Fill and Sign the Mn Separation Agreement Form

STATE OF MINNESOTA DISTRICT COURT COUNTY OF JUDICIAL DISTRICT FAMILY COURT DIVISION In Re the Marriage of: Court File No. , Petitioner, PETITION FOR LEGAL SEPARATION AND , Respondent, For (his)(her) Petition for Legal Separation, Petitioner alleges: I . The true and correct names, addresses, and social security numbers of Petitioner and Respondent are: Petitioner: _________________________ _________________________ _________________________ SSN: _________________________ Respondent: _________________________ _________________________ _________________________ SSN: _________________________ II . _______________ has previously been known (as _______________ )(by no other names) and _______________ has previously been known (as _______________ )(by no other names). - 1 - III . Petitioner(s) (is) (are) being represented in these proceedings by Attorney's Name , of , Address_________ , City , ST Zip . IV . Petitioner and Respondent are both persons who have attained the age of majority. Petitioner is _______________ ( ___ ) years of age, and (his)(her) date of birth is _______________ , 20 ___ ; Respondent is _______________ ( __ ) years of age, and (his)(her) date of birth is _______________ , 20 __ . V . Petitioner and Respondent were duly married on _______________ , 20 __ , in the City of _______________ , County of _______________ , State of _______________ , and ever since said date have been and now are husband and wife. VI . Petitioner is a resident of the City of _______________ , County of _______________ , and State of Minnesota, and Respondent is a resident of the City of _______________ , County of _______________ and State of Minnesota. VII . No separate proceeding for dissolution, legal separation, or custody is pending in a Court in this State or elsewhere. VIII . Pursuant to Minn. Stat. ?518.06, as amended, the parties hereto need a legal separation. (The parties have separated and have been living apart since _______________ ). IX . Neither party is or has been in the military service of the United States at any time which is relevant to this proceeding. [If a party is or has been in the military, set forth facts and waiver of any rights under the Soldier’s and Sailor’s Civil Relief Act of 1940, as amended.] - 2 - X . The parties hereto have _______________ ( __ ) minor or dependent child(ren), namely: Name of child, born _______________ , 20 __ , presently _______________ ( __ ) years of age; and Name of child, born _______________ , 20 __ , presently _______________ ( __ ) years of age. The best interests and welfare of the child(ren) will be served if _______________ (is)(are) granted _______________ legal custody and _______________ (is)(are) granted _______________ physical custody, subject to (reasonable)(reasonable and liberal)(supervised) visitation by _______________ . XI. _______________ is not pregnant. [If wife is pregnant, include that fact and the anticipated date of the child's birth.] OR There (has)(have) been _______________ ( __ ) child(ren) born as issue of this marriage who are no longer minors or dependent upon the parties for support. OR There are no minor or dependent children of said marriage. XI . Minnesota is the proper jurisdiction within the contemplation of the Uniform Child Custody Jurisdiction Act to enter an Order regarding the custody, care and control of the minor child(ren). XII . Petitioner is employed as a _______________ by _______________ , located at _______________ . (He)(She) has gross income of approximately $ _______________ per _______________ and net income of approximately $ _______________ per _______________ . Respondent is employed as a _______________ by _______________ _______________ , located at _______________ . (He)(She) has gross income of approximately $ _______________ per - 3 - _______________ and net income of approximately $ _______________ per _______________ . The parties have income of $ _______________ per _______________ from _______________ . _______________ is dependent upon _______________ for a contribution to (his)(her) support and the support of the minor child(ren) of the parties. Neither party receives public assistance. XIII . The parties hereto are the owners of, or have an interest in, their homestead located at _______________ , in the City of _______________ , County of _______________ , State of Minnesota, and legally described as: [Recite complete and accurate legal description here.] Petitioner estimates that the property has a fair market value of $ _______________ , and it is encumbered by _______________ of approximately $ _______________ in favor of _______________ . [Indicate non-marital interest, if any.] XIV . The parties hereto are the owners of, or have an interest in, real property located at _______________ , in the City of _______________ , County of _______________ , State of _______________ , and legally described as: [Recite complete and accurate legal description here.] Petitioner estimates that the property has a fair market value of $ _______________ , and it is encumbered by _______________ of approximately $ _______________ in favor of _______________ . [indicate non-marital interest, if any.] XV . The parties are the owners of, or have acquired an interest in, assets of (substantial) value, including _______________ _______________ , (a business known as _______________ ) and (retirement assets). [Indicate non-marital claims, if any.] XVI . The parties are the owners of personal property, household goods, and furnishings located - 4 - in and about their respective dwellings. XVII . The parties have incurred miscellaneous bills and obligations during the marriage. [Provide more detail, if appropriate.] XVIII . Petitioner is seeking a name change from _______________ to _______________ solely because of this legal separation and not to defraud or mislead anyone. XIX . This Petition for Legal Separation is filed in good faith and for the purposes set forth herein. WHEREFORE, Petitioner prays for the Judgment and Decree of this Court: LEGAL SEPARATION 1 . Granting Petitioner a Decree of Legal Separation. CUSTODY/VISITATION 2 . Granting _______________ legal and physical custody, of the minor child(ren) of the parties subject to _______________ 's right to (reasonable) (reasonable and liberal)(supervised) visitation. 2. Granting Petitioner and Respondent joint legal custody of the minor child(ren) of the parties, and granting _______________ physical custody subject to _______________ 's right to (reasonable)(reasonable and liberal) (supervised) visitation. 2. Granting Petitioner and Respondent joint legal and physical custody of the minor child(ren) of the parties. 2. Granting such custody, care and control of the minor child(ren) of the parties as the Court deems in (his)(her)(their) best interests. CHILD SUPPORT 3. Ordering such support for the minor child(ren) as the Court deems just, fair and equitable. 3. Ordering _______________ to pay to _______________ a reasonable sum of money for the support of the minor child(ren) of the parties. 3. Reserving the issue of support for the minor child(ren) of the parties. - 5 - MAINTENANCE 4. Ordering such maintenance as the Court deems just, fair and equitable. 4. Ordering _______________ to pay to _______________ a reasonable sum of money for (permanent) maintenance. 4. Awarding neither party maintenance from the other. 4. Reserving the issue of maintenance. PROPERTY 5. Granting _______________ the exclusive use and possession of the homestead of the parties. 5. Allocating the use and possession of the real and personal property of the parties in a just and equitable manner. 5. Awarding _______________ the exclusive use and benefit of the personal property in (his)(her) possession or under (his)(her) control. 5. Awarding _______________ the exclusive use and benefit of the real property in (his)(her) possession or under (his)(her) control. 5. Awarding _______________ (his)(her) non-marital interest in _______________ . DEBTS 6. Ordering an equitable and just allocation of the outstanding bills and obligations of the parties. 6. Ordering _______________ to pay the joint debts and obligations of the parties. ATTORNEYS' FEES 7. Ordering that each party be responsible for their own attorneys' fees and suit costs incurred incident to this proceeding. 7. Ordering an equitable and just allocation of the attorneys' fees and suit costs incurred incident to this proceeding. 7. Ordering that _______________ pay for _______________ 's attorneys' fees and suit costs incurred incident to this proceeding. - 6 - NAME CHANGE 8. Ordering that _______________ 's name be changed from _______________ to _______________ . 8. Ordering that _______________ 's maiden name, _______________ , be restored to her. SUCH OTHER 9. For such other and further relief as the Court may deem just, fair and equitable in the premises. Dated _______________ By____________________________ _______________________________ __________________ Attorney for Petitioner #1 Address #2 Address City, State Zip Telephone ( ____ ) __________ Attorney Reg. No.: ______ - 7 - VERIFICATION STATE OF MINNESOTA) ) SS. COUNTY OF ________) _______________ , being first duly upon oath, deposes and states that (he)(she) is Petitioner in the above-entitled action; that (he)(she) has read the foregoing Petition for Legal Separation, knows the contents thereof and that the same is true and correct, except as to those matters therein stated on information and belief and as to those matters (he)(she) believes them to be true. ______________________________ [Name of Client] Petitioner Dated: Petitioner/Respondent Subscribed and sworn to before me this day of , 20 . _______________________________ NOTARY PUBLIC - 8 - ACKNOWLEDGMENT STATE OF MINNESOTA ) ) SS. COUNTY OF ________ ) Attorney's Name , the attorney for Petitioner in the above-captioned matter, and _______________ , Petitioner herein, hereby acknowledge that pursuant to Minn. Stat. ?549.21, costs, disbursements, witness fees and reasonable attorneys' fees may be awarded to Respondent in the event Petitioner is found to be acting in bad faith and/or asserting a frivolous claim. ______________________________ [Name of Client] Petitioner Dated: Petitioner/Respondent Subscribed and sworn to before me this day of , 20 . _______________________________ NOTARY PUBLIC ______________________________ Attorney for Petitioner Dated: Petitioner/Respondent Subscribed and sworn to before me this day of , 20 . _______________________________ NOTARY PUBLIC - 9 -