Fill and Sign the Decree of Dissolution of Marriage and Settlement Agreement Form

Form #PS-3115 2-1 Approved b y State Cour t Administration 02/10 ) SS: IN RE THE MARRIAGE OF: Petitioner, V. Respondent. DECREE OF DISSOLUTION O F M ARRIAGE AND S ETT LEME NT AGRE EMENT The parties having sub mitted their Settlem ent Agreem ent and the Cou rt hav ing see n and considered the Verified Petition for Dissolution of Marriage and Veri fied W aiver of Final Hearing subm itted by the par tie s, now approves the f ollo wing agree ment: 1. The parties were m arried on ________________, and separated on ________________. 2. ____________________________________________________________ has been a continuous resident of ____________________ County for the last three months, and the State of Indiana for the last six m onths prio r to the filing of the Verified Petition for Dissolution of Marriage. 3. W ife is not pregnant and there are n o child ren of the m arriag e. 4. Neither p arty is a m ember of the m ilita ry. 5. The parties have agreed on th e following debt division: The parties already have divided their debts. Petitioner w ill b e solely responsib le fo r and shall hold Respondent harm less from , the following debts: Name of Creditor Amount of Debt ______________________________ __________________ ______________________________ __________________ ______________________________ __________________ STATE OF INDIANA ) IN THE ___________________ SUPERIOR/CIRCUIT COURT COUNTY OF _______________ ) CASE NO. ________________ ______________________ ______________________ Form #PS-3115 2-1 Approved b y State Cour t Administration 02/10 Respondent will be so lely responsib le for, and shall ho ld Petitioner harm less from the following debts: Name of Creditor Amount of Debt ______________________________ __________________ ______________________________ __________________ ______________________________ __________________ 6. The parties have agreed on th e following vehicle division: There are no vehicles to divide. Petitioner w ill h ave sole possession o f the following vehicles, and Respondent shall execute all do cum ents neces sary to transf er title of said vehicles within thirty (30) days of the date of this Order: ___________________________________________________ Vehicle #1, Make, Model, and Year ___________________________________________________ Vehicle #2, Make, Model, and Year Respondent will have sole possess ion of the following vehicles, and Petitioner shall execute all do cum ents neces sary to transf er title of said vehicles within thirty (30) days of the date of this Order: ___________________________________________________ Vehicle #1, Make, Model, and Year ___________________________________________________ Vehicle #2, Make, Model, and Year 7. The parties have agreed on th e following property division: The parties already have divi ded all item s of property. Petitioner w ill h ave sole possession o f the f ollowing item s of property : Respondent will have so le posses sio n of the following item s of property: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Form #PS-3115 2-1 Approved b y State Cour t Administration 02/10 8. The m arriage has suffered an irretrieva ble breakdown and should be dissolved. 9. Change of nam es: W ife would like her m aiden nam e or previous m arried nam e of ____________________________________________________________ restored to he r. W ife does not want to change her nam e. The parties have disclosed all relevant docum en ts and exchanged all inform ation on value of property, pensions, real estate, and other assets and debts. T he part ies ag ree th at th is division of property is/is not an approxim ate e qual division of the assets and debt s. The parties agree that if this division is not a nearly equal division, that the deviation from the presum ptive equal division should be accepted by the Court b ecause it is the partie s’ agreem ent and neither party has been forced or th reatened to accept this ag reem ent. I affirm under the penalties of perjury th at the foregoing repres entations are true. ______________________________ Your Signature STATE OF INDIANA ) ) SS: COUNTY OF ____________ ) Before m e, ____________________, a notary public in and for ____________ County, State of Indiana, personally appeared _________________________, and he being first duly sworn upon his/her oath, says that the facts allege d in the foregoing instrum ent are true. Date ________________ __________________________________ NOTARY PUBLIC MY COMM ISSION EXPIRES: _________________________ ______________________________ Spouse’s Signature STATE OF INDIANA ) ) SS: COUNTY OF ____________ ) Before m e, __________________, a notary public in and for ______________ County, State of Indiana, personally appeared _________________________, and he being first duly sworn upon his/her oath, says that the facts allege d in the foregoing instrum ent are true. Date ________________ __________________________________ NOTARY PUBLIC MY COMM ISSION EXPIRES: _________________________ Form #PS-3115 2-1 Approved b y State Cour t Administration 02/10 IT IS THEREFORE ORDERED by the Court that the parties’ m arriage is hereby dissolved, and the terms of their agreem ent as set out a bove shall be incorporated into this Order. ________________________________ _________________________________ Date Judge Distribu tion : _____________________________________ _____________________________________ Type or Print Name Type or Print Name _____________________________________ _____________________________________ Street Address Street Address _____________________________________ _____________________________________ City, State and Zip Code City, State and Zip Code