Fill and Sign the Comes Petitioners Who Files This Petition for Form

Page 1 of 3 IN THE DISTRICT COURT OF ______________ COUNTY, NEBRASKA _________________________, Case No. ______________ Petitioner, PETITION FOR DISSOLUTION vs. OF MARRIAGE _________________________,Respondent.COMES, _________________________, Petitioners, who files this Petition for Dissolution of Marriage and would state in support thereof the following:1.JURISDICTION: The petitioner is an actual and bona fide resident of ______________ County, Nebraska, and has resided in the State of Nebraska for at least one year immediately prior to the commencement of this action. Neither party is now a party to any other pending action in any court for divorce, legal separation, or dissolution of marriage. Neither party is a member of the Armed Forces of the United States or any of its allies. The Court has jurisdiction of both parties and the subject matter of this action.2.MARRIAGE: The petitioner and the respondent were married on the ___ day of ______________, 20___, in the City of ______________, ______________ County, Nebraska, and separated on the ___ day of ______________, 20___.3. DISSOLUTION: All reasonable efforts to reconcile have been made and there is no reasonable possibility of reconciliation. The marriage is irretrievably broken and should be dissolved. 4.VITAL STATISTICS OF THE PARTIES: The parties’ vital statistics are:Name _________________________ Name _________________________Age ___DOB ______________ Age ___DOB ______________ Page 2 of 3 Social Security number ______________ Social Security number ______________Residence Address___________________ Residence Address _______________________________________________________________________________________Length of Residence in NE ___ Length of Residence in NE ___5.CHILDREN OF THE MARRIAGE: There are no children borne of said marriage or adopted by the parties, and the wife is not now pregnant. 6.WRITTEN AGREEMENT: The Parties have executed a Separation and Property Settlement Agreement disposing of all jointly owned property and settling all jointly owed debts and rights and liabilities of the parties, a copy of which is to be filed with the Court.7. RECORD OF THE PROCEEDINGS: A complete record of the proceedings is hereby waived by both parties.8.RESTORATION OF FORMER NAME: Party _________________________ request restoration of her former name, _________________________ . This request is not made for any illegal or fraudulent reason.WHEREFORE, Petitioner _________________________ request the following relief:(a) A Decree of Dissolution of Marriage dissolving the bonds of matrimony between the parties, the same to become final upon entry.(b)That the Separation and Property Settlement Agreement disposing of all jointly owned property and settling all jointly owed debts and rights and liabilities of the parties, a copy of which is to be filed with the Court, be incorporated into the final judgment of divorce;(c) Party, _________________________, requests that she be restored her maiden name of _________________________.(d)For judgment and relief as set forth in this Petition. Page 3 of 3 (e) For such other relief and judgment as is just and equitable in the premises. Respectfully submitted, _________________________________ Signature of Petitioner__________________________________Print Name STATE OF NEBRASKA COUNTY OF _____________COMES NOW, _________________________, and being first duly sworn, deposes and states that he/she is the Petitioner in the above-entitled action, that he/she has read the foregoing Petition and voluntarily executed the same, and that he/she knows the contents thereof to be true, except as to those items stated on information, and believe those items to be true.Respectfully submitted, _________________________________ Signature of Petitioner__________________________________ Print Name SUBSCRIBED AND SWORN to before me this ___ day of ______________, 20___.(Seal, if any) ______________________________Notary Public My commission expires: Title (and Rank): _______________Print Name: ________________________________________