Minnesota Dissolution of Marriage with Children

Findings of Fact, Conclusions of Law, Order for Judgment, Judgment and Decree

State of Minnesota

In Re the Marriage of:

Name of Petitioner (first, middle, last):

and

Name of Respondent (first, middle, last):

A. This proceeding for dissolution of marriage came before the undersigned judge of district court on at in the State of Minnesota.

Petitioner did did not appear. Respondent did did not appear. appeared as attorney for

B. Petitioner is NOT represented by an attorney OR Petitioner is represented by the following attorney:

C. Respondent is NOT represented by an attorney OR Respondent is represented by the following attorney:

D. Service of the Summons and Petition for Dissolution of Marriage:

Respondent was personally served on .

Respondent signed an Admission of Service on .

Respondent was served by alternate means as ordered by the court as follows:

By mailing the Summons and Petition to Respondent at the address(es) stated in the Order for Service by Alternate Means on this date:

By publication of the Summons in newspaper for 3 consecutive weeks, once each week, on the following 3 dates: , , and .

E. Petitioner was served with an Answer and Counter-Petition: YES NO

If YES, Petitioner was served with the Answer and Counter-Petition on

F. Respondent did not respond, so Petitioner proceeded by default.

Findings of Fact

1. Information about Petitioner

Full Name:

Address:

Mailing address same as above: Same as above OR

Date of Birth:

2. Information about Respondent

Full Name:

Address:

Respondent's address is unknown.

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

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

Respondent has been living in Minnesota for the past six (6) months YES NO UNKNOWN

5. Armed Forces

Petitioner is 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

Respondent is 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 the marriage relationship and the marriage between Petitioner and Respondent cannot be saved.

7. Physical Living Situation

The Petitioner and Respondent live together at this time. YES NO

If NO, the date of separation was:

8. Other Proceedings

9. Protection or Harassment Order

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

10. Child Protection Court Case

There is a Child Protection court case involving the parties’ joint children. YES NO

11. Children Petitioner and Respondent have Together (Joint Children)

12. Adult Dependent Children

13. Pregnancy

Petitioner is pregnant.

If Petitioner is pregnant, due date:

Do Petitioner and Respondent agree spouse is biological father? YES NO

Respondent is Pregnant. NO UNKNOWN

If Respondent is pregnant, due date:

14. Petitioner’s Children from Other Relationship (Non-Joint Children)

15. Respondent’s Children from Other Relationship (Nonjoint Children)

16. Custody

Legal custody: Joint legal custody to both parents Sole legal custody to Petitioner Sole legal custody to Respondent

Physical custody: Joint physical custody to both parents Sole physical custody to Petitioner Sole physical custody to Respondent

17. Parenting Time

Petitioner's parenting time shall be: Unsupervised Supervised Reserved

Respondent's parenting time shall be: Unsupervised Supervised Reserved

18. Public Assistance from State of Minnesota

Petitioner receives public assistance: YES NO

Respondent receives public assistance: YES NO UNKNOWN

Joint children receive public assistance: YES NO UNKNOWN

19. Supplemental Security Income (SSI)

Petitioner receives SSI: NO YES

Respondent receives SSI: NO YES

Joint children receive SSI: NO YES

20. School

21. Petitioner’s Employment

Petitioner is employed. YES NO

22. Petitioner’s Income

23. Living Expenses for the Family

24. Expenses for Special Needs for the Children

25. Respondent’s Employment

Respondent is employed. YES NO UNKNOWN

26. Respondent’s Income

27. Child Care Costs

28. Health Care Coverage

29. Spousal Maintenance

30. Vehicles

31. Marital Property

32. Non-Marital Property

33. Cash & Accounts – Not including Pension and Employer-Funded Retirement Accounts

34. Business Interest

35. Manufactured Home

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

37. Retirement Plans

38. Debts

39. Name Change

Petitioner wants to change name: YES NO

Petitioner’s new name:

Respondent wants to change name: YES NO

Respondent’s new name:

40. Other Findings

Conclusions of Law

1. The bonds of matrimony between Petitioner and Respondent are dissolved.

2. Legal custody determinations:

3. Physical custody determinations:

4. Parenting time:

5. Basic support for the joint children:

6. Health care coverage for the joint children:

7. Uninsured and unreimbursed medical and dental expenses:

8. Health care coverage for the parties:

9. Child care support:

10. Spousal maintenance:

11. Vehicles:

12. Marital property:

13. Non-marital property:

14. Cash and accounts:

15. Business:

16. Manufactured home:

17. Real property:

18. Additional real property:

19. Retirement funds:

20. Debts:

21. Name change:

22. Paternity questions:

23. Other: