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The Family Court of East Baton Rouge Parish, State of Louisiana

Louisiana Civil Code Article 102 Divorce Form
(If there are no minor children of the marriage)
_____________________________________
Petitioner

Suit Number __________________ Division ______________________ Judge ________________________

VS. _____________________________________
Respondent

Note: Must be completed by mover's attorney and filed in open court on the date RULE is fixed for hearing. (If attorney for absentee involved, he/she must testify in open court.)

A. The Petition CCP Art. 3951
1. 2. 3. 4. 5. 6. 7. 8. 9. Date the PETITION was filed: Is the PETITION in the record? Is the proper jurisdiction expressly alleged in the PETITION? Is the proper venue expressly alleged in the PETITION? Is the PETITION verified by the petitioner? Date the PETITION was served on the defendant: Is the Sheriff's return in the record showing SERVICE? Is the waiver of service in the record? Is it expressly alleged in a pleading that there are no minor children of the marriage? __________DATE __________ YES __________ YES __________ YES __________ YES __________DATE __________ YES __________ YES __________ YES __________DATE __________DATE __________ YES

B. Rule To Show Cause CCP Art. 3952
10. Date the parties physically separated: 11. Date the RULE was filed: 12. Is the RULE in record? 13. Does the RULE allege: (a) proper service of the PETITION or waiver of service of the PETITION? (b) that 180 days or more have elapsed since service or execution of a written waiver of service of the PETITION? (c) that the parties have lived separate and apart continuously for the 180 days previous to the filing of the RULE? 14. Is the RULE verified by the affidavit of the Petitioner? 15. Was the RULE filed within 2 years of service of the PETITION or execution the of written waiver of service of the PETITION? 16. Is the sheriff's return of service of the RULE in the record? 17. Is the waiver of service of the RULE in the record?

__________ YES __________ YES __________ YES __________ YES __________ YES __________ YES __________ YES

C. Affidavit Of Mover CCP Art. 3956(5)
18. Does the record contain the AFFIDAVIT of the mover executed AFTER the RULE was filed and specifically states that: (a) the parties have lived separate and apart continuously for at least 180 days prior to filing of the RULE? __________ YES (b) the parties are living apart at the time of execution of the AFFIDAVIT? __________ YES (c) the mover desires to be divorced? __________ YES 19. Was the AFFIDAVIT executed AFTER the RULE was filed? __________ YES
I hereby certify that I have examined the record in the above captioned case and the information is accurate. This certification is made to the court for use in the determination of eligibility for divorce in accordance with the provisions of Article 102 of the Louisiana Civil Code, the Louisiana Code of Civil Procedure Articles 3951 et seq., and revised statutes.

___________________________
Date of Record Examination

_________________________
Signed by (Attorney for Mover)

__________________
Bar Number

___________________________
Date of Certification

_________________________
Address

__________________
Telephone Number

Form G(1), Louisiana Civil Code Article 102 and Code of Civil Procedure Articles 3951 et seq., For Petitions filed after December 31, 2006 Form revised: January, 2007