ACDAS

Your Name: _________________________

Address: ____________________________
City, State, Zip: ______________________
Phone: _____________________________
Email: ______________________________
Self-Represented

DISTRICT COURT
CLARK COUNTY, NEVADA

______________________________ CASE NO.: ____________________

Plaintiff, DEPT: ____________________
vs.
______________________________
Defendant.

ANSWER AND COUNTERCLAIM FOR ANNULMENT OR IN THE ALTERNATIVE

FOR DIVORCE AND UCCJEA DECLARATION
(With Children)

Defendant respectfully states:

1. Defendant admits the following allegations: (write the paragraph numbers from the
Complaint you agree with) ________________________________________________.

2. Defendant denies the following allegations: (write the paragraph numbers from the
Complaint you disagree with) ______________________________________________.

3. Defendant is without sufficient knowledge to admit or deny the following allegations:

(write the paragraph numbers you are unsure about) ___________________________.

© 2017 Family Law Self-Help Center Answer & Counterclaim for Annulment (With Kids)

* You are responsible for knowing the law about your case. For more information on the law, this form, and free
classes, visit www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road. To find
an attorney, call the State Bar of Nevada at (702) 382-0504.
1
 AFFIRMATIVE DEFENSES

 The parties were not married in Nevada, and neither party is a Nevada resident.
 Nevada is not the home state of the child(ren).
 There is another case concerning these parties in another state.
 Other: ___________________________________________________________.

COUNTERCLAIM FOR ANNULMENT OR IN THE ALTERNATIVE FOR DIVORCE

1. Jurisdiction. (☒ check all that apply)

 The parties were married in the State of Nevada on (date of marriage)
____________________.
 The following spouse has been a resident of the State of Nevada for at least six weeks
prior to filing this Complaint and intends to make Nevada his/her home for an
indefinite period of time: (name of Nevada resident)
_________________________________________. The parties were married on
(date of marriage) ______________________ in (city) ___________________,
(state) __________________.

2. Reason for Annulment. (☒ check all that apply)

 There is a close enough blood relationship between the parties that the marriage is
prohibited by law.
 Plaintiff was married to someone else on the day of the wedding ceremony.
 Defendant was married to someone else on the day of the wedding ceremony.
 Defendant was under the age of 18 at the time of the marriage ceremony and did not
get the proper consent from the parents, guardians, and/or district court. This
Complaint is being filed within one year of Defendant reaching 18 years of age, and
the parties have not freely cohabited since that time.
 Defendant lacked understanding of his/her actions to the extent that he/she was
incapable of agreeing to the marriage because (explain):
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

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  Defendant was insane at the time of the wedding and has regained sanity. The parties
have not freely cohabited since Defendant regained sanity.
 Defendant’s consent to the marriage was obtained by fraud because (describe):
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Defendant has not freely cohabited with the other party since learning of the fraud.

3. Pregnancy. (☒ check one)

 Neither spouse is pregnant.
 The following spouse is pregnant: (name of pregnant spouse) __________________.
The other spouse  is /  is not the parent of the unborn child. The child is due to be
born on (date): _______________.
 It is unknown whether either spouse is currently pregnant.

4. Children. There are (number) _______ minor children in common born to or adopted
by the parties. The name(s) and information is listed below:
Child’s Name Date of State of How long child Disability
Birth Residence lived in the state

5. UCCJEA Declaration. (☒ check one)

 The child(ren) have lived in Nevada for the past six months, or since birth.
 The child(ren) have NOT lived in Nevada for the past six months.

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a. Living Arrangements Last 5 Years. The children have lived with the following
persons in the following places within the last five years:
Time Period Name of Person the City and State Child’s Name (if
(mo/yr – mo/yr) Child(ren) Lived With: not all children)
______ - present
______ - _____
______ - _____
______ - _____
______ - _____

The names and current addresses of each non-parent the children lived with during the
last five years are:

b. Participation in Other Cases: (☒ check one)

I  have /  have not participated as a party or witness or in some other capacity in any
other case involving the child(ren): (if you have, provide all specifics including the state,
the court, children involved, the case number and the date of the child custody order, if
any):

c. Knowledge of Other Cases: (☒ check one)

I  do /  do not know of a different case that could affect the current case: (if you do,
provide all specifics including the state, the court, parties involved, the case number and
the nature of the proceeding):

d. Person(s) Who Claim Custody / Visitation: (☒ check one)

I  do /  do not know of anyone other than the parents who has physical custody of the
child(ren) or who claims custody/visitation rights to the child(ren). (if so, list names and
addresses of anyone who claims custody/visitation rights)

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6. Legal Custody. Legal custody refers to the ability to make major decisions about the
child, such as medical care, education, and religious upbringing. (☒ check one)

 The parties should share joint legal custody of the child(ren).

 Plaintiff should have sole legal custody of the child(ren).
 Defendant should have sole legal custody of the child(ren).
 Nevada is not the “home state” of the child(ren) and cannot enter custody orders.

7. Physical Custody. Physical custody refers to the amount of time the child spends with
each parent. (☒ check one)

 The parties should share joint physical custody of the child(ren) (each parent must
have the child(ren) at least 40% of the time, or 146 days per year). A proposed
parenting timeshare and holiday schedule is attached as Exhibit 1.
 The (☒ check one)  Plaintiff /  Defendant should have primary physical custody
of the child(ren). A proposed parenting timeshare and holiday schedule is attached
as Exhibit 1.
 The (☒ check one)  Plaintiff /  Defendant should have sole physical custody of
the child(ren).
 Nevada is not the “home state” of the child(ren) and cannot enter custody orders.

8. Other Considerations. The Court should consider the following issues in determining
custody: (☒ check all that apply)

 Domestic Violence  State of Residency

 CPS Involvement  Other: _____________________
 Military Deployment

9. Public Assistance. (☒ check one)

 None of the parties in this case have ever received state assistance or welfare.
 State assistance or welfare has been or is being provided to parties in this case.

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10. Child Support. Complete the attached Child Support Worksheet that applies to your
custody arrangement before you complete this section. (☒ check one)
 Child support should be paid by (name of parent who should pay child support)
_________________________________ in the amount of (amount) $_________ per
month. This is based on: (☒ check one)
 The statutory minimum of $100/month per child.
 The calculation from the attached Child Support Worksheet.
 The amount already established by the District Attorney, Family Support
Division, case (insert case number) R____________.
 No child support is requested. (Explain why not):

 I’m not sure how much child support should be paid, and ask the court to set support.

11. Child Support Arrears. (☒ check one)

 No back child support or arrears are requested.
 Child support arrears are being handled by the District Attorney, Family Support
Division, case (insert case number) R____________ and should continue as ordered
in that case.
 Back child support should be paid by (name of parent who should pay back child
support) ____________________________________ from (date back child support
should begin) ___________________ to present.

12. Wage Withholding. (☒ check one)

 A wage withholding order should be entered to secure payment of any support owed.
 A wage withholding order should NOT be entered.

13. Health Insurance. (☒ check all that apply)

 Both parties should provide future health insurance for the minor child(ren) if
available.
 Future health insurance for the minor child(ren) should be provided by (name of
parent) ____________________________________ if available.

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 14. Unreimbursed Medical Expenses. (☒ check one)
 Any expenses not covered by insurance should be paid equally by both parties.
 Any expenses not covered by insurance should be paid by (name of parent)
_____________________________ due to the following extraordinary circumstances:
(explain)

15. “30/30 Rule.” (☒ check one)

 The Court should order the 30/30 Rule for payment of all unreimbursed medical /
dental expenses.1 (see below for explanation)
 The Court should NOT order the 30/30 Rule for payment of unreimbursed medical /
dental expenses.

16. Tax Deduction. IRS rules state that the custodial parent usually has the right to claim
the child on their taxes. The custodial parent can waive this right by filling out IRS Form
8332. Talk to a tax professional if you are not sure what to do. (☒ check all that apply)

 The Plaintiff should claim the following children as dependents for tax purposes
every year: (insert child(ren)’s names): _____________________________________
 The Defendant should claim the following children as dependents for tax purposes
every year: (insert child(ren)’s names): _____________________________________
 The tax deduction should alternate, with Plaintiff claiming the child(ren) in (☒ check
one)  even /  odd years, and Defendant claiming the child(ren) the other years.
 The tax deduction should be determined by federal law.

17. Name Change. (☒ check one)

 Defendant does not request a name change.
 Defendant would like to be restored to his/her former name of (insert former name
you would like to go back to) ____________________________________________.

1
The “30/30 Rule:” If a parent pays a medical or dental expense for a child that is not paid by insurance, that parent
must send proof of the expense to the other parent within 30 days of incurring the expense. The other parent then
has 30 days to reimburse the paying parent ½ the cost.

Page 7 of 10 - Answer & Counterclaim for Annulment (With Kids)

18. Alternate Request for Divorce. (☒ check one)
 Defendant does not want to include a claim for divorce as part of this case. (Skip the
remaining sections and sign page 9)
 If the Court does not grant an annulment, Defendant requests a divorce. The parties
are incompatible.

19. Community Property. If a divorce is granted: (☒ check one)

 There is no community property to divide.
 Any community property has already been divided.
 I do not know the full extent of the community property.
 The community property should be divided as follows:
Plaintiff:
1. ______________________________________________________
2. ______________________________________________________
3. ______________________________________________________
4. ______________________________________________________
Defendant:
1. ______________________________________________________
2. ______________________________________________________
3. ______________________________________________________
4. ______________________________________________________

20. Community Debt. If a divorce is granted: (☒ check one)

 There is no community debt to divide.
 Any community debt has already been divided.
 I do not know the full extent of the community debt.
 The community debt should be divided as follows:
Plaintiff:
1. ______________________________________________________
2. ______________________________________________________
3. ______________________________________________________
4. ______________________________________________________

Page 8 of 10 - Answer & Counterclaim for Annulment (With Kids)

 Defendant:
1. ______________________________________________________
2. ______________________________________________________
3. ______________________________________________________
4. ______________________________________________________

21. Alimony. If a divorce is granted: (☒ check one)

 No spousal support is requested.
 Plaintiff should pay $________ per month in spousal support for the next (number)
_______ years.
 Defendant should pay $________ per month in spousal support for the next (number)
_______ years.

22. If Defendant is able to hire counsel, attorney’s fees and costs are requested.

Defendant requests:
1. That the marriage existing between Plaintiff and Defendant be declared null and
void and/or dissolved, and that Defendant be granted an absolute Decree of
Annulment and/or Decree of Divorce, and that each of the parties be restored to
the status of a single, unmarried person;
2. That the Court grant the relief requested in this Counterclaim; and
3. For such other relief as the Court finds to be just and proper.

DATED this (day) ______ day of (month) ___________________, 20____.

Submitted By: (your signature)  _______________________________

(print your name) _______________________________

Page 9 of 10 - Answer & Counterclaim for Annulment (With Kids)

 VERIFICATION

Under penalty of perjury, I declare that I am the Defendant in the above-entitled action;
that I have read the foregoing Answer and Counterclaim and know the contents thereof; that the
pleading is true of my own knowledge, except for those matters therein contained stated upon
information and belief, and that as to those matters, I believe them to be true.
I declare under penalty of perjury under the law of the State of Nevada that the
foregoing is true and correct.
DATED this (day) ______ day of (month) ___________________, 20____.

Submitted By: (your signature)  _______________________________

(print your name) _______________________________

Page 10 of 10 - Answer & Counterclaim for Annulment (With Kids)

 EXHIBIT 1: Parenting Timeshare and Holiday Schedule
 No Visitation Requested Because: (explain) ______________________________

Regular Schedule:
Be very specific. Include _____________________________________________________
the times and days of the
week for each parent’s _____________________________________________________
timeshare. _____________________________________________________
(ex.: Mom: Saturday 7pm –
Wednesday 3pm, _____________________________________________________
Dad: Wednesday 3pm – _____________________________________________________
Saturday 7pm)
_____________________________________________________
_____________________________________________________

Summer Schedule:  Same as the regular schedule.

 Other: ____________________________________________

Mother’s Day and Mother’s  Mother every year from 9am – 7pm.
Birthday:  Other: ____________________________________________

Father’s Day and Father’s  Father every year from 9am – 7pm.
Birthday:  Other: ____________________________________________

Child’s Birthday:  Even years with (parent) ___________________________.

Odd years with (parent) ____________________________.
*Time shall be from 9am – 7pm.*
 Other: ___________________________________________

3 Day Weekends:  Even Years: MLK Jr. Day, Memorial Day, Labor Day with
(parent) _________________________________,
President’s Day, Independence Day, Nevada Admissions
Day with the other parent.
Odd Years: MLK Jr. Day, Memorial Day, Labor Day with
(parent) _________________________________,
President’s Day, Independence Day, Nevada Admissions
Day with the other parent.
*Time begins when school lets out the day before the holiday
weekend (or 3pm if no school), and ends the day following
the holiday weekend when school resumes (or 9am).*
**If Independence Day falls on a Tuesday, Wednesday, or
Thursday, the time shall be from July 3 at 9am until July 5
at 9am.**
 Other: ____________________________________________
Easter / Spring Break:  Even years with (parent) _____________________________.
Odd years with the other parent.
*Time shall begin the day school lets out until noon the day
before school resumes.*
 Other: ____________________________________________

Thanksgiving:  Odd years with (parent) _____________________________.

Even years with the other parent.
*Time shall begin the day school lets out until noon the day
before school resumes.*
 Other: ____________________________________________

Winter Break / Christmas:  Segment 1 (Christmas) consists of the day school lets out until
December 26 at noon.
Segment 2 (New Year’s) consists of December 26 at noon
until noon the day before school resumes.
Even years: segment 1 with (parent) ____________________,
segment 2 with the other parent.
Odd years: segment 1 with (parent) ____________________,
segment 2 with the other parent.
 Other: ____________________________________________
_________________________________________________

Other Holidays:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Vacation:  The parents will not establish a formal vacation plan, and will
instead mutually agree on vacation days and times with the
child(ren).
 Each parent may have up to (number) ______ vacation days
per year with the child(ren). The parent shall notify the other
parent of the vacation and provide a general vacation itinerary
at least (number) _____ days before the planned vacation.
Vacation time is not allowed during a holiday allotted to
the other parent.
Worksheet A - Primary Physical Custody Child Support Calculation Worksheet
If you are asking for primary physical custody, fill out this worksheet and attach it to the document you are filing. Primary physical
custody exists when one parent has the child more than 60% (219 days) of the time calculated over a one year period.

Determine the Gross Monthly Income (GMI) of the non-custodial parent (estimate if unknown).
Gross monthly income is the income received from all sources. If you do not know the parent’s gross monthly
income, you can calculate the number with the formula on the last page.

 Determine Child Support Obligation. Monthly Child Support:

.18 (for 1 Child)
GMI
X .25 (for 2 Children) = $ _______ OR $100 per child $_______
$ ___________ .29 (for 3 Children) (write the higher amount)
.31 (for 4 Children) Higher Amount: $__________
Add .02 for each additional child

 Apply the Presumptive Maximum (rarely applicable). Presumptive Maximum

Usually, this is the maximum amount a parent may be required to pay per month per
Reduction to:
child (and can reduce – not increase – the amount that would be owed under step
$________
). This amount changes every year on July 1st and can be found by going to
http://nvcourts.gov and searching the phrase “presumptive maximum.” Make sure Or  not applicable
you are using the most current chart.

 Deviations. You may request an amount of child support that is lower or higher than the amount in  or , but
your reason(s) must be based upon one of the following factors. ( check all that apply)
 The cost of health insurance  Expenses reasonably related to the mother’s
 The cost of childcare pregnancy and confinement
 Special educational needs  Cost of transportation for visitation if the
custodial parent moved out of the jurisdiction
 Age of the child
 The amount of time the child spends with each
 Parent’s legal responsibility to support others
parent
 The value of services contributed by either
 Any other necessary expenses for the benefit of
parent
the child
 Public assistance paid to support the child
 The relative income of both parents

Explain:_______________________________________________________
________________________________________________________________ Total Child Support:
________________________________________________________________ $ _________
________________________________________________________________

© Family Law Self-Help Center Child Support Worksheet A

 Worksheet B - Joint Ph
hysical Cu
ustody Chiild Supporrt Calculaation Work
ksheet
If youu are asking for
f joint physiccal custody, fiill out this wo orksheet and atttach it to the document youu are filing. A joint physicaal
custody arrangemen nt exists when each parent haas the child at leeast 40% (146 days) of the tiime calculated over a one yeaar period.

Pare
ent 1’s Na
ame: Parent 2’s Name
e:

Determine Eaach Parent’’s Gross Moonthly Incomme (GMI) (eestimate othher parent’ss income if uunknown).
Gross monthhly income iss the income received
r from all sources. If you do nott know a pareent’s gross moonthly
income, you
u can calculatte the numberr with the form
mula on the laast page.

 DDetermine Each
E Parentt’s Child Support Oblig
gation. Parent 1’’s Monthly Chilld Support:
Parent 1 GM
MI $ _______ OR $100 pper child $______
.18 (for 1 Child)
C (write thhe higher amounnt and use in stepp 3)
$ ______
____ H
Higher Amount: $$__________
.25 (for 2 Children)
C
X .29 (for 3 Children)
C = Parent 2’’s Monthly Chilld Support:
Parent 2 GM
MI .31 (for 4 Children)
C $ _______ OR $100 pper child $______
$ ______
____ Add .02 foor each addittional child (write thhe higher amounnt and use in stepp 3)
H
Higher Amount: $$__________

 SSubtract the lower earninng parent’s amount

a hild support in  from tthe higher eaarning parennt’s amount.
of ch

Higher Lower Child

d Support Obliigation Nam
me of higher inccome parent:
$ ______
__ $ _______ $__
____________ ______________________
- = paaid by

 AApply the Prresumptive Maximum (rarely appllicable). Presumptivve Maximum

U
Usually, this iss the maximum m amount a parent
p may bee required to ppay per monthh per child
Reducction to:
ount that woulld be owed unnder step ). This
(aand can reducce – not increaase – the amo
$_________
ammount changees every year on July 1st annd can be foun
nd by going to http://nvcouurts.gov
Or  nott applicable
annd searching the
t phrase “prresumptive maximum.”
m Make
M sure youu are using thee most
cuurrent chart.

 DDeviations. You
Y may requ
uest an amoun
nt of child sup mount in  orr , but yourr
pport that is l ower or higheer than the am
rreason(s) musst be based up
pon one of thee following faactors. ( cheeck all that appply)
 The cost of health inssurance  EExpenses reaasonably rellated to the m mother’s
 The cost of childcaree ppregnancy aand confinem ment
 Special educational
e needs
n  CCost of transsportation foor visitation if the
ccustodial parrent moved out of the juurisdiction
 Age of thhe child
 TThe amount of time the child spendss with each
 Parent’s legal responnsibility to su
upport otherss
pparent
 The value of servicess contributed d by either
 AAny other neecessary exppenses for thhe benefit of
parent
tthe child
 Public asssistance paid to support the child
 TThe relative income of bboth parents

EExplain:______________________________________________________________ Tootal Child S

Support:
___
___________
___________
__________
___________
__________________________
___
___________
___________
__________
___________
__________________________ $ __________

© Fam
mily Law Self-Help
p Center Child Suppport Worksheet B
To Determine a Parent’s Gross Monthly Income:
Gross monthly income is a parent’s income from all sources before taxes. To find this number,
calculate the following:

Parent 1 Parent 2
*Monthly Wages from Employment (before taxes) $ $
Monthly Tip Income $ $
Monthly Self-Employment Income (after business expenses) $ $
Monthly Unemployment Benefits $ $
Social Security $ $
Social Security Disability $ $
Retirement / Pension $ $
Other: _____________________________________ $ $
TOTAL INCOME $ $

*To Determine a Parent’s Employment Income:

If you do not know a parent’s gross monthly income from employment, you can calculate the
number if you know the 1) hourly wage, 2) weekly income, or 3) annual income.

Gross Monthly Income Based on Annual Income:

Annual Income $_________  12 = $_________

Gross Monthly Income Based on Weekly Income:

Weekly Income $_________ x 52 = Annual Income $_________

Annual Income $_________  12 = $_________

Gross Monthly Income Based on Hourly Wage:

Hourly Wage $________ x # of Hours Worked per week ______ = Weekly Income $_________
Weekly Income $_________ x 52 = Annual Income $_________
Annual Income $_________  12 = $_________