Form L 0966 PDF Details

Form L-0966 is a form that must be completed in order to request an exemption from the individual shared responsibility payment for not maintaining qualifying health coverage. This form can be used by individuals, families, or groups of people who have sincerely held religious beliefs or moral convictions against health insurance. Completing this form and submitting it to the IRS will help ensure you are not penalized for not having health insurance. Note that exemptions may only be claimed on a year-by-year basis. If you have sincere religious beliefs or moral convictions against health insurance, the Form L-0966 must be completed in order to request an exemption from the individual shared responsibility payment. This form can be used by individuals, families, or groups of people and needs to be submitted to the IRS. Exemptions may only be claimed on a year-by-year basis though, so make sure to submit this form again each year if you still do not want to pay for health insurance.

QuestionAnswer
Form NameForm L 0966
Form Length7 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 45 sec
Other namessettlement conference tried, california settlement conference brief, settlement conference brief sample, orange county settlement conference statement

Form Preview Example

ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME & ADDRESS):

FOR COURT USE ONLY

TELEPHONE NO.:

FAX NO. (Optional):

 

E-MAIL ADDRESS (Optional):

 

 

ATTORNEY FOR (NAME):

BAR NO.:

 

SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE

 

JUSTICE CENTER:

 

 

Central – 700 Civic Center Dr. West, Santa Ana, CA 92701-4045

 

Lamoreaux - 341 The City Drive, Orange, CA 92868-3205

 

PETITIONER:

 

 

RESPONDENT:

 

 

PETITIONER’S

SETTLEMENT CONFERENCE BRIEF

CASE NUMBER:

 

RESPONDENT’S

JOINT STATEMENT OF ISSUES TO BE TRIED

 

 

 

 

I.MEET AND CONFER STATEMENT:

A. Date, time and place of meet and confer:

B.

There was no meet and confer because:

C.Issues settled are:

Child Custody

Parenting Time

Child Support

Spousal Support

Attorney’s Fees and Costs

Other:

Property Division

Characterization and Division of Assets

Characterization and Division of Debts

Retirement/Pensions

D.Issues to be litigated are:

Child Custody

Property Division

Parenting Time

Characterization and Division of Assets

Child Support

Characterization and Division of Debts

Spousal Support

Retirement/Pensions

Attorney’s Fees and Costs

 

Other:

 

 

II. STATISTICAL DATA:

 

 

 

 

 

 

 

 

A.

Date of Marriage:

 

 

 

 

Date of Separation:

 

 

Length of Marriage:

 

 

 

 

 

 

 

 

 

B.

Marital Status Terminated?

No

Yes

If yes, Date of Termination:

C.

Petitioner’s Age:

 

 

Petitioner’s Employer:

 

 

 

 

 

D.

Petitioner’s Monthly Income: Gross: $

 

 

 

Net: $

 

E.Petitioner’s Pay Days:

F. Cohabitee or New Spouse’s Monthly Income: Gross: $

 

Net: $

Page 1 of 4

Approved for Optional Use Form # L-0966

New October 25, 2010

SETTLEMENT CONFERENCE BRIEF/

JOINT STATEMENT OF ISSUES TO BE TRIED

Orange County Local Rules 707 and 709

CASE NAME:

CASE NUMBER:

G.

Respondent’s Age:

 

Respondent’s Employer:

 

 

 

H.

Respondent’s Monthly Income: Gross: $

 

 

Net: $

 

I.Respondent’s Pay Days:

J. Cohabitee or New Spouse’s Monthly Income: Gross: $

 

Net: $

K.Minor children:

Name

Birthdate

Age

Gender Residing With

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

III.

PETITIONER’S

RESPONDENT’S PROPOSALS RE ISSUES:

A. Child Custody Issue:

Proposed Resolution:

B.

Parenting Time

Estimated Time Share

Issue:

Proposed Resolution:

C. Child Support Issue:

Proposed Resolution:

 

 

Page 2 of 4

Approved for Optional Use

SETTLEMENT CONFERENCE BRIEF/

Orange County Local Rules 707 and 709

Form # L-0966

 

JOINT STATEMENT OF ISSUES TO BE TRIED

 

New October 25, 2010

 

CASE NAME:

CASE NUMBER:

D. Spousal Support Issue:

Family Code section 4320 factors attached

Proposed Resolution:

E. Attorney’s Fees and Costs Issue:

Proposed Resolution:

F. Property Division Issue:

Proposed Resolution:

G. Characterization and Division of Assets Issue:

Proposed Resolution:

H. Characterization and Division of Debts Issue:

Proposed Resolution:

 

 

Page 3 of 4

Approved for Optional Use

SETTLEMENT CONFERENCE BRIEF/

Orange County Local Rules 707 and 709

Form # L-0966

 

JOINT STATEMENT OF ISSUES TO BE TRIED

 

New October 25, 2010

 

CASE NAME:

CASE NUMBER:

I. Retirement/Pensions Issue:

Proposed Resolution:

J. Other Issue:

Proposed Resolution:

IV. ATTACHMENTS AND EXHIBITS

Attachment 1: Current Income and Expense Declaration (Judicial Council form FL-150) and required attachments

If a party’s Income and Expense Declaration is over three months old or if there have

been significant changes since the filing of the last Income and Expense Declaration, a new declaration must be prepared and filed with this statement.

Attachment 2: Proposed Division of Community Assets and Debts

If a party requests reimbursements for community debts paid from separate funds (Smith/Epstein), attach a schedule and canceled checks, receipts or other supporting materials.

If a party requests reimbursements for separate property contribution to the acquisition of

community property, attach a schedule and canceled checks, receipts or other supporting materials.

Attachment 3: Kelley Blue Book Valuation(s) for Vehicle(s)

Attachment 4: List of Witnesses

Attachment 5: List of Proposed Exhibits

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

Attorney for

Petitioner

Respondent

 

 

Page 4 of 4

Approved for Optional Use

SETTLEMENT CONFERENCE BRIEF/

Orange County Local Rules 707 and 709

Form # L-0966

 

JOINT STATEMENT OF ISSUES TO BE TRIED

 

New October 25, 2010

 

CASE NAME:

CASE NUMBER:

 

 

ATTACHMENT 2

PROPOSED DIVISION OF ASSETS AND DEBTS

STIPULATED

 

FAIR

 

 

 

 

 

MARKET

ASSET

 

DEBT

AMOUNT

ASSET

VALUE

DEBT

NET

OWED TO

OF DEBT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PETITIONER

 

RESPONDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISPUTED

 

FAIR

 

 

 

 

 

MARKET

ASSET

 

DEBT

AMOUNT

ASSET

VALUE

DEBT

NET

OWED TO

OF DEBT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PETITIONER

 

RESPONDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approved for Optional Use Attachment 2 to L-0966 New October 25, 2010

ATTACHMENT 2

PROPOSED DIVISION OF COMMUNITY ASSETS AND DEBTS

Page 1 of 1

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CASE NAME:

CASE NUMBER:

 

 

ATTACHMENT 4

 

 

 

LIST OF WITNESSES

 

Petitioner

Respondent intends to call the following witnesses to testify at the time of trial:

 

 

 

 

 

Name

 

Relationship/Profession

Telephone #

Subject of Testimony

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 1 of 1

Approved for Optional Use Attachment 4 to L-0966 New October 25, 2010

ATTACHMENT 4

LIST OF WITNESSES

CASE NAME:

CASE NUMBER:

Petitioner

ATTACHMENT 5

LIST OF PROPOSED EXHIBITS

Respondent submits the following proposed exhibits:

 

Exhibit Description

Purpose of Exhibit

1

 

 

 

 

 

2

 

 

 

 

 

3

 

 

 

 

 

4

 

 

 

 

 

5

 

 

 

 

 

6

 

 

 

 

 

7

 

 

 

 

 

8

 

 

 

 

 

9

 

 

 

 

 

10

 

 

 

 

 

11

 

 

 

 

 

12

 

 

 

 

 

13

 

 

 

 

 

14

 

 

 

 

 

15

 

 

 

 

 

16

 

 

 

 

 

Approved for Optional Use Attachment 5 to L-0966 New October 25, 2010

ATTACHMENT 5

LIST OF PROPOSED EXHIBITS

Page 1 of 1

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How to Edit Form L 0966 Online for Free

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The best ways to prepare form settlement conference brief step 1

2. Once the previous part is done, you're ready to include the needed specifics in Issues settled are, Child Custody Parenting Time Child, Issues to be litigated are, Child Custody Parenting Time Child, II STATISTICAL DATA, A Date of Marriage, Length of Marriage, Property Division Characterization, Property Division Characterization, Date of Separation, B Marital Status Terminated, Yes, If yes Date of Termination, C Petitioners Age, and Petitioners Employer in order to move forward further.

Writing segment 2 in form settlement conference brief

In terms of Date of Separation and Child Custody Parenting Time Child, be certain that you review things here. The two of these are considered the most important ones in this page.

3. Completing D Petitioners Monthly Income Gross, E Petitioners Pay Days, F Cohabitee or New Spouses Monthly, Net, Net, Approved for Optional Use Form L, SETTLEMENT CONFERENCE BRIEF, JOINT STATEMENT OF ISSUES TO BE, Orange County Local Rules and, and Page of is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

form settlement conference brief conclusion process shown (portion 3)

4. This next section requires some additional information. Ensure you complete all the necessary fields - CASE NAME, CASE NUMBER, G Respondents Age, Respondents Employer, H Respondents Monthly Income Gross, I Respondents Pay Days, J Cohabitee or New Spouses Monthly, Net, Net, K Minor children, Name, Birthdate, Age, and Gender Residing With - to proceed further in your process!

form settlement conference brief conclusion process explained (part 4)

5. Lastly, the following last portion is what you will need to wrap up before closing the PDF. The blanks under consideration are the next: III, PETITIONERS, RESPONDENTS PROPOSALS RE ISSUES, Child Custody, Issue, Proposed Resolution, Parenting Time, Issue, Proposed Resolution, Child Support, Issue, and Estimated Time Share.

How you can complete form settlement conference brief stage 5

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