Minnesota Petition for Dissolution of Marriage Without Children

Petition For Dissolution Of Marriage Without Children

State of Minnesota District Court

In Re the Marriage of:

1. Information about Petitioner

Full Name:

Address where Petitioner lives:

Mailing address: Same as above address OR

Date of Birth:

2. Information about Respondent

Full Name:

Address where Respondent lives:

Respondent's address is unknown to Petitioner.

Respondent’s Date of Birth:

3. Our Marriage

Petitioner and Respondent were married on: in the City of County of State of Country of .

4. 180 Day Requirement

a. Has Petitioner been living in Minnesota for the past six (6) months? YES NO

b. Has Respondent been living in Minnesota for the past six (6) months? YES NO UNKNOWN

c. Petitioners were married in Minnesota but neither resides in Minnesota, nor in a jurisdiction that will allow dissolution because of sex or sexual orientation: YES NO

5. Armed Forces

a. Is Petitioner an active duty member of the armed forces? YES NO

If YES, has Petitioner been stationed in Minnesota for the past six (6) months? YES NO

b. Is Respondent an active duty member of the armed forces? YES NO UNKNOWN

If YES, has Respondent been stationed in Minnesota for the past six (6) months? YES NO

6. Marriage Cannot be Saved

There has been an irretrievable breakdown of my marriage relationship with Respondent and the marriage cannot be saved.

7. Physical Living Situation

Do Petitioner and Respondent live together at this time? YES NO

If NO, the date we separated was:

8. Other Proceedings

Has a separate court case for marriage dissolution, legal separation, or annulment already been started? YES NO

Status: Open Closed I do not know

9. Protection or Harassment Order

Is an Order for Protection or a Harassment/Restraining Order in effect? YES NO

The Order protects: Petitioner Respondent

10. Children

Do Petitioner and Respondent have minor children together? YES NO

Do Petitioner and Respondent have any adult dependent children? YES NO

Has either party given birth during the marriage to a child who is not a child of the other spouse? YES NO

11. Public Assistance / Medical Assistance

Petitioner receives public assistance from the State of Minnesota: YES NO

County:

Check all that apply: MFIP Tribal TANF General Assistance Child Care Assistance Minnesota Care Medical Assistance

12. Supplemental Security Income (SSI)

Petitioner receives SSI: NO YES in the amount of $ per month.

Respondent receives SSI: NO YES in the amount of $ per month, or UNKNOWN

13. Petitioner’s Employment

Is Petitioner employed? YES NO

Is Petitioner self-employed? YES NO

14. Petitioner’s Gross Income

15. Respondent’s Employment

Is Respondent employed? YES NO UNKNOWN

Is Respondent self-employed? YES NO UNKNOWN

16. Respondent’s Gross Income

17. Health Care Coverage

Does Petitioner have insurance through employment? Medical YES NO; Dental YES NO

Does Respondent have insurance through employment? Medical YES NO UNKNOWN; Dental YES NO UNKNOWN

18. Spousal Maintenance

Petitioner and Respondent can each pay their own living expenses and do not need spousal maintenance.

Petitioner or Respondent may need spousal maintenance in the future.

19. Vehicles

Does Petitioner own a vehicle? YES NO

Does Respondent own a vehicle? YES NO UNKNOWN

20. Marital Property

Has the marital property been divided to Petitioner’s satisfaction? YES NO

21. Non-Marital Property

Does Petitioner have non-marital property? YES NO

Does Respondent have non-marital property? YES NO UNKNOWN

22. Cash & Accounts

Does Petitioner have money in banks, savings, cash or investments? YES NO

Does Respondent have money in banks, savings, cash or investments? YES NO UNKNOWN

23. Business Interest

Does Petitioner have an interest in a business? YES NO

Does Respondent have an interest in a business? YES NO UNKNOWN

24. Manufactured Home

Does Petitioner own a manufactured home? YES NO

Does Respondent own a manufactured home? YES NO UNKNOWN

25. Real Property - Land, Buildings, Contracts for Deed

Do Petitioner and Respondent jointly own real property? YES NO

Does Petitioner own real property solely or with someone other than Respondent? YES NO

Does Respondent own real property solely or with someone other than Petitioner? YES NO UNKNOWN

26. Retirement Plans

Does Petitioner have a retirement account? YES NO

Does Respondent have a retirement account? YES NO UNKNOWN

27. Debts

Does Petitioner have debt? YES NO

Does Respondent have debt? YES NO UNKNOWN

28. Name Change

Does Petitioner want to change his/her name? YES NO

Petitioner’s new name:

Former legal name or maiden name? YES NO

29. Other

Requested Relief

Verification and Acknowledgments

STATE OF MINNESOTA ) SS

COUNTY OF

I have read this document and the information is true and correct.

I have not been determined to be a frivolous litigant and am not subject to an order precluding filing.

I am not filing this document for an improper purpose.

I understand I could be prosecuted for perjury if I am not telling the truth.