VIRGINIA:
IN THE CIRCUIT COURT OF FAIRFAX COUNTY
JANE DOE,
Plaintiff,
*
*
*
*
*
*
*
v.
JOHN DOE,
Defendant.
CL No. 06-111111
FINAL DECREE OF DIVORCE
THIS MATTER CAME ON upon the Complaint filed by the Plaintiff; an
Answer and Cross-Complaint filed by the Defendant; upon the taking of
depositions of the Plaintiff and her witness before a Notary Public; the filing of
a transcript of said depositions herein; and
IT APPEARING unto the Court:
1. The parties hereto were lawfully married to each other on August 2, 1987
in Fairfax, Virginia;
2. That there was one child born or adopted of this marriage, to wit:
SLOE MOE DOE, born September 1, 1990;
3. That the Plaintiff is a bona fide resident and domiciliary of the
Commonwealth of Virginia and has been so continuously for at least six months
prior to institution of this suit;
4. That both parties are over the age of eighteen years and neither party is
or has been a member of the Armed Forces of the United States on active duty
during the pendency of this proceeding;
5. That the parties have lived separate and apart, continuously and
uninterrupted, without any cohabitation, for a period of more than one year, that
11/7/06
1
is from September 1, 2005 to the present, and the Plaintiff has maintained for
that time the intent to permanently terminate the marital relationship;
6. That the parties have settled all property, custody and support matters,
and that settlement is embodied in this Decree.
7. That the Plaintiff is entitled to a divorce a vinculo matrimonii pursuant
to §20-91(9) of the Code of Virginia; and
WHEREUPON, pursuant to §20-60.3, Code of Virginia, the parties are
hereby notified of the following provisions of Virginia law and the parties
hereby represent to this Court that the information provided below is
accurate:
NOTICES and INFORMATION:
1. Support payments may be withheld as they become due pursuant to
§20-79.1 or §20-79.2, from income as defined in §63.2-1900, without
further amendments of this Order or having to file an application for
services with the Department of Social Services.
2. Support payments may be withheld pursuant to Chapter 19 (§63.21900, et seq.) of Title 63.2 without further amendments to the order upon
application for services with the Department of Social Services.
3. A duty of support is owed for the following children of the parties:
Name
Date of Birth
Resides With
Sloe Moe Doe
July 1, 1990
Mother
4. The following is true information regarding the parties who are subject
of this Order:
Plaintiff:
Date of Birth:
SSN:
Drivers License #:
State of Issuance:
Address:
11/7/06
Jane Doe
11/1/60
(See Private Addendum)
123-456-78
Virginia
1111 Fair Street
Fairfax, Virginia 22033
2
Home Phone #:
Employment:
Address:
Work Phone #:
Defendant:
Date of Birth:
SSN:
Drivers License #:
State of Issuance:
Address:
Home Phone #:
Employment:
Address:
Work Phone #:
703-999-9999
Manny Mo and Jack
999 East Street
Alexandria, Virginia 22310
703-888-8888
John Doe
6/2/59
(See Private Addendum)
98-87-65-43
Virginia
2222 Last Court
Alexandria, Virginia 22319
703-999-9999
Home Depot
888 This Street
Manassas, Virginia 20999
703-111-1111
[Note: Drivers License numbers do not have to be in Private addendum unless they are
same as SSN.]
5. A petition may be filed for the suspension of any license, certificate,
registration or other authorization to engage in a profession, trade, business
or occupation issued by the Commonwealth of Virginia to a person
responsible for support as provided in §63.2-1937, upon a delinquency for a
period of ninety days or more or in an amount of $5,000 or more.
[ ] Neither party holds any such a license, certificate, registration or other
authorization issued by the Commonwealth of Virginia.
6. a. The Order of this Court as to the amount of the child support and
spousal support, expressed in fixed sums per monthly period, together with
the payment intervals, the dates payments are due, the date the first payment
is due, and the amount of each payment are set forth in the support
provisions of this Order. By agreement of the parties, payment of child
support shall be paid by the ___________________ directly to the
11/7/06
3
________________________________, and shall NOT be paid by Income
Deduction Order.
b. There is no spousal support payable by one party to the other.
7. a. The Order of this Court as to health care insurance for the minor
child is as set forth in the health care provisions of this Order.
b. This Order contains a statement whether any unreimbursed medical
expenses are to be paid by or reimbursed to a party pursuant to Subsections D
and G of §20-108.2, and if such expenses are ordered, then the provisions
governing how such payment is to be made.
8. The Order of this Court as to the amount and terms of any arrearages in
support is set forth in the arrearage provision of this Order.
9. If child support payments have been ordered, then, unless the Court
orders otherwise for good cause shown, the parties shall give each other and
this Court at least 30 days advance written notice of any change in address,
and shall give notice of any change of telephone number within 30 days after
the change. The parties shall give these notices to each other and when
payments are to be made through the Department of Social Services (DSS), to
the DSS.
10. If child support payments are ordered to be paid through the (DSS),
the obligor shall keep the DSS informed of his or her current employer’s
name, address and telephone number. If payments are made directly to the
obligee then the obligor shall keep this Court informed of his or her current
employer’s name, address and telephone number.
11. The separate amounts due to each person under this Order for child
support, for spousal support or for a unitary award, or the affirmation of a
separation agreement, are set forth in the support provision of this Order.
11/7/06
4
12. In determination of a support obligation, the support obligation as it
becomes due and unpaid creates a judgment by operation of law.
13. The Department of Social Services may, pursuant to Chapter 19
(§63.2-1900, et seq.) of Title 63.2 and in accordance with §20-108.2 and
§63.2-1921, initiate a review of the amount of support ordered by any court.
14. If any arrearages for child support, including interest or fees, exist at
the time the youngest child included in this order emancipates, payments shall
continue in the total amount due (current support plus amount applied toward
arrearages) at the time of emancipation until all arrearages are paid.
WHEREFORE, It is:
ADJUDGED, ORDERED and DECREED as follows:
1. Divorce:
That the Plaintiff, JANE DOE, is hereby granted a Final Decree of Divorce,
a vinculo matrimonii, from the Defendant, JOHN DOE, pursuant to §20-91(9)
of the Code of Virginia, 1950, as amended, based on the parties having lived
separate and apart, continuously and uninterrupted, without any cohabitation, for
more than one year;
2. Custody:
a. The parties shall share the joint legal custody of the minor child and the
primary residence shall be with the Plaintiff, JANE DOE. JOHN DOE shall
have liberal and reasonable visitation rights on alternate weekends from 6:00
p.m. on Friday until 8:00 p.m. on Sunday. He shall also have the child for onehalf of the Christmas school break and for the Thanksgiving holiday, and for
four weeks in the summer. The person who has the child for the weekend shall
have any Federal holiday Monday attached to that weekend.
11/7/06
5
b. That both parties shall notify this Court and each other in writing at least
thirty (30) days in advance of any intention to relocate their residence pursuant
to §124.5 of the Code of Virginia.
3. Child Support:
a. The Defendant shall pay to the Plaintiff as and for child support and
maintenance, the sum of Five Hundred and Seventy Dollars ($570.00) per
month, commencing on July 1, 2005 and continuing on the first day of each and
every month thereafter until further order of the court.
b. The aforesaid support payment for such minor children shall continue to
be paid for each such child until the age of eighteen (18), and thereafter for a
child who is (i) a full-time high school student, (ii) not self-supporting and (iii)
living in the home of the party receiving child support until such child reaches
the age of nineteen (19) or graduates from high school, whichever first occurs.
c. By agreement of the parties, payment of child support shall be paid by the
directly to the
,
and shall NOT be paid by Income Deduction Order.
4. Spousal Support:
That there is no spousal support payable by one party to the other.
5. Health Care Coverage and Medical Expenses:
A. For Minor Child: JOHN DOE shall maintain health insurance coverage
for the minor child, through his current medical insurance provider, for as long
as it remains available to him at reasonable cost. The current coverage for the
parties’ minor child is provided by Aetna Insurance, Policy No. 9900990.
[Note: The policy number of health insurance is NOT an account number required to be in
the Private Addendum, AND the policy number need not be in the Decree at all if health
coverage is supplied through a party’s employer.]
B. For Spouse or Former Spouse: Health insurance is not required by this
Order for a spouse or former spouse.
11/7/06
6
C. Unreimbursed Medical Expenses: JANE DOE shall pay the first $250 of
unreimbursed medical expenses for the minor child in each calendar year, as
said expenses are defined in §20-108.2, Code of Virginia. The parties shall
share all remaining unreimbursed medical expenses in the calendar year in the
same proportion as their respective income shares, currently 62% Defendant and
38% Plaintiff.
6. Arrearages:
There are no child support arrearages as of the date of this Decree.
7. Property Settlement:
A. Debts:
(1) The Plaintiff shall be responsible for the credit card accounts: VISA
#1, Mastercard #1, and Lord & Taylor. (See Private Addendum).
(2) The Defendant shall be responsible for the credit card accounts:
VISA # 2, Mastercard # 2, and Home Deport. (See Private Addendum).
(3) The Plaintiff shall fully retire VISA #1 by May 1, 2006 and shall
fully retire the balance of Mastercard #1 by March 1, 2006. The Defendant shall
transfer the balance of Mastercard #2 to VISA #2 and shall close Mastercard #2
by May 1, 2006. (See Private Addendum).
B. Stocks and Securities:
(1) The Plaintiff shall have the following accounts for her sole and
separate property: (See Private Addendum).
(2) The Defendant shall have the following accounts for his sole and
separate property: (See Private Addendum).
C. Pensions and Retirement Accounts
(1)
The Plaintiff shall have the following pension and retirement
accounts for her sole and separate property: (See Private Addendum).
11/7/06
7
(2) The Defendant shall have the following pension and retirement
accounts for his sole and separate property: (See Private Addendum).
11/7/06
8
D. Marital Home
The parties currently have the former marital home listed for sale. They shall
continue to market the property. When the property is sold and settled and the
mortgage and expenses of sale are paid, the remaining net proceeds shall be
divided equally.
E. Life Insurance
The Defendant shall maintain his life insurance with Aetna, Policy #XX: and
with U.S Life, Policy #YY, with the child as the sole beneficiary, until the child
has reached the age of 23 years, or has sooner graduated from college with a
four-year degree. (See Private Addendum).
THIS CAUSE IS FINAL.
ENTERED this ___ day of ____________________, 200_.
______________________________________
JUDGE
WE ASK FOR THIS:
___________________
Counsel
Etc.
SEEN and AGREED:
__________________
Counsel
Etc.
[Private Addendum Follows]
11/7/06
9
PRIVATE ADDENDUM
Pursuant to Va. Code §20-121.03
VIRGINIA:
IN THE CIRCUIT COURT OF FAIRFAX COUNTY
JANE DOE,
Plaintiff,
v.
JOHN DOE,
Defendant.
*
*
*
*
*
*
*
Cl. No. 06-111111
PRIVATE ADDENDUM TO FINAL DECREE OF DIVORCE
This document is a Private Addendum, and is an integral part of the Final
Decree of Divorce entered in this matter on _______________. This
Addendum contains identification numbers which are restricted from being
contained in a Public Order of this Court. All references contained herein are
to the aforementioned Final Decree of Divorce.
1. Page 2 & 3, Para 4:
The Social Security Number of Plaintiff, Jane Doe is: 1111-11-1111.
The Social Security Number of Defendant, John Doe is: 2222-22-2222.
2. Page 7 & 8, Para 7:
A. Debts:
(1) The Plaintiff is responsible for: VISA #1: VISA Acct #12345678-1234, and Mastercard #1: Mastercard Acct #9999-8888-7777 and Lord
& Taylor: Acct #73486AZR5.
(2) The Defendant is responsible for: VISA #2: VISA Acct #98123245-7474, and Mastercard #2: Mastercard Acct #7855-8674-4346, and
Home Depot: Acct #2345-96.
(3) The Plaintiff shall fully retire VISA Acct #1234-5678-1234 by
May 1, 2006, and shall fully retire the balance of Mastercard Acct #9999-
11/7/06
10
8888-7777 by March 1, 2006. The Defendant shall transfer the balance of
Mastercard Acct #7855-8674-4346 to VISA Acct #9812-3245-7474, and
shall close Mastercard Acct #7855-8674-4346 by May 1, 2006.
B. Stocks and Securities:
(1) The Plaintiff shall have the following accounts for her sole and
separate property: Schwab Account #97-12345.XY.
(2) The Defendant shall have the following accounts for his sole and
separate property: ETRADE Brokerage #8AA-76549-8458, and Schwab
Account #97-12345.AB.
C. Pensions and Retirement Accounts:
(1) The Plaintiff shall have the following pension and retirement accounts
for her sole and separate property: Fidelity IRA #89-1234, ABC Corp. 401(k)
#9876-92, Royce Trust Plan #9254892-88.
(2) The Defendant shall have the following pension and retirement
accounts for his sole and separate property: Fidelity IRA #89-1235.
D. Life Insurance:
The Defendant shall maintain his life insurance with Aetna, Policy #23989: and with U.S Life, Policy #96-9876-XZ, with the child, Sloe Moe Doe,
as the sole beneficiary, until the child has reached the age of 23 years, or has
sooner graduated from college with a four-year degree.
WE ASK FOR THIS:
___________________
Counsel
Etc.
11/7/06
SEEN and AGREED:
__________________
Counsel
Etc.
11