Free IN THE SUPERIOR COURT FOR THE STATE OF ALASKA - Alaska

Case Type: DIS

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Dissolution of the Marriage of ) ) ) ) and ) ) , ) ) ) )

CASE NO. PETITION FOR DISSOLUTION OF MARRIAGE

Husband and Wife.

We consent to the court's jurisdiction and request a decree of dissolution of marriage pursuant to AS 25.24.200-.260. An incompatibility of temperament has caused the irremediable breakdown of our marriage. We agree that this petition constitutes the entire agreement between us. We understand that agreements not written in this petition or its attachments will not be enforceable. I. INFORMATION ABOUT PETITIONERS Has either spouse filed an action for legal separation prior to the filing of this action? Yes No. If yes, please list case number, date and place of filing: TYPE OR PRINT IN BLACK INK

A. Children 1. Are there any children under age 19 who were born to the wife or adopted during the time you were married? Yes No 2. Is the wife now pregnant? Yes No

If you checked "yes" in response to either of the above questions, you should not use this form. You must use Packet No. 1 unless the paternity of the husband has been legally disestablished. (If it has been, attach to this petition a copy of the documentation disestablishing paternity.) B. Husband 1. Length of residence in Alaska: 2. Residence address: (street address) 3. Home phone: 4. Mailing address: (box or street number) 5. Occupation: (city) Work phone: (state) (ZIP) (city) (state) (ZIP)

Husband's Signature
Page 1 of 7 DR-100 (10/06)(cs) PETITION FOR DISSOLUTION OF MARRIAGE (NO CHILDREN)

Wife's Signature
AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)(B), (i)(1)

C. Wife 1. Length of residence in Alaska: 2. Residence address: (street address) 3. Home phone: 4. Mailing address: (box or street number) 5. Occupation: D. Date and place of marriage: E. Does either spouse require medical care or treatment? Yes No (city) (state) (ZIP)

(city) Work phone:

(state)

(ZIP)

If yes, state which spouse and describe the care or treatment required:

Is either spouse covered by health insurance (through an employer or otherwise)? Yes No. If yes, state which spouse and the amount paid for the insurance by the spouse or spouses:

F. Have any of the following been issued or filed during the marriage by or regarding either spouse as defendant, participant, or respondent: 1. a criminal charge of a crime involving domestic violence; 2. a domestic violence protective order under AS 18.66.100 - 18.66.180; 3. injunctive relief against domestic violence under former AS 25.35.010 or 25.35.020; or 4. a domestic violence protective order issued in another jurisdiction and filed with the court in this state under AS 18.66.140? Yes No If yes, describe:

Has there been any domestic violence during the marriage (whether or not a complaint was filed)? Yes No G. Has either spouse received advice from legal counsel about a divorce or dissolution? Yes No If yes, state which spouse(s): Is either spouse represented by legal counsel? If yes, state which spouse(s): Yes No

Husband's Signature
Page 2 of 7 DR-100 (10/06)(cs) PETITION FOR DISSOLUTION OF MARRIAGE (NO CHILDREN)

Wife's Signature
AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)(B), (i)(1)

II.

FINANCIAL INFORMATION AND AGREEMENT OF PETITIONERS Each party must attach a copy of his or her most recent federal tax return and most recent pay stubs to verify income and deductions. The following income and deductions are monthly If your work is seasonal, show yearly income. A. Gross Income (Do not list ATAP or SSI below.) Husband Gross wages Value of employer-provided housing/food/etc. Unemployment compensation Permanent fund dividend Other: $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Wife yearly.

TOTAL INCOME B. Deductions: Federal income tax Social security tax Medicare tax Employment security tax Mandatory retirement deductions Mandatory union dues Other mandatory deductions (Specify):

$ $ $ $ $ $ $ $ $ $

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $

Child support/alimony ordered in other cases and currently being paid TOTAL DEDUCTIONS C. Net Income TOTAL INCOME from section A TOTAL DEDUCTIONS from section B Subtract deductions from income to get NET INCOME

$ $ $ $ $

Husband's Signature
Page 3 of 7 DR-100 (10/06)(cs) PETITION FOR DISSOLUTION OF MARRIAGE (NO CHILDREN)

Wife's Signature
AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)(B), (i)(1)

D. Monthly Expenses Housing & Utilities Food Transportation Medical Other $ $ $ $ $ $ $ $

Husband $ $ $ $ $ $ $ $

Wife

TOTAL

E. Assets [Describe your property and its value. Then check the boxes showing whether it was acquired during the marriage, who owns it now and to whom you want it awarded.] 1. Do you have a written community property agreement or a community property trust under Alaska law (AS 34.77)? Yes No Be sure to include any community property in the lists below. Acquired To Be During Presently Awarded 2. Real Property (land & buildings). Marriage Owned By To Legal description required. Value yes no H W JT H W JT $ $ $ $ $ $ $ $ 3. Motor Vehicles (include make, model, vehicle ID/serial number and license number of each vehicle, mobile home, ATV, boat and snow machine) Value $ $ $ $ $ $ $

Acquired During Marriage yes no

Presently Owned By H W JT

To Be Awarded To H W JT

Husband's Signature
Page 4 of 7 DR-100 (10/06)(cs) PETITION FOR DISSOLUTION OF MARRIAGE (NO CHILDREN)

Wife's Signature
AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)(B), (i)(1)

4. Other Personal Property (household furnishings, appliances, jewelry, computers, guns, tools, bank accounts, etc.) For bank, credit union, or other financial institution accounts, you may list the last 3 digits of the account number & name of financial institution. Value $ $ $ $ $ $ $ 5. Retirement Benefits.

Acquired During Marriage yes no

Presently Owned By H W JT

To Be Awarded To H W JT

Neither spouse has earned retirement or military pension benefits during the marriage. Our agreement about the distribution of retirement or military pension benefits is attached. If this agreement is not accepted by the retirement plan administrator as a qualified domestic relations order, we agree that the court, upon motion by a party, may make any necessary corrections. We agree any such court-ordered modifications will be effective retroactive to the date of the original dissolution decree. A copy of the present value statement from the plan administrator for each retirement account is attached. 6. Title transfer. All transactions necessary to effect any transfers required by the above agreements will be completed by . (date) F. Debts. [List to whom each debt is owed and the amount owed. Then check the boxes showing whether the debt was incurred during the marriage, who now owes the debt and who you agree will be responsible for paying it. For credit card, bank card or debit card accounts, you may list the last 4 digits of the account number & the name of the issuing institution.] Incurred During Presently To Be Marriage Owed By Paid By Amount yes no H W JT H W JT Owed To $ $ $ $ $ $ $ We believe the above division of assets and debts is fair and just.

Husband's Signature
Page 5 of 7 DR-100 (10/06)(cs) PETITION FOR DISSOLUTION OF MARRIAGE (NO CHILDREN)

Wife's Signature
AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)(B), (i)(1)

III.

SPOUSAL MAINTENANCE (ALIMONY): $ Husband

per month to be paid by Wife, beginning until or until the recipient dies or remarries.

IV.

RESTORATION OR CHANGE OF NAME. Restoration. Petitioner wants a prior name restored as follows: (Print full names clearly.) From: (wife's current full name) From: (husband's current full name) To: (husband's prior full name) To: (wife's prior full name)

Change. [Before checking this box, it is important to read pages 10-11 of the instructions about publication costs and hearing delay.] Petitioner (current legal name) known by a new name, which is The reasons for this request for a change of name are: wants to take and be legally

Petitioner seeks this name change for personal reasons and not to avoid judgments, debts, obligations, or to defraud any person. The reasons stated are consistent with the public interest. V. OTHER AGREEMENTS.

Husband's Signature
Page 6 of 7 DR-100 (10/06)(cs) PETITION FOR DISSOLUTION OF MARRIAGE (NO CHILDREN)

Wife's Signature
AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)(B), (i)(1)

X. SIGNATURES AND VERIFICATIONS. Do not sign until this petition has been completely filled out. Each signature on this page must be individually notarized. Verification I say on oath or affirm under penalty of perjury that I have read the foregoing petition and believe all statements made in the petition are true. I further certify that my signature is voluntary and not the result of fear, threat, coercion or restraint. I further state that this petition contains the entire agreement between my spouse and me. Husband's Signature Date Subscribed and sworn to or affirmed before me at , Alaska, on . Wife's Signature Date Subscribed and sworn to or affirmed before me at , Alaska, on .

Clerk of Court, Notary Public or other person authorized to administer oaths. My commission expires: (SEAL)

Clerk of Court, Notary Public or other person authorized to administer oaths. My commission expires: (SEAL)

Page 7 of 7 DR-100 (10/06)(cs) PETITION FOR DISSOLUTION OF MARRIAGE (NO CHILDREN)

AS 25.24.200-.260 Civil Rule 90.1(a), f(2)(A)(B), (i)(1)