

follow the insurance plan in selecting a doctor or dentist;

use doctors and dentists who are part of the insurance plan;

make sure each parent has a copy of the insurance card and policy; and

cooperate and work together to promptly submit all insurance forms.

Exchange of information. Once a year either parent can ask, in writing, for both parents

to exchange the following information (this paragraph is required by statute, Section 40-

4-11.4 NMSA 1978):

federal and state tax returns for the prior year;

W-2 statements for the prior year;

IRS form 1099s for the prior year;

work related day care statements for the prior year;

dependent medical insurance premiums for the prior year; and

wage and payroll statements for the four months prior to the request.

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Tax issues.

This is the plan about tax issues, such as the dependency exemption, that

relate to the children:

[ ] Follow IRS regulations; or

[ ] Adopt another plan as follows:

Other expenses. Each parent shall provide the children with items they need while they

are with that parent.

[ ] (If applicable) The parents shall pay for special activities as follows:

VERIFICATION

I affirm under oath and penalty of perjury under the laws of the State of New Mexico that I have

read this document, that I agree with everything in it, and that the statements in it are true and

correct to the best of my knowledge and belief.

Name of parent (print) Name of parent (print)

Parent=s signature Parent=s signature

Date Date

Mailing address Mailing address

Physical address Physical address

Telephone Telephone

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Recommended by (if one is assigned):

Hearing Officer

APPROVED, ADOPTED AND ORDERED BY THE DISTRICT COURT

Date District Court Judge

STATE OF NEW MEXICO }

COUNTY OF } ss.

Acknowledged, signed and sworn before me on (mm/dd/yyyy) by

(name of person making statement), the PARENT.

Signature of Judge, Notary or other officer

Authorized to administer oaths

Title or date commission expires

STATE OF NEW MEXICO }

COUNTY OF } ss.

Acknowledged, signed and sworn before me on (mm/dd/yyyy) by

(name of person making statement), the PARENT.

Signature of Judge, Notary or other officer

Authorized to administer oaths

Title or date commission expires

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With Children)

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USE NOTE

A child support obligation must be filed in every dissolution of marriage case if the parties have

minor children or a child under nineteen years of age who is attending high school. For more information about

filling out this form, see Form 4A-300 NMRA.

If child support is not paid in a timely manner, interest will be added to the amount owed at the

rate provided by law. See NMSA 1978 Section 40-4-7.3 for accrual of interest on delinquent child support.

See NMSA 1978 Section 40-4-11.1 for the child support worksheet. An interactive version of this

worksheet may be found at www.nmcourts.com, click on AFamily Law Forms.@ See also Form 4A-300 NMRA for a

further explanation of the child support worksheet. The child support worksheet is used to determine the monthly

child support obligation.

If child support is being paid for more than one child, the end of a child support obligation for a

child may be a change of circumstances that justifies a different child support amount. A new child support

worksheet must be completed and adopted by the court. If your child has an intellectual or physical disability, you

should consult with an attorney.

The judge may or may not accept a proposed change from the worksheet amount. Proposed

changes may be appropriate if application of the child support guidelines would be unjust or inappropriate, or create

a substantial hardship. If child support has been ordered in another proceeding, tell the court about it here and attach

that child support worksheet.

See NMSA 1978 Section 40-4C-4 for medical support orders. In some circumstances the court

may order both parties to provide employer-provided health insurance.

See Form 4A-304 NMRA for the Wage Withholding Order. Wage withholding is required unless

the parties show good cause and make alternate payment arrangements. Wage withholding is mandatory if the

children are receiving public assistance. Payments made by wage withholding go through the Title IV-D agency

(CSED) and cannot be directly sent by the employer to a party. Either party may request the court to enter a Wage

Withholding Order. See also Form 4A-300 NMRA for a further explanation of the Wage Withholding Order.

You need a court order to adjust child support payments.

Consult with a professional about tax issues that relate to any children.

[Approved by Supreme Court Order No. 13-8300-010, effective for all pleadings and papers filed on or after May 31, 2013, in all

cases pending or filed on or after May 31, 2013; as amended by Supreme Court Order No. 14-8300-011, effective for all

pleadings and papers filed on or after December 31, 2014, in all cases filed or pending on or after December 31, 2014

; as

amended by Supreme Court Order No. 15-8300-024, effective for all pleadings and papers filed after November 18, 2015.]

INCOME WITHHOLDING FOR SUPPORT

 ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO)

 AMENDED IWO

 ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT

 TERMINATION of IWO Date:

State/Tribe/Territory

City/County/Dist./Tribe

Private Individual/Entity

Remittance Identifier (include w/payment)

Order Identifier

CSE Agency Case Identifier

ORDER INFORMATION: This document is based on the support or withholding order from (State/Tribe).

You are required by law to deduct these amounts from the employee/obligor’s income until further notice.

$ Per

current child support

past-due child support - Arrears greater than 12 weeks?  Yes No

current cash medical support

past-due cash medical support

current spousal support

past-due spousal support

other (must specify) .

for a Total Amount to Withhold of $ per .

AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If

your pay cycle does not match the ordered payment cycle, withhold one of the following amounts:

$ per weekly pay period $

$ per biweekly pay period (every two weeks)$

per semimonthly pay period (twice a month)

per monthly pay period

$ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.

REMITTANCE INFORMATION: If the employee/obligor’s principal place of employment is

(State/Tribe),

you must begin withholding no later than the first pay period that occurs days after the date of . Send

payment within working days of the pay date. If you cannot withhold the full amount of support for any or all orders

for

this employee/obligor, withhold up to % of disposable income for all orders. If the employee/obligor’s principal

place of employment is not (State/Tribe), obtain withholding limitations, time requirements, and any

allowable employer fees at http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact_map.htm for the

employee/obligor’s principal place of employment.

Document Tracking Identifier OMB 0970-0154

RE: Employer/Income Withholder’s Name

Employee/Obligor’s Name (Last, First, Middle)

Employer/Income Withholder’s Address

Employee/Obligor’s Social Security Number

Custodial Party/Obligee’s Name (Last, First, Middle)

Employer/Income Withholder’s FEIN

Child(ren)’s Name(s) (Last, First, Middle)

Child(ren)’s Birth Date(s)



Child Support Enforcement (CSE) Agency



Court



Attorney



Private Individual/Entity (Check One)

NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the

sender (see IWO instructions http://www.acf.hhs.gov/programs/cse/forms/OMB-0970-0154_instructions.pdf

). If you

receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order

must be attached.

For electronic payment requirements and centralized payment collection and disbursement facility information (State

Disbursement Unit [SDU]), see http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact_map.htm.

Include the Remittance Identifier with the payment and if necessary this FIPS code: .

Remit payment to (SDU/Tribal Order Payee)

at (SDU/Tribal Payee Address)



Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in

accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed

to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender.

If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy

of this IWO must be provided to the employee/obligor.



If checked, the employer/income withholder must provide a copy of this form to the employee/obligor.

ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS

State-specific contact and withholding information can be found on the Federal Employer Services website located at:

http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact_map.htm

Priority: Withholding for support has priority over any other legal process under State law against the same income

(USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender.

Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts

from more than one employee/obligor’s income in a single payment. You must, however, separately identify each

employee/obligor’s portion of the payment.

Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a

Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the

custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this

IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or

the order was issued by a Tribal CSE agency, you must follow the “Remit payment to” instructions on this form.

Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the

amount was withheld from the employee/obligor’s wages. You must comply with the law of the State (or Tribal law if

applicable) of the employee/obligor’s principal place of employment regarding time periods within which you must

implement the withholding and forward the support payments.

Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs

due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority

to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the

employee/obligor’s principal place of employment to determine the appropriate allocation method.

Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to

this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are

required to report and/or withhold lump sum payments.

Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the

employee/obligor’s income as the IWO directs, you are liable for both the accumulated amount you should have withheld

and any penalties set by State or Tribal law/procedure.

Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor

from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO.

OMB Expiration Date – 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the

version of the form currently in use.

Signature of Judge/Issuing Official (if required by State or Tribal law):

Print Name of Judge/Issuing Official:

Title of Judge/Issuing Official:

Date of Signature:

Employer’s Name: Employer FEIN:

Employee/Obligor’s Name:

CSE Agency Case Identifier: Order Identifier:

Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer

Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the

employee/obligor’s principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net

income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory

pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting

another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits

increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may

deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this

section.

For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal

employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the

law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section

303(d) of the CCPA (15 U.S.C. 1673 (b)).

Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums

in determining disposable income and applying appropriate withholding limits.

Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks,

then the Employer should calculate the CCPA limit using the lower percentage.

Additional Information:

CONTACT INFORMATION:

To Employer/Income Withholder: If you have any questions, contact (Issuer name)

by phone at , by fax at , by email or website at: .

Send termination/income status notice and other correspondence to:

(Issuer address).

To Employee/Obligor: If the employee/obligor has questions, contact (Issuer name)

by phone at , by fax at , by email or website at .

IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor.

NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for

you or you are no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency

and/or the sender by returning this form to the address listed in the Contact Information below:

 This person has never worked for this employer nor received periodic income.

 This person no longer works for this employer nor receives periodic income.

Please provide the following information for the employee/obligor:

Termination date: Last known phone number:

Last known address:

Final payment date to SDU/ Tribal Payee: Final payment amount:

New employer’s name:

New employer’s address:

INCOME WITHHOLDING FOR SUPPORT (OMB 0970-0154) – Instructions

Page 1 of 6

INCOME WITHHOLDING FOR SUPPORT - Instructions

The Income Withholding for Support (IWO) is the OMB-approved form used for income withholding in

Tribal, intrastate, and interstate cases as well as all child support orders which are initially issued in the

State on or after January 1, 1994, and all child support orders which are initially issued (or modified) in

the State before January 1, 1994 if arrearages occur. This form is the standard format prescribed by the

Secretary in accordance with USC 42 §666(b)(6)(A)(ii). Except as noted, the following information must

be included.

Please note:



For the purpose of this IWO form and these instructions, “State” is defined as a State or Territory.

COMPLETED BY SENDER:

1a. Original Income Withholding Order/Notice for Support (IWO). Check the box if this is an

original IWO.

1b. Amended IWO. Check the box to indicate that this form amends a previous IWO. Any changes

to an IWO must be done through an amended IWO.

1c. One-Time Order/Notice For Lump Sum Payment. Check the box when this IWO is to attach a

one-time collection of a lump sum payment. When this box is checked, enter the amount in field

14, Lump Sum Payment, in the Amounts to Withhold section. Additional IWOs must be issued to

collect subsequent lump sum payments.

1d. Termination of IWO. Check the box to stop income withholding on an IWO. Complete all

applicable identifying information to aid the employer/income withholder in terminating the correct

IWO.

1e. Date. Date this form is completed and/or signed.

1f. Child Support Enforcement (CSE) Agency, Court, Attorney, Private Individual/Entity

(Check One). Check the appropriate box to indicate which entity is sending the IWO. If this IWO

is not completed by a State or Tribal CSE agency, the sender should contact the CSE agency

(see http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact_map.htm

) to

determine if the CSE agency needs a copy of this form to facilitate payment processing.

NOTE TO EMPLOYER/INCOME WITHHOLDER:

This IWO must be regular on its face. Under the following circumstances, the IWO must be rejected and

returned to sender:

•

IWO instructs the employer/income withholder to send a payment to an entity other than a State

Disbursement Unit (e.g., payable to the custodial party, court, or attorney). Each State is required

to operate a State Disbursement Unit (SDU), which is a centralized facility for collection and

disbursement of child support payments. Exception: If this IWO is issued by a Court, Attorney, or

Private Individual/Entity and the initial child support order was entered before January 1, 1994 or

the order was issued by a Tribal CSE agency, the employer/income withholder must follow the

payment instructions on the form.

•

Form does not contain all information necessary for the employer to comply with the withholding.

•

Form is altered or contains invalid information.

•

Amount to withhold is not a dollar amount.

•

Sender has not used the OMB-approved form for the IWO (effective May 31, 2012).

•

A copy of the underlying order is required and not included.

If you receive this document from an Attorney or Private Individual/Entity, a copy of the underlying order

containing a provision authorizing income withholding must be attached.

INCOME WITHHOLDING FOR SUPPORT (OMB 0970-0154) – Instructions

Page 2 of 6

COMPLETED BY SENDER:

1g. State/Tribe/Territory. Name of State or Tribe sending this form. This must be a governmental

entity of the State or a Tribal organization authorized by a Tribal government to operate a CSE

program. If you are a Tribe submitting this form on behalf of another Tribe, complete line 1i.

1h. Remittance Identifier (include w/payment). Identifier that employers must include when

sending payments for this IWO. The remittance identifier is entered as the case identifier on the

Electronic Funds Transfer/Electronic Data Interchange (EFT/EDI) record.

NOTE TO EMPLOYER/INCOME WITHHOLDER:

The employer/income withholder must use the Remittance Identifier when remitting payments so the SDU

or Tribe can identify and apply the payment correctly. The remittance identifier is entered as the case

identifier on the EFT/EDI record.

COMPLETED BY SENDER:

1i. City/County/Dist./Tribe. Name of the city, county or district sending this form. This must be a

governmental entity of the State or the name of the Tribe authorized by a Tribal government to

operate a CSE program for which this form is being sent. (A Tribe should leave this field blank

unless submitting this form on behalf of another Tribe.)

1j. Order Identifier. Unique identifier that is associated with a specific child support obligation. It

could be a court case number, docket number, or other identifier designated by the sender.

1k. Private Individual/Entity. Name of the private individual/entity or non-IV-D Tribal CSE

organization sending this form.

1l. CSE Agency Case Identifier. Unique identifier assigned to a State or Tribal CSE case. In a

State CSE case, this is the identifier that is reported to the Federal Case Registry (FCR). For

Tribes this would be either the FCR identifier or other applicable identifier.

Fields 2 and 3 refer to the employee/obligor’s employer/income withholder and specific case information.

2a. Employer/Income Withholder's Name. Name of employer or income withholder.

2b. Employer/Income Withholder's Address. Employer/income withholder's mailing address

including street/PO box, city, state and zip code. (This may differ from the employee/obligor’s

work site.) If the employer/income withholder is a federal government agency, the IWO should be

sent to the address listed under Federal Agencies – Addresses for Income Withholding Purposes

at http://www.acf.hhs.gov/programs/cse/newhire/contacts/iw_fedcontacts.htm

2c. Employer/Income Withholder's FEIN. Employer/income withholder's nine-digit Federal

Employer Identification Number (FEIN) (if available).

3a. Employee/Obligor’s Name. Employee/obligor’s last name, first name, middle name.

3b. Employee/Obligor’s Social Security Number. Employee/obligor’s Social Security number or

other taxpayer identification number.

3c. Custodial Party/Obligee’s Name. Custodial party/obligee’s last name, first name, middle name.

3d. Child(ren)’s Name(s). Child(ren)’s last name(s), first name(s), middle name(s). (Note: If there

are more than six children for this IWO, list additional children’s names and birth dates in field 33

- Additional Information).

INCOME WITHHOLDING FOR SUPPORT (OMB 0970-0154) – Instructions

Page 3 of 6

3e. Child(ren)’s Birth Date(s). Date of birth for each child named.

3f. Blank box. Space for court stamps, bar codes, or other information.

ORDER INFORMATION - Fields 5 through 12 identify the dollar amount to withhold for a specific kind of

support (taken directly from the support order) for a specific time period.

NOTE TO EMPLOYER/INCOME WITHHOLDER:

Payments are forwarded to the SDU within each State, unless the order was issued by a Tribal CSE

agency. If the order was issued by a Tribal CSE agency, the employer/income withholder must follow the

remittance instructions on the form.

COMPLETED BY SENDER:

4. State/Tribe. Name of the State or Tribe that issued the order.

5a-b. Current Child Support. Dollar amount to be withheld per the time period (e.g., week, month)

specified in the underlying order.

6a-b. Past-due Child Support. Dollar amount to be withheld per the time period (e.g., week, month)

specified in the underlying order.

6c. Arrears Greater Than 12 Weeks? The appropriate box (Yes/No) must be checked indicating

whether arrears are greater than 12 weeks so the employer/income withholder can determine the

withholding limit.

7a-b. Current Cash Medical Support. Dollar amount to be withheld per the time period (e.g., week,

month) specified in the underlying order.

8a-b. Past-due Cash Medical Support. Dollar amount to be withheld per the time period (e.g., week,

month) specified in the underlying order.

9a-b. Current Spousal Support. (Alimony) dollar amount to be withheld per the time period (e.g.,

week, month) specified in the underlying order.

10a-b. Past-due Spousal Support. (Alimony) dollar amount to be withheld per the time period (e.g.,

week, month) specified in the underlying order.

11a-c. Other. Miscellaneous obligations dollar amount to be withheld per the time period (e.g., week,

month) specified in the underlying order. Must specify. Description of the obligation.

12a-b. Total Amount to Withhold. The total amount of the deductions per the corresponding time

period. Fields 5a, 6a, 7a, 8a, 9a, 10a, and 11a should total the amount in 12a.

AMOUNTS TO WITHHOLD - Fields 13a through 13d specify the dollar amount to be withheld for this

IWO if the employer/income withholder’s pay cycle does not correspond with field 12b.

13a. Per Weekly Pay Period. Total amount an employer/income withholder should withhold if the

employee/obligor is paid weekly.

13b. Per Semimonthly Pay Period. Total amount an employer/income withholder should withhold if

the employee/obligor is paid twice a month.

INCOME WITHHOLDING FOR SUPPORT (OMB 0970-0154) – Instructions

Page 4 of 6

13c. Per Biweekly Pay Period. Total amount an employer/income withholder should withhold if the

employee/obligor is paid every two weeks.

13d. Per Monthly Pay Period. Total amount an employer/income withholder should withhold if the

employee/obligor is paid once a month.

14.

Lump Sum Payment. Dollar amount to be withheld when the IWO is used to attach a lump sum

payment. This field should be used when field 1c is checked.

REMITTANCE INFORMATION

15.

State/Tribe. Name of the State or Tribe sending this document.

16.

Days. Number of days after the effective date noted in field 17 in which withholding must begin

according to the State or Tribal laws/procedures for the employee/obligor’s principal place of

employment.

17.

Date. Effective date of this IWO.

18.

Working Days. Number of working days within which an employer/income withholder must remit

amounts withheld pursuant to the State or Tribal laws/procedures of the principal place of

employment.

19.

% of Disposable Income. The percentage of disposable income that may be withheld from the

employee/obligor’s paycheck.

NOTE TO EMPLOYER/INCOME WITHHOLDER:

For State orders, the employer/income withholder may not withhold more than the lesser of: 1) the

amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. § 1673(b)); or 2) the amounts

allowed by the State of the employee/obligor’s principal place of employment.

For Tribal orders, the employer/income withholder may not withhold more than the amounts allowed

under the law of the issuing Tribe. For Tribal employer/income withholders who receive a State order, the

employer/income withholder may not withhold more than the limit set by the law of the jurisdiction in which

the employer/income withholder is located or the maximum amount permitted under section 303(d) of the

Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)).

A federal government agency may withhold from a variety of incomes and forms of payment, including

voluntary separation incentive payments (buy-out payments), incentive pay, and cash awards. For a

more complete list, see 5 Code of Federal Regulations (CFR) 581.103.

COMPLETED BY SENDER:

20.

State/Tribe. Name of the State or Tribe sending this document.

21.

Document Tracking Identifier. Optional unique identifier for this form assigned by the sender.

22.

FIPS Code. Federal Information Processing Standards (FIPS) code.

23.

SDU/Tribal Order Payee. Name of SDU (or payee specified in the underlying Tribal support

order) to which payments are required to be sent. Federal law requires payments made by IWO

to be sent to the SDU except for payments in which the initial child support order was entered

before January 1, 1994 or payments in Tribal CSE orders.

INCOME WITHHOLDING FOR SUPPORT (OMB 0970-0154) – Instructions

Page 5 of 6

24.

SDU/Tribal Payee Address. Address of the SDU (or payee specified in the underlying Tribal

support order) to which payments are required to be sent. Federal law requires payments made

by IWO to be sent to the SDU except for payments in which the initial child support order was

entered before January 1, 1994 or payments in Tribal CSE orders.

COMPLETED BY EMPLOYER/INCOME WITHHOLDER:

25.

Return to Sender Checkbox. The employer/income withholder should check this box and return

the IWO to the sender if this IWO is not payable to an SDU or Tribal Payee or this IWO is not

regular on its face. Federal law requires payments made by IWO to be sent to the SDU except for

payments in which the initial child support order was entered before January 1, 1994 or payments

in Tribal CSE orders.

COMPLETED BY SENDER:

26.

Signature of Judge/Issuing Official. Signature (if required by State or Tribal law) of the official

authorizing this IWO.

27.

Print Name of Judge/Issuing Official. Name of the official authorizing this IWO.

28.

Title of Judge/Issuing Official. Title of the official authorizing this IWO.

29.

Date of Signature. Optional date the judge/issuing official signs this IWO.

30.

Copy of IWO checkbox. If checked, the employer/income withholder is required to provide a

copy of the IWO to the employee/obligor.

ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS

The following fields refer to Federal, State, or Tribal laws that apply to issuing an IWO to an

employer/income withholder. State- or Tribal-specific information may be included only in the fields

below.

COMPLETED BY SENDER:

31.

Liability. Additional information on the penalty and/or citation of the penalty for an

employer/income withholder who fails to comply with the IWO. The State or Tribal

law/procedures of the employee/obligor’s principal place of employment govern the penalty.

32.

Anti-discrimination. Additional information on the penalty and/or citation of the penalty for an

employer/income withholder who discharges, refuses to employ, or disciplines an

employee/obligor as a result of the IWO. The State or Tribal law/procedures of the

employee/obligor’s principal place of employment govern the penalty.

33.

Additional Information. Any additional information, e.g., fees the employer/income withholder

may charge the obligor for income withholding or children’s names and DOBs if there are more

than six children on this IWO. Additional information must be consistent with the requirements of

the form and the instructions.

COMPLETED BY EMPLOYER/INCOME WITHHOLDER:

NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS

The employer must complete this section when the employee/obligor’s employment is terminated, income

withholding ceases, or if the employee/obligor has never worked for the employer.

INCOME WITHHOLDING FOR SUPPORT (OMB 0970-0154) – Instructions

Page 6 of 6

Please Note: Employer’s Name, FEIN, Employee/Obligor’s Name, CSE Agency Case Identifier, and

Order Identifier must appear in the header on the page with the Notification of Employment Termination

or Income Status.

34a-b. Employment/Income Status Checkbox. Check the employment/income status of the

employee/obligor.

35.

Termination Date. If applicable, date employee/obligor was terminated.

36.

Last Known Phone Number. Last known (home/cell/other) phone number of the

employee/obligor.

37.

Last Known Address. Last known home/mailing address of the employee/obligor.

38.

Final Payment Date. Date employer sent final payment to SDU/Tribal payee.

39.

Final Payment Amount. Amount of final payment sent to SDU/Tribal payee.

40.

New Employer’s Name. Name of employee’s/obligor’s new employer (if known).

41.

New Employer’s Address. Address of employee’s/obligor’s new employer (if known).

COMPLETED BY SENDER:

CONTACT INFORMATION

42.

Issuer Name (Employer/Income Withholder Contact). Name of the contact person that the

employer/income withholder can call for information regarding this IWO.

43.

Issuer Phone Number. Phone number of the contact person.

44.

Issuer Fax Number. Fax number of the contact person.

45.

Issuer Email/Website. Email or website of the contact person.

46.

Termination/Income Status and Correspondence Address. Address to which the employer

should return the Employment Termination or Income Status notice. It is also the address that

the employer should use to correspond with the issuing entity.

47.

Issuer Name (Employee/Obligor Contact). Name of the contact person that the

employee/obligor can call for information.

48.

Issuer Phone Number. Phone number of the contact person.

49.

Issuer Fax Number. Fax number of the contact person.

50.

Issuer Email/Website. Email or website of the contact person.

The Paperwork Reduction Act of 1995

This information collection and associated responses are conducted in accordance with 45 CFR 303.100

of the Child Support Enforcement Program. This form is designed to provide uniformity and

standardization. Public reporting for this collection of information is estimated to average two to five

minutes per response. An agency may not conduct or sponsor, and a person is not required to respond

to, a collection of information unless it displays a currently valid OMB control number.

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

4A-304. Wage Withholding Order (domestic relations actions) (rev. 01/2015)

Page 1 of

4A-304. Wage withholding order (domestic relations actions).

STATE OF NEW MEXICO

COUNTY OF SAN JUAN

ELEVENTH JUDICIAL DISTRICT COURT

Petitioner

No. D-1116-DM

Respondent.

WAGE WITHHOLDING ORDER

(domestic relations actions)

This matter, having come before the Court for entry of a wage withholding order and the

parties having submitted a completed Income Withholding for Support Form,

the Court

ORDERS:

The provisions of the Income Withholding for Support Form, attached as Exhibit

A and signed by the Court, are incorporated by reference and adopted in full.

Wage withholding shall be implemented as stated in Exhibit A.

Exhibit A, which includes personal identifier information that is necessary to

include in the record, shall be protected in accordance with Rule 1-079 NMRA if requested to be

sealed by the parties.

Recommended by (if one is assigned):

HEARING OFFICER/SPECIAL COMMISSIONER

REVIEWED, APPROVED, AND ADOPTED AS AN ORDER OF THE COURT.

DISTRICT COURT JUDGE

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

4A-304. Wage Withholding Order (domestic relations actions) (rev. 01/2015)

Page 2 of

APPROVED:

Mother=s signature:

Mailing address:

Telephone:

Father=s signature:

Mailing address:

Telephone:

USE NOTE

See Form 4A-300 NMRA for an explanation of the Wage Withholding Order.

A completed Income Withholding for Support Form (OMB 0970-0154) is required in all cases

where a Wage Withholding Order is issued by the Court. A copy of the form is available at

http://www.acf.hhs.gov/sites/default/files/ocse/omb_0970_0154.pdf. Instructions for filling out the form are

available at http://www.acf.hhs.gov/sites/default/files/ocse/omb_0970_0154_ instructions.pdf. The form and

instructions also may be obtained from the New Mexico Human Services Department, Child Support Enforcement

Division.

[Approved by Supreme Court Order No. 13-8300-010, effective for all pleadings and papers filed on or after May

31, 2013, in all cases pending or filed on or after May 31, 2013.]

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

4A-306. Final Decree of Dissolution of Marriage (with children) (rev. 01/2015, 12/2016, 07/2019)

Page 1 of

4A-306. Final decree of dissolution of marriage (with children).

STATE OF NEW MEXICO

COUNTY OF SAN JUAN

ELEVENTH JUDICIAL DISTRICT COURT

Petitioner,

No. D-1116-DM

Respondent.

FINAL DECREE OF DISSOLUTION OF MARRIAGE

(with children)

This matter was brought before the Court to enter a Final Decree of Dissolution of Marriage by

Petitioner and Respondent (“the parties”).

The following documents are referenced in this decree:

[ ] A Marital Settlement Agreement signed and filed by the parties, that settles the

claims related to their marital relationship;

[ ] A Custody Plan and Order signed and submitted by the parties, that sets out the

custody of their children;

[ ] A Child Support Obligation and Order, including a child support worksheet

signed and submitted by the parties, that sets out the child support for their

children.

The Court, having considered the evidence FINDS AND CONCLUDES:

The Court has jurisdiction over the subject matter of this action and over the

parties and the children.

The parties were married on (date of marriage).

The parties are incompatible.

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

4A-306. Final Decree of Dissolution of Marriage (with children) (rev. 01/2015, 12/2016, 07/2019)

Page 2 of

The Marital Settlement Agreement is fair and reasonable and should be adopted

by the Court.

The Custody Plan and Order is fair and reasonable and should be adopted by the

Court.

The Child Support Obligation and Order is fair and reasonable and should be

adopted by the Court.

IT IS THEREFORE ORDERED, ADJUDGED, AND DECREED:

The marriage of Petitioner and Respondent is dissolved on the grounds of

incompatibility.

The parties are ordered to comply with the terms of the Marital Settlement

Agreement, which has been filed with the Court and is incorporated here by

reference.

The parties are ordered to comply with the terms of the Custody Plan and Order,

which has been adopted by the Court and is incorporated here by reference.

The parties are ordered to comply with the terms of the Child Support Obligation

and Order, which has been adopted by the Court and is incorporated here by

reference.

[ ] Petitioner (or) [ ] Respondent is ordered to pay child support in the amount of

$ per month to the other parent.

Legal custody of the children is as follows (select one):

[ ] The parties have joint legal custody of the children.

(Or)

[ ] [ ] Petitioner (or) [ ] Respondent has sole legal custody of the children.

The Court has continuing jurisdiction over issues relating to the children of the

marriage until the children reach the age of majority as provided by law.

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

4A-306. Final Decree of Dissolution of Marriage (with children) (rev. 01/2015, 12/2016, 07/2019)

Page 3 of

(Select and complete the following paragraphs if applicable)

[ ] 8. The Court retains jurisdiction to enter QDROs or other orders dividing the

retirement plans referenced in the Marital Settlement Agreement.

[ ] 9. Judgment in favor of [ ] Petitioner (or) [ ] Respondent is awarded in the amount of

$ , as set forth in Section III of the Marital Settlement

Agreement (Cash Payment). The statutory interest rate shall apply as provided in

Section 56-8-4(A) NMSA 1978.

[ ] 10. Petitioner’s name is restored to the former name of:

(insert full legal name):

[ ] 11. Respondent’s name is restored to the former name of:

(insert full legal name):

SO ORDERED:

District Court Judge

By signing below I affirm under penalty of perjury under the laws of the State of New

Mexico that everything in this document is true and correct to the best of my knowledge,

information and belief, including the following:

Right to trial is waived. I understand that by signing the Final Decree, I am

waiving my right to a trial before a Judge.

No duress or coercion; complete agreement. I am not under force, threats,

duress, coercion or undue influence from anyone, including the other party, to sign this Final

Decree. This Decree and any attachments that I have signed is our full agreement. I have not

agreed to something different from what is stated in writing in this Decree.

Legal advice. I understand that even if I am representing myself without an

attorney, I have the right to be represented by an attorney. I have the right to call an attorney and

get legal advice before I sign this Final Decree.

Eleventh Judicial District Court, San Juan County

Packet D (Uncontested Divorce - With Children)

4A-306. Final Decree of Dissolution of Marriage (with children) (rev. 01/2015, 12/2016, 07/2019)

Page 4 of

Petitioner’s signature Respondent’s signature

Date: Date:

Mailing address: Mailing address:

Telephone: Telephone:

USE NOTE

1. This form may be used anywhere in this state by the court to enter a final decree of dissolution of

marriage when the parties have minor children or a child under nineteen years of age who is attending high school.

[Approved by Supreme Court Order No. 14-8300-011, effective for all pleadings and papers filed on or after December 31, 2014,

in all cases filed or pending on or after December 31, 2014; as amended by Supreme Court Order No. 16-8300-020, effective for

all pleadings and papers filed on or after December 31, 2016; as amended by Supreme Court Order No. 19-8300-006, effective

for all pleadings and papers filed on or after July 1, 2019.]

STOP!!!

LOOK AT YOUR DOCUMENTS BEFORE YOU

SUBMIT TO THE CLERK’S OFFICE TO MAKE SURE

Once you have reviewed for the following, please check below

 DID BOTH PEOPLE SIGN ALL DOCUMENTS?

 DID BOTH PEOPLE GET SIGNATURES NOTARIZED WHERE NEEDED?

 DID BOTH PEOPLE DATE THEIR SIGNATURES?

 IF YOU ARE FILING A DIVORCE, DID YOU SUBMIT A SETTLEMENT

AGREEMENT WITH NOTARIZED SIGNATURES OF BOTH PEOPLE?

IF YOU HAVE MINOR CHILDREN WITH OTHER PARTY, DID YOU SUBMIT A

 CHILD SUPPORT OBLIGATION AND ORDER, WITH AN ATTACHED CHILD

SUPPORT WORKSHEET? (EVEN IF YOU AGREE TO A LESSER AMOUNT OR

$0.00) IF YOU BOTH AGREE TO A DIFFERENT AMOUNT THAN WHAT IS IN

THE CHILD SUPPORT WORKSHEET, DID YOU GIVE THE JUDGE A REASON

WHY YOU AGREED TO DIFFERENT AMOUNT?

 CUSTODY PLAN AND ORDER?

IF YOU ANSWERED NO TO ANY OF THESE QUESTIONS, YOU DO NOT HAVE

AN AGREEMENT. YOU MUST HAVE AN APPROPRIATE PERSON SERVE THE

OTHER PARTY WITH A SUMMONS AND A COPY OF THE PETITION AND

FILE A CERTIFICATE OF SERVICE PURSUANT TO NMRA 1-004. IF YOU

FAIL TO FILE A CERTIFICATE OF SERVICE, YOUR CASE WILL NOT

PROCEED AND YOUR CASE MAY BE DISMISSED.

A SAMPLE CERTIFICATE OF SERVICE AND MOST FORMS CAN BE FOUND

AT https://www.nmcourts.gov/self-help/forms/.

ONCE YOU HAVE DOUBLE CHECKED THE ABOVE PLEASE

FEEL FREE TO FILE WITH THE CLERKS