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- 1 - 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 ( h is )(h er) P etitio n f o r L eg al S ep ara tio n, P etitio ner a lle g es: I. T he t r u e a n d c o rre ct n am es, a d dre sse s, a n d s o cia l s e cu rity n um bers o f P etitio ner a n d Resp ond en t a re : P etiti o ner: _____ ____________________ __________________________________________________S SN : _ ______________ __________ R esp onden t: _____ ____________________ __________________________________________________S SN : _ ______________ __________ II. _ ______________ h as p re v io usly b een k now n ( a s _ ______________)(b y n o o th er n am es) an d _ ______________ h as p re v io usly b een k now n ( a s _ ______________)(b y n o o th er n am es). - 2 - III. P etitio ner(s ) ( is ) ( a re ) b ein g r e p re se n te d i n t h ese p ro ceed in gs b y Attorney's Name , o f , Address_________, City , ST Zip. I V . Petitio ner a n d R esp o nden t a re b oth p ers o ns w ho h av e a tta in ed t h e a g e o f m ajo rity . Pe titio ner i s _ _ __________ ___ ( _ __) y ears o f a g e, a n d ( h is )(h er) d ate o f b ir th i s _ ______________, 20 _ __; R esp on den t i s _ _____ _________ ( _ _) y ears o f a g e, a n d ( h is )(h er) d ate o f b ir th i s __ _____ ________ , 2 0 __. V . Petitio ner a n d R esp o nden t w ere d uly m arrie d o n _ ______________, 2 0__, i n t h e C ity o f __ _____ ________ , C ounty o f _ ______________, S ta te o f _ ______________, a n d e v er s in ce s a id date h av e b een a n d n ow a re h usb an d a n d w if e . V I. P etitio ner i s a r e sid en t o f t h e C ity o f _ ______________, C ounty o f _ ______________, a n d Sta te o f M in neso ta , a n d R esp onden t i s a r e sid en t o f t h e C ity o f _ ______________, C ounty o f __ _____ ________ a n d S ta te o f M in neso ta . V II. N o s e p ara te p ro ceed in g f o r d is so lu tio n, l e g al s e p ara tio n, o r c u sto dy i s p en din g i n a C ourt i n this S ta te o r e ls e w here . V III. P urs u an t t o M in n. S ta t. ? 5 18.0 6, a s a m en ded , t h e p artie s h ere to n eed a l e g al s e p ara tio n. (T he p artie s h av e s e p ara te d a n d h av e b een l iv in g a p art s in ce _ ______________). IX . N eith er p arty i s o r h as b een i n t h e m ilita ry s e rv ic e o f t h e U nite d S ta te s a t a n y t im e w hic h i s re le v an t t o t h is p ro ceed in g. [If a p arty i s o r h as b een i n t h e m ilita ry , s e t f o rth f a cts a n d w aiv er o f a n y r ig hts u nder t h e S old ie r’s an d S ailo r’s C iv il R elie f A ct o f 1 940, a s a m en ded .] - 3 - X. The p artie s h ere to h av e _ ______________ ( _ _) m in or o r d ep en den t c h ild (re n ), n am ely : N am e o f c h ild , b orn _ ______________, 2 0_ _, p re se n tly __ ________ _____ ( _ _) y ears o f a g e; a n dN am e o f c h ild , b orn _ ______________, 2 0_ _, p re se n tly __ ________ _____ ( _ _) y ears o f a g e. T he b est i n te re sts a n d w elf a re o f t h e c h ild (re n ) w ill b e s e rv ed i f _ ______________ ( is )(a re ) g ra n te d __ _____ ________ l e g al c u sto dy a n d _ ______________ ( is )(a re ) g ra n te d _ ______________ ph ysic al c u sto dy, s u bje ct t o ( re aso nab le )(re aso nab le a n d l ib era l) (s u perv is e d ) v is ita tio n b y __ _____ ________ . X I. _ ______________ i s n ot p re g nan t. [ If w if e i s p re g nan t, i n clu de t h at f a ct a n d t h e a n tic ip ate d date o f t h e c h il d 's b ir th .] O R There ( h as)(h av e) b ee n _ ______________ ( _ _) c h ild (re n ) b orn a s i s su e o f t h is m arria g e w ho are n o l o nger m in ors o r d ep en den t u pon t h e p artie s f o r s u pport. O R There a re n o m in or o r d ep en den t c h ild re n o f s a id m arria g e. X I. M in neso ta i s t h e p ro per j u ris d ic tio n w ith in t h e c o nte m pla tio n o f t h e U nif o rm C hild C usto dy Juris d ic tio n A ct t o e n te r a n O rd er r e g ard in g t h e c u sto dy , c are a n d c o ntr o l o f t h e m in or c h ild (re n ). X II. P etitio ner i s e m plo yed a s a _ ______________ b y _ ______________, l o cate d a t __ _____ ________ . ( H e)(S he) h as g ro ss i n co m e o f a p pro xim ate ly $ _______________ p er __ _____ ________ a n d n et i n co m e o f a p pro xim ate ly $ _______________ p er _ ______________. Re sp ond en t i s e m plo yed a s a _ ______________ b y _ ___ ___________ _ ______________, l o cate d at _ _ _____________ . ( H e)(S he) h as g ro ss i n co m e o f a p pro xim ate ly $ _______________ p er - 4 - __ _____ ________ a n d n et i n co m e o f a p pro xim ate ly $ _______________ p er _ ______________. Th e p artie s h av e i n co m e o f $ _______________ p er _ ______________ f ro m _ ______________. __ _____ ________ i s d ep en d en t u pon _ ______________ f o r a c o ntr ib utio n t o ( h is )(h er) s u pport a n d th e s u pport o f t h e m in or c h il d (re n ) o f t h e p artie s. N eith er p arty r e ceiv es p ublic a ssis ta n ce. X III. T he p artie s h ere to a re t h e o w ners o f, o r h av e a n i n te re st i n , t h eir h om este ad l o cate d a t __ _____ ________ , i n t h e C ity o f _ ______________, C ounty o f _ ______________, S ta te o f Min neso ta , a n d l e g ally d esc rib ed a s: [R ecite c o m ple te a n d a ccu ra te l e g al d esc rip tio n h ere .] P etitio ner e sti m ate s t h at t h e p ro perty h as a f a ir m ark et v alu e o f $ _______________, a n d i t i s en cu m bere d b y _ _________ _____ o f a p pro xim ate ly $ _______________ i n f a v or o f __ _____ ________ . [ In dic a te n on-m arita l i n te re st, i f a n y.] X IV . The p artie s h ere to a re t h e o w ners o f, o r h av e a n i n te re st i n , r e al p ro perty l o cate d a t __ _____ ________ , i n t h e C ity o f _ ______________, C ounty o f _ ______________, S ta te o f __ _____ ________ , a n d l e g ally d esc rib ed a s: [R ecite c o m ple te a n d a ccu ra te l e g al d esc rip tio n h ere .] P etitio ner e sti m ate s t h at t h e p ro perty h as a f a ir m ark et v alu e o f $ _______________, a n d i t i s en cu m bere d b y _ _________ _____ o f a p pro xim ate ly $ _______________ i n f a v or o f __ _____ ________ . [ in dic a te n on-m arita l i n te re st, i f a n y.] X V. The p artie s a re t h e o w ners o f, o r h av e a cq uir e d a n i n te re st i n , a sse ts o f ( s u bsta n tia l) v alu e, in clu din g _ __ ___________ _ _ ______________, ( a b usin ess k now n a s _ ______________) a n d (re ti r e m en t a sse ts ). [ In dic ate n on-m arita l c la im s, i f a n y.] X VI. T he p artie s a re t h e o w ners o f p ers o nal p ro perty , h ouse h old g oods, a n d f u rn is h in gs l o cate d i n - 5 - an d a b out t h eir r e sp ectiv e d w ellin gs. X VII. T he p artie s h av e in cu rre d m is c ella n eo us b ills a n d o blig atio ns d urin g th e m arria g e. [ P ro vid e mo re d eta il, i f a p pro pria te .] X VIII. P etitio ner i s s e ek in g a n am e c h an ge f ro m _ ______________ t o _ ______________ s o le ly becau se o f t h is l e g al s e p ara ti o n a n d n ot t o d efra u d o r m is le ad a n yone. X IX . This P etitio n f o r L eg al S ep ara tio n i s f ile d i n g oo d f a ith a n d f o r t h e p urp ose s s e t f o rth h ere in .W HER EFO RE, P etitio ner p ra y s f o r t h e J u dgm en t a n d D ecre e o f t h is C ourt: L EG AL S E PA RATIO N 1. Gra n tin g P etitio ner a D ecre e o f L eg al S ep ara tio n. C UST O DY/V IS IT A TIO N 2. Gra n tin g _ _ _____________ l e g al a n d p hysic al c u sto dy, o f t h e m in or ch ild (re n ) o f t h e p artie s s u bje ct t o _ ______________'s r ig ht t o (re aso nab le )( re aso nab le a n d l ib era l) (s u perv is e d ) v is ita tio n.2. Gra n tin g P etitio ner a n d R esp onden t j o in t l e g al c u sto dy o f t h e m in or ch ild (re n ) o f t h e p artie s, a n d g ra n tin g _ ______________ p hysic al c u sto dy su bje ct t o _ __ ____________'s r ig ht t o ( r e aso nab le )(re aso nab le a n d lib era l) (s u perv is e d ) v is ita tio n.2. Gra n tin g P etitio ner a n d R esp onden t j o in t l e g al a n d p hysic al c u sto dy o f t h e min or c h ild (re n ) o f t h e p artie s.2 . Gra n tin g s u ch c u sto dy, c are a n d c o ntr o l o f t h e m in or c h ild (re n ) o f t h e p artie s as t h e C ourt d eem s i n ( h is )(h er)(th eir ) b est i n te re sts . C H IL D S U PP O RT 3. Ord erin g s u ch s u pport f o r t h e m in or c h il d (re n ) a s t h e C ourt d eem s j u st, f a ir an d e q uita b le .3 . Ord erin g _ __ ____________ t o p ay t o _ ______________ a r e aso nab le s u m of m oney f o r t h e s u pport o f t h e m in or c h ild (re n ) o f t h e p artie s. - 6 - 3. Rese rv in g t h e i s su e o f s u pport f o r t h e m in or c h ild (re n ) o f t h e p artie s. M AIN TEN ANCE 4. Ord erin g s u ch m ain te n an ce a s t h e C ourt d eem s j u st, f a ir a n d e q uita b le .4 . Ord erin g _ __ ____________ t o p ay t o _ ______________ a r e aso nab le s u m of m oney f o r ( p erm an en t) m ain te n an ce.4 . Award in g n eith er p arty m ain te n an ce f ro m t h e o th er.4 . Rese rv in g t h e i s su e o f m ain te n an ce. P R O PE R TY 5. Gra n tin g _ _ _____________ t h e e x clu siv e u se a n d p osse ssio n o f t h e ho m este ad o f t h e p artie s.5 . Allo catin g t h e u se a n d p osse ssio n o f t h e r e al a n d p ers o nal p ro perty o f t h e pa rtie s i n a j u st a n d e q uita b le m an ner.5 . Award in g _ _ _____________ t h e e x clu siv e u se a n d b en efit o f t h e p ers o nal pr o perty i n ( h is )(h er) p osse ssio n o r u nder ( h is )(h er) c o ntr o l.5 . Award in g _ _ _____________ t h e e x clu siv e u se a n d b en efit o f t h e r e al pr o perty i n ( h is )(h er) p osse ssio n o r u nder ( h is )(h er) c o ntr o l.5 . Award in g _ _ _____________(h is )(h er) n on-m arita l i n te re st i n __________ _____. D EBTS 6. Ord erin g a n e q uita b le a n d j u st a llo catio n o f t h e o uts ta n din g b ills a n d ob lig atio ns o f t h e p artie s.6 . Ord erin g _ __ ____________ t o p ay t h e j o in t d eb ts a n d o blig atio ns o f t h e pa rtie s. A TTO RNEY S' F E ES 7. Ord erin g t h at e ach p arty b e r e sp onsib le f o r t h eir o w n a tto rn ey s' f e es a n d s u it co sts i n cu rre d i n cid en t t o t h is p ro ceed in g.7. Ord erin g a n e q uita b le a n d j u st a llo catio n o f t h e a tto rn ey s' f e es a n d s u it c o sts in cu rre d i n cid en t t o t h is p ro ceed in g. - 7 - 7. Ord erin g t h at _ ______________ p ay f o r _ ______________'s a tto rn ey s' f e es an d s u it c o sts i n cu rre d i n cid en t t o t h is p ro ceed in g. N AM E C H AN G E 8. Ord erin g t h at _ ______________'s n am e b e c h an ged f ro m _ ______________ to _ ________ ______.8 . Ord erin g t h at _ ______________'s m aid en n am e, _ ______________, b e re sto re d t o h er. S U CH O TH ER 9. For s u ch o th er a n d f u rth er r e lie f a s t h e C ourt m ay d eem j u st, f a ir a n d eq uita b le i n t h e p re m is e s. D ate d _ ______________ B y____________________________ _________________________________________________Attorney for Petitioner#1 Address#2 AddressCity, State ZipTelephone (____) __________Attorney Reg. No.: ______ - 8 -VER IF IC ATIO N ST A TE O F M IN NESO TA ) ) S S. C O UNTY O F _ _______) _______________ , b ein g f ir s t d uly u pon o ath , d ep ose s a n d s ta te s t h at ( h e)(s h e) i s P etitio ner in t h e a b ove-e n title d a ctio n; t h at ( h e)(s h e) h as r e ad t h e f o re g oin g P etitio n f o r L eg al S ep ara tio n, kn ow s t h e c o n te n ts t h ere o f a n d t h at t h e s a m e i s t r u e a n d c o rre ct, e x cep t a s t o t h ose m atte rs t h ere in sta te d o n i n fo rm atio n a n d b elie f a n d a s t o t h ose m atte rs ( h e)(s h e) b elie v es t h em t o b e t r u e. _ _____________________________[N am e o f C lie n t]P etitio ner D ate d : P etitio ner/R esp onden tS ub sc rib ed a n d s w orn to b efo re m e th is d ay of , 2 0 . _ __ ___ _________________________N OTA RY P U BLIC - 9 - ACK NO W LED G M EN T ST A TE O F M IN NESO TA ) ) S S.C O UNTY O F _ _______ ) Attorney's Name, t h e a tto rn ey f o r P etitio ner i n t h e a b ove-c ap tio ned m atte r, a n d _ _ _____ ________ , P etitio n er h ere in , h ere b y a ck now le d ge t h at p urs u an t t o M in n. S ta t. ? 5 49.2 1, co sts , d is b urs e m en ts , w itn ess f e es a n d r e aso nab le a tto rn ey s' f e es m ay b e a w ard ed t o R esp onden t i n the e v en t P etiti o ner i s f o und t o b e a ctin g i n b ad f a ith a n d/o r a sse rtin g a f riv olo us c la im . ______________________________[N am e o f C lie n t]P etitio ner D ate d : P etitio ner/R esp onden tS ub sc rib ed a n d s w orn to b efo re m e th is d ay o f , 2 0 . _ __ ___ _________________________N OTA RY P U BLIC _ _____________________________A tto rn ey f o r P etitio ner D ate d : P etitio ner/R esp onden tS ub sc rib ed a n d s w orn to b efo re m e th is d ay o f , 2 0 . _ __ ___ _________________________N OTA RY P U BLIC