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Fillable Printable Stipulated Permanent Parenting Plan - Montana

Fillable Printable Stipulated Permanent Parenting Plan - Montana

Stipulated Permanent Parenting Plan - Montana

Stipulated Permanent Parenting Plan - Montana

FORM #232– STIPULATED PERMANENT PARENTING PLAN Page 1 of 16
4th Judicial District Forms - Pro se Petition for Parenting Plan (Revision Date: 3/10)
_______________________________
FORM #232
Name
_____________________________________
Address
Exhibit A
_____________________________________
City State Zip Code
_____________________________________
Phone Number
_____________________________________
Email Address
CO-PETITIONER, MOTHER
_______________________________
Name
_____________________________________
Address
_____________________________________
City State Zip Code
_____________________________________
Phone Number
_____________________________________
Email Address
CO-PETITIONER, FATHER
MONTANA FOURTH JUDICIAL DISTRICT COURT
MISSOULA COUNTY
In re the Parenting of:
____________________________________,
Initials of Minor Child(ren),
___________________________________,
Co-Petitioner,
and
___________________________________,
Co-Petitioner.
Cause No.: _________________
Department No.: ____________
STIPULATED PERMANENT
PARENTING PLAN
1. Identification of the Parties
a. Petitioner-(Mother) Name: ____________________________________________
Address: __________________________________________________________
b. Petitioner-(Father) Name: ____________________________________________
Address: __________________________________________________________
2. Identification of the Child(ren)
FORM #232- STIPULATED PARENT ING PLAN Page 2 of 16
4th Judicial District Forms - Pro se Petition for Parenting Plan (Revision Date: 3/10)
This parenting plan applies to the following minor child(ren) of the parties:
Name (first and last) Age State of residence for
Last 6 months
3. Objectives of the Parenting Plan
a. To protect the best interest(s) of the minor child(ren);
b. To provide for the physical care of the minor child(ren);
c. To maintain the child(ren)’s emotional stability and minimize the child(ren)’s
exposure to parental conflict;
d. To provide for the minor child(ren)’s changing needs as they grow and mature;
e. To set forth the authority and responsibilities of each parent with respect to the
minor child(ren);
f. To help the parents avoid expensive future court battles over the minor child(ren).
4. Residential Schedule for the Child(ren) The provisions set forth below in Paragraphs
4(a)-(i) are one way to write your residential schedule. This schedule is designed to
provide for the child(ren)’s changing needs as they grow and mature. It specifies the
periods of time during which the child(ren) will reside with each parent, including
holidays, vacations, and other special occasions. If you choose not to use the provisions
provided, you may write your own schedule in Paragraph 4(j) below.
a. Pre-School Schedule (Choose One):
[ ] There are no child(ren) under school age.
[ ] There are child(ren) under school age, but the school schedule set forth in
4(b) below shall apply to the child(ren) regardless of their age(s).
[ ] Prior to enrollment in school, the child(ren) shall reside primarily with the
[ ] Mother [ ] Father, except for the following days and times when the
other parent shall have parenting time with the child(ren):
________________________
____________________________________________________________
______
______________________________________________________
____________
Or
FORM #232– STIPULATED PERMANENT PARENTING PLAN Page 3 of 16
4th Judicial District Forms - Pro se Petition for Parenting Plan (Revision Date: 3/10)
[ ] Describe the residential schedule for the minor child(ren) prior to their enrollment
in school: __________________________________________________________
____________ .
b. School Schedule (Choose One):
[ ] Upon enrollment in school, the child(ren) shall reside with the
[ ] Mother [ ] Father, except for the following days and times when the other
parent shall have parenting time with the child(ren): _______________________
____________
.
or
[ ] Describe the residential schedule for the minor child(ren):
_____________
_
___________________________________________________________________
___________________________________________________________________
c. Holiday and Special Occasion Schedule
[ ] No holiday and special occasion schedule shall apply. The school year or pre-
school schedule set forth above shall apply.
or
[ ] The following schedule shall apply for the holidays and special occasions listed
below:
Following is the customary visitation schedule when children are over 5 years old and parents
reside less than 200 miles apart. Parents may consult Local Rule 12(f) for further guidance.
(http://www.montanacourts.org/dcourt/rules/local/4th.pdf)
(Specify Odd or Even)
HOLIDAY
MOTHER FATHER
Thanksgiving
(Wed. 5:30 p.m. – Sun. 7:00 p.m.)
Christmas Eve
(Chr. Eve Noon -- Chr. Day Noon)
Christmas Day
(Noon to 9:00 p.m .)
New Years
(NY Eve Noon -- NY Day Noon)
Easter Weekend
(Fri. 5:30 p.m. – Sun. 7:00 p.m.)
Memorial Day Weekend
(Fri. 5:30 p.m. – Mon. 7:00 p.m.)
Labor Day Weekend
(Fri. 5:30 p.m. – Mon. 7:00 p.m.)
Fourth of July
Halloween
FORM #232– STIPULATED PERMANENT PARENTING PLAN Page 4 of 16
4th Judicial District Forms - Pro se Petition for Parenting Plan (Revision Date: 3/10)
HOLIDAY
MOTHER FATHER
Mother’s Day Weekend
(Fri. 5:30 p.m. – Sun. 7:00 p.m.)
Father’s Day Weekend
(Fri. 5:30 p.m. – Sun. 7:00 p.m.)
Child(ren)’s Birthday
Mother’s Birthday
Father’s Birthday
The child(ren)’s school attendance shall take priority over the holiday and special day
schedule. The child(ren) shall not miss school because of the holiday or special occasion
schedule.
d. Winter Vacation (Choose One):
[ ] No winter vacation schedule shall apply. The school year or pre-school schedule
set forth above shall apply.
or
[ ] (i) The parent exercising parenting time with the child(ren) on Christmas Eve
(as outlined above) shall have the following additional parenting time with
the child(ren) over winter vacation:
_____________________________________________________________
____________________________________________________________.
(ii) The parent exercising parenting time with the child(ren) on Christmas Day
(as outlined above) shall have the following additional parenting time with
the child(ren) over winter vacation:
_____________________________________________________________
____________________________________________________________.
or
[ ] Describe the residential schedule fo r the child(ren)’s winter vacation:
___________________________________________________________
___________________________________________________________
__________________________________________________________________
__________________________________________________________________.
e. Summer Vacation (Choose One):
[ ] No summer vacation schedule shall apply. The school year or pre-school schedule
set forth above shall apply.
or
[ ] The child(ren) shall reside with the [ ] Mother [ ] Father during summer
vacations, except for the following days and times when the child(ren)
shall be with the other parent: __________________________________________
__________________________________________________________________.
or
[ ] Describe the residential schedule for the child(ren)’s summer vacation:
___________________________________________________________________
FORM #232– STIPULATED PERMANENT PARENTING PLAN Page 5 of 16
4th Judicial District Forms - Pro se Petition for Parenting Plan (Revision Date: 3/10)
___________________________________________________________________
___________________________________________________________________
f. Spring Break (Choose One):
[ ] No Spring Break schedule shall apply. The school year or pre-school schedule set
forth above shall apply.
or
[ ] The child(ren) shall reside with the [ ] Mother [ ] Father during Spring
Break, except for the following days and times when the ch ild(ren) shall
be with the other parent: ______________________________________
__________________________________________________________.
or
[ ] Describe the residential schedule for the child(ren)’s Spring Break:
___________________________________________________________
___________________________________________________________
___________________________________________________________.
g. Other Vacations with Parents
Describe the schedules for any other vacations with the parents:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
h. Priorities under the Residential Schedule
If the residential schedule outlined above results in a conflict where the child(ren) are
scheduled to be with both parents at the same time, the conflict shall be resolved by
priority being given as follows:
[ ] Rank the order of priority, with 1 being the highest priority
____ Preschool and School Schedule
Holidays/Special Occasions
Winter/Summer/Spring Break Vacations
Other Vacations with Parents
or
[ ] Other:
___________________________________________________________
_ .
i. Supervised and Limited Visitation (Choose One):
[ ] The residential schedule listed above is not subject to any additional restrictions or
limitations on parenting time.
or
[ ] (i) The [ ] Mother’s [ ] Father’s parenting time shall be supervised or
limited because he/she has exhibited the following behavior which is not in
the best interest(s) of the minor child(ren):
______________________________________________________
______________________________________________________
FORM #232– STIPULATED PERMANENT PARENTING PLAN Page 6 of 16
4th Judicial District Forms - Pro se Petition for Parenting Plan (Revision Date: 3/10)
_____________________________________________________.
(ii) It is in th e best interest(s) of the minor child(ren) that the
[ ] Mother’s [ ] Father’s parenting time be subject to the following
conditions:
How Often/ For How Long: _______________________________
Where: .
Supervised by Whom: .
(iii) The supervised and limited visitation conditions shall take priority over any
other terms of the residential schedule above.
(iv) If the [ ] Mother [ ] Father has completed the following and has followed
through with any and all recommendations by the evaluator, treatment
counselor, and/or other professional recommendations, the [ ] Mother [ ]
Father agrees to consider a modification to allow less restricted visitation
after ______ months of supervised and limited visitation. (Check All That
Apply):
[ ] Alcohol / drug evaluation
[ ] Substance abuse treatment
[ ] Psychological evaluation
[ ] Anger management counseling
[ ] Parenting classes
[ ] Other: .
[ ] Other: .
j. Other: ___________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________.
5. Designation of Primary Parent
For the purpose of all other state and federal statutes which require a designation or determination
of parenting, the [ ] Mother [ ] Father shall be designated the primary parent. However, this
designation shall not affect either parent’s rights and responsibilities under this parenting plan.
6. Transportation Arrangements (Choose All That Apply):
[ ] Transportation arrangements for the child(ren) b etween parents shall be as follows:
_______________________________________________________________
_______________________________________________________________
[ ] Unless both parents agree upon a different meeting place, the exchange of the child(ren)
shall be at: .
[ ] Transportation costs shall be distributed as follows:
.
FORM #232– STIPULATED PERMANENT PARENTING PLAN Page 7 of 16
4th Judicial District Forms - Pro se Petition for Parenting Plan (Revision Date: 3/10)
[ ] If the [ ] Mother [ ] Father is more than ____ minutes late to pick the child(ren) up for a
visit, that visit shall be canceled.
7. Telephone Contact (Choose One):
[ ] While the child(ren) reside with one parent, the other parent shall be permitted to speak
with the child(ren) at reasonable times.
or
[ ] While the child(ren) reside with one parent, the other parent shall be permitted to
speak with the child(ren) at the following times only: ______________________
_________________________________________________________________.
8. Co-Parenting Guidelines (Choose All That Apply):
[ ] Each parent shall promote a healthy, beneficial relationship between the child(ren) and the
other parent and shall not demean or speak out negatively in any manner that would
damage the relationship between either parent and the child(ren).
[ ] Each parent shall notify the other parent at least days in advance when a
particular parenting time shall not be exercised. The missed time shall not be substituted
unless mutually agreed to by both parents. The parents are expected to fairly modify
visitation when family necessities, illnesses, or other commitments reasonably so require.
The requesting parent shall act in good faith and give as much notice as circumstances
permit.
[ ] Each parent shall supply the appropriate child(ren)’s cloth i ng with them for their sched u led
time with the other parent. These clothes are to be considered the child(ren)’s clothes and
shall be returned with the child(ren).
[ ] Each parent shall provide separate clothes for the child(ren) at their own residence, unless
mutually agreed to by both parents. In the cold months of the year, both parents are
required to have adequate boots, gloves, hats, and jackets for the child(ren), unless
mutually agreed to by both parents.
[ ] If a parent plans a special activity that requires clothing and/or equipment that would
normally not be with the child(ren), it is that parent’s responsibility to check to see if the
child(ren) have such clothing and/or equipment with the other parent, to ask that the
clothing and/or equipment travels with the child(ren), and to ensure that the clothing and/or
equipment returns the same with the child(ren).
[ ] Each parent shall be responsible for ensuring that the child(ren) attend regularly scheduled
activities, including but not limited to sports and extra-curricular activities, while the
child(ren) are with that parent.
[ ] Neither parent shall permit the child(ren) to be subjected to:
(Choose All That Apply):
[ ] Persons abusing alcohol or using illegal drugs within 24 hours of contact with the
child(ren). This includes the abuse of alcohol or the use of illegal drugs by the
FORM #232– STIPULATED PERMANENT PARENTING PLAN Page 8 of 16
4th Judicial District Forms - Pro se Petition for Parenting Plan (Revision Date: 3/10)
parent.
[ ] Smoking environment.
[ ] Use of profane language.
[ ] Removal of the child(ren) from Montana, except as authorized by the Court or
mutually agreed to by both parents.
[ ] Other: .
[ ] Other: .
[ ] Any violation of these terms will result in the immediate termination of that
parent’s contact with the child(ren).
[ ] Relationships between th e child(ren) and relatives and family friends on both sides of the
family shall be protected and encouraged. The parents shall have their child(ren) maintain
ties with both the maternal and paternal relatives. In Montana, grandparents have a legal
right to request a court to order reasonable visitation with their grandchild(ren), if it is in
the best interest(s) of the child(ren). Usually the child(ren) will visit with the paternal
relatives during times the child(ren) are with their father and with the maternal relatives
during times they are with their mother.
9. Decision Making
a. Day-to-Day Decisions
Each parent shall be authorized to make decisions regarding the day-to-day care and
control of the child(ren ) while the child(ren) are residing with that parent, unless or except
as provided below (Choose All That Apply):
[ ] Sole decision making shall be granted to the [ ] Mother [ ] Father for the
following reasons: ____________________________________________
____________________________________________________________
___________________________________________________________.
[ ] Major decisions concerning the child(ren)’s education shall be made by
[ ] the Mother [ ] the Father [ ] both parents jointly.
[ ] Major decisions concerning the non-emergency health care of the child(ren) shall
be made by [ ] the Mother [ ] the Father [ ] both parents jointly.
[ ] Major decisions concerning the spiritual development of the child(ren) shall be
made by [ ] the Mother [ ] the Father [ ] both parents jointly.
[ ] The consent of both parents shall be required before any minor child(ren) shall be
permitted to (Choose All That Apply):
[ ] Get a tattoo
[ ] Pierce any body part
[ ] Marry
[ ] Enlist in the armed services
[ ] Other: _______________________________________________
[ ] Other: _______________________________________________
[ ] Other: _______________________________________________
b. Emergency Decisions
Regardless of the allocation of decision making in this parenting plan, each parent shall be
authorized to make emergency decisions affecting the health or safety of the child(ren).
FORM #232– STIPULATED PERMANENT PARENTING PLAN Page 9 of 16
4th Judicial District Forms - Pro se Petition for Parenting Plan (Revision Date: 3/10)
10. Access to Information
a. As required by M.C.A. § 40-4-225, both parents shall have access to all information
relating to their child(ren) including, but not limited to, school records, counseling records,
medical and dental records.
b. As required by M.C.A. § 40-4-204(6)(a), both parents shall update each other and the
Court with written notice of changes to the following information:
(i) Residential and mailing addresses;
(ii) Telephone number;
(iii) Social Security number;
(iv) Driver’s license number;
(v) Name, address, and phone number of employers;
(vi) Health insurance coverage for the child(ren);
(vii) Health insurance available through either parent’s employer which could cover the
minor child(ren).
[ ] It is appropriate that the personal information of the [ ] Mother [ ] Father shall remain
confidential and shall not be provided to the other parent because:
________________________________________________________________
________________________________________________________________.
11. Residential Changes
As required by M.C.A. § 40-4-217, if a parent’s change in residence will significantly affect the
other parent’s contact with the child(ren), written notice shall be served personally or sent by
certified mail to the other parent not less than 30 days before the proposed change in residence and
must include a proposed revised residential schedule. Proof of service must be filed with the court
that adopted the parenting plan. Failure of the parent who receives notice to respond to the written
notice or to seek amendment of the residential schedule within the 30-day period constitutes
acceptance of the proposed revised residential schedule.
12. Review of Parenting Plan (Optional)
[ ] The parents will review this parenting plan at the following times:
_______________________________________________________________
_______________________________________________________________.
13. Dispute Resolution
The following shall apply when disputes arise between the parents in carrying out or amending
this parenting plan (Choose One):
[ ] No alternative dispute resolution process, except court action, shall apply unless ordered at
the discretion of the Court.
[ ] No alternative dispute resolution process is appropriate. The following limiting factors
exist, as provided in M.C.A. § 40-4-219(9) (Choose All That Apply):
[ ] This is a case of physical abuse or threat of physical abuse by one parent against
the other parent or the child(ren).
[ ] A parent has been convicted of deliberate homicide, mitigated deliberate homicide,
FORM #232– STIPULATED PERMANENT PARENTING PLAN Page 10 of 16
4th Judicial District Forms - Pro se Petition for Parenting Plan (Revision Date: 3/10)
sexual assault, sexual intercourse without consent, deviate sexual conduct with an
animal, incest, aggravated promotion of prostitution of a child, endangering the
welfare of children, partner or family member assault, or sexual abuse of children.
or
[ ] a. Disputes between the parents shall be submitted to mediation, counseling,
or arbitration by: ____________________________________________
__________________________________________________________.
b. The cost of this process shall be allocated between the parents as follows
(Choose One):
[ ] Based on each parent’s proportional share of income as determined from the
child support worksheet.
[ ] As determined in the dispute resolution process.
[ ] Mother: _______ % , Father: ________%.
c. A parent will begin the dispute resolution process by notifying the other parent by
written request sent by certified mail.
d. In the dispute resolution process:
(i) Preference shall be given to carrying out this parenting plan.
(ii) Unless an emergency exists, the parents shall use the designated process to
resolve disputes relating to implementation of the plan, except those related
to financial support.
(iii) A written record shall be prepared of any agreement or arbitration award
reached in counseling or mediation, and a copy shall be provided to each
parent.
(iv) If the court finds that a parent has used or frustrated the dispute resolution
process without good reason, the court may award attorney’s fees and
financial sanctions to the other parent.
(v) The parents have the right of review from the dispute resolution process to
the district court.
14. Other Provisions:
15. Child Support: The parties agree to the proposed child support order attached as Exhibit “B.”
16. Medical Support: The parties agree to the proposed medical support order attached as Exhibit
“C.”
WARNING: One parent’s failure to comply with a provision of the parenting plan will not affect
the other parent’s obligation to comply with the parenting plan. Violation of any provision of this
order with actual knowledge of its terms is p unishable by contempt of court and may be a criminal
offense under M.C.A. §§ 45-5-631 or 45-7-309. Violation of the Final Parenting Plan may subject a
FORM #232– STIPULATED PERMANENT PARENTING PLAN Page 11 of 16
4th Judicial District Forms - Pro se Petition for Parenting Plan (Revision Date: 3/10)
violator to arrest and a fine up to $500 or imprisonment in the county jail.
DATED this _______ day of ____________________, 20___.
_____________________________________
Petitioner, Pro se
STATE OF MONTANA )
) ss.
COUNTY OF ______________________ )
SUBSCRIBED AND SWORN to before me this _____ day of _______________, 20___.
__________________________________________
Name (printed): ____________________________
(Seal) Notary Public for the State of Montana
Residing at ________________________________
My Commission Expires _____________________
DATED this _______ day of ____________________, 20___.
_____________________________________
Respondent, Pro se
STATE OF MONTANA )
) ss.
COUNTY OF ______________________ )
SUBSCRIBED AND SWORN to before me this _____ day of _______________, 20___.
__________________________________________
Name (printed): ____________________________
(Seal) Notary Public for the State of Montana
Residing at ________________________________
My Commission Expires _____________________
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