Free Microsoft Word - DIV202 - Minnesota

State of Minnesota
County
Select County

District Court
Judicial District: Court File Number: Case Type: Dissolution

In Re the Marriage of:

First Middle Husband's Name and

Last

Joint Petition for Summary Dissolution of a Marriage (Minn. Stat. §518.195)
Last

First Middle Wife's Name

YOU MUST TYPE OR PRINT CLEARLY IN BLACK INK. COURT PERSONNEL ARE NOT PERMITTED TO HELP YOU IN FILLING OUT THIS FORM.

Husband and Wife state that the following information is true: 1. Husband's full name is:
First Middle Last

1a.

Husband has been known by the following other names:
First Middle Last

1b.

Husband's current residential address:
Number and Street City, State, and Zip Code

1c. 1d. 1e.

Husband resides in the following County: Husband's date of birth is:
Month, Day, and Year

Husband's telephone number: Work: Home:

DIV202

State

ENG

Rev 10/08

www.mncourts.gov/forms

Page 1 of 13

2.

Wife's full name is:
First Middle Last

2a.

Wife has been known by the following other names:
First Middle Last

2b.

Wife's current residential address:
Number and Street City, State, and Zip Code

2c. 2d.

Wife resides in the following County: Wife's date of birth is:
Month, Day, and Year

2e.

Wife's telephone number:

Work: Home:

3.

Husband and Wife were married on:
Month, Day, and Year

4.

Husband and Wife were married at:
City and State

5.

Answer all of the following that apply: Husband (please initial) Yes No 5a. Husband has lived in Minnesota for at least six (6) months immediately before filing this Petition. Wife has lived in Minnesota at least six (6) months immediately before filing this Petition. Husband has been a member of the armed services stationed in Minnesota for at least six (6) months immediately before filing this Petition. Wife has been a member of the armed services stationed in Minnesota for at least six (6) months immediately before filing this Petition. ____ ____ Wife (please initial) Yes No ____ ____

5b.

____ ____

____

____

5c.

____ ____

____

____

5d.

____ ____

____

____

5e.

Husband has lived temporarily outside the state, ____ ____ but he has remained a resident of Minnesota for at least six (6) months immediately before filing this petition.
ENG Rev 10/08 www.mncourts.gov/forms

____

____

DIV202

State

Page 2 of 13

5f.

Wife has lived temporarily outside the state, but she has remained a resident of Minnesota for at least six (6) months immediately before filing this petition.

Please Initial Husband Wife Yes No Yes No ____ ____ ____ ____

6.

Answer the following: 6a. Husband and Wife together have living minor children. ____ ____ ____ ____

6b.

Wife has given birth during the marriage to children who are not children of the Husband.

____ ____

____

____

7. 8.

Wife is pregnant. Check each of the following: 8a. Has the Husband or Wife ever been the victim of domestic abuse by the spouse? Has the Husband or Wife ever obtained a court order for protection from the spouse?

____ ____

____

____

____ ____

____

____

8b.

____ ____

____

____

9.

Is there another court action in a court of this state or any other state for dissolution of this marriage, legal separation or custody? Husband and Wife agree that there has been an irretrievable breakdown of the marriage and ask that the court dissolve the marriage. Complete the following: 11a. Do the Husband and Wife together own or have any type of ownership interest in real estate (such as a lot, a farm, a house, a townhouse, timeshare, condominium, or any other type of building)?

____ ____

____

____

10.

____ ____

____

____

11.

____ ____

____

____

11b.

Does the Husband by himself or with another ____ ____ (not including Wife) own or have any type of ownership interest in real estate (such as a lot, a farm, a house, a townhouse, timeshare, condominium, or any other type of building)?

____

____

DIV202

State

ENG

Rev 10/08

www.mncourts.gov/forms

Page 3 of 13

Please Initial Husband Wife Yes No Yes No 11c. Does the Wife by herself or with another (not ____ ____ including Husband) own or have any type of ownership interest in real estate (such as a lot, a farm, a house, a townhouse, timeshare, condominium, or any other type of building)? ____ ____

12. 13. 14.

Husband has non-marital property which has total value of $ Wife has non-marital property which has total value of $

. .

Enter total present value of all marital property of Husband and Wife, including automobiles and pensions: $ . Enter total amount of money the Husband and Wife presently owe excluding vehicle debt: $ Husband and Wife agree that the property is to be divided as follows: Please Initial Husband Wife Yes No Yes No 16a. Husband and wife know the value of your spouse's pension, 401K or retirement accounts. ____ ____ ____ ____

15.

.

16.

DIV202

State

ENG

Rev 10/08

www.mncourts.gov/forms

Page 4 of 13

List all property below.

Place the Present Value of the property below. Present Value

Place that portion of the present value of the item again in the column below for the person who will receive the item. Awarded to Husband Awarded to Wife

Item 1. 1. 2. 2. 3. 3. 4. 4. 5. 5. 6. 7. 8. 9. 10. 11. Pensions--Husband Pensions--Wife Profit Sharing--Husband Profit Sharing--Wife IRA's--Husband IRA's--Wife Keogh Plans--Husband Keogh Plans--Wife Deferred Income--Husband Deferred Income--Wife Savings/Checking Stocks and Bonds Life Insurance Business Interests Household Goods Cars, Trucks & Vans

12.

Other Vehicles

SUBTOTAL

DIV202

State

ENG

Rev 10/08

www.mncourts.gov/forms

Page 5 of 13

List all property below.

Place the present value of the item below. Present Value

Item 13. Miscellaneous

Place that portion of the present value of the item again in the column below for the person who will receive the item. Awarded to Awarded to Husband Wife

SUBTOTAL TOTAL: (Add the SUBTOTAL amounts from Pages 5 and 6 and fill them in here.)

DIV202

State

ENG

Rev 10/08

www.mncourts.gov/forms

Page 6 of 13

17. Husband shall pay the following debts (credit cards, loans, etc.), and he must pay the Wife if she pays any of these debts:
Creditor Amount Owed

TOTAL

DIV202

State

ENG

Rev 10/08

www.mncourts.gov/forms

Page 7 of 13

18. Wife shall pay the following debts (credit cards, loans, etc.), and she must pay the Husband if he pays any of these debts:
Creditor Amount Owed

TOTAL

DIV202

State

ENG

Rev 10/08

www.mncourts.gov/forms

Page 8 of 13

19.

Answer each of the following: 19a. 19b. 19c. 19d. Husband's current gross monthly income is: $ Wife's current gross monthly income is: $ Husband's current monthly living expenses are: $ Wife's current monthly living expenses are: $

20.

Check only one of the following: Please Initial Husband Wife Yes No Yes No 20a. Husband and Wife will each be responsible for their own health insurance. Husband will continue to carry health insurance for the Wife through his group plan. Wife will pay all the costs of continued coverage. Wife will continue to carry health insurance for the Husband through her group plan. Husband will pay all of the costs of continued coverage. ____ ____ ____ ____

20b.

____ ____

____

____

20c.

____ ____

____

____

21.

If Husband or Wife or both want to change his or her present name to a former name, listed on line 1a or 2a of this form, complete the following: 21a. After the dissolution, the name the Husband will have is: First Middle Last

Husband is/is not a convicted felon. If Husband is a felon, Husband has complied with Minn. Stat. Section 259.13 by serving notice of the name change on the proper authorities, thirty days have lapsed since notice was given, and the prosecuting authority has not filed an objection. Husband has no intent to defraud or mislead anyone by changing his name. 21b. After the dissolution, the name Wife will have is:

First

Middle

Last

Wife is/is not a convicted felon. If Wife is a felon, Wife has complied with Minn. Stat. Section 259.13 by serving notice of the name change on the proper authorities, thirty days have lapsed since notice was given, and the prosecuting authority has not filed an objection. Wife has no intent to defraud or mislead anyone by changing her name.

DIV202

State

ENG

Rev 10/08

www.mncourts.gov/forms

Page 9 of 13

I. Verification of Husband
STATE OF MINNESOTA) ) ss. COUNTY OF )

I, First Middle Last

, being first duly sworn on oath states that each of

the following statements are true: (1) (2) (3) (4) (5) I am the Husband filing this Joint Petition for Summary Dissolution. I have read this Joint Petition for Summary Dissolution of Marriage. I know and understand the contents of this Joint Petition. I know the contents of this Joint Petition are true to the best of my knowledge and belief. I have fully and honestly disclosed all income, debts, cash, and property, including pensions, 401k and retirement accounts, to my Wife before completing this Joint Petition. If I am asking for a name change, I am not asking for the name change in order to avoid any responsibilities. I understand that the right to receive spousal maintenance is specifically reserved. This means that Husband or Wife may, at some future time, seek to receive some spousal support maintenance from the other, depending on the circumstances of each. I understand that this Joint Petition does not dissolve the marriage unless it is found to qualify for the Summary Dissolution of Marriage Process. I also understand that I am still married and this Joint Petition is not effective until the court administrator has entered judgment in the official record. I ask for a decree dissolving my marriage according to the terms in this Joint Petition. I understand that this petition includes all the agreements between Husband and Wife and the court will not enforce any agreements not included.

(6)

(7)

(8)

(9)

(10) (11)

DIV202

State

ENG

Rev 10/08

www.mncourts.gov/forms

Page 10 of 13

Dated:
Husband's Signature (Sign only in front of notary public or court administrator.)

Name: Subscribed and sworn to before me Date:
Notary Public \ Deputy Court Administrator

Mailing Address: City/State/Zip: Telephone:

WARNING!! DO NOT ASSUME THIS DISSOLUTION IS FINAL UNTIL YOU HAVE RECEIVED WRITTEN NOTICE FROM THE COURT ADMINISTRATOR THAT JUDGMENT HAS BEEN ENTERED AND YOUR MARRIAGE IS DISSOLVED.

DIV202

State

ENG

Rev 10/08

www.mncourts.gov/forms

Page 11 of 13

II. Verification of Wife STATE OF MINNESOTA COUNTY OF ) ) )

I, First Middle Last

, being first duly sworn on oath states that

Each of the following statements are true: (1) (2) (3) (4) (5) I am the Wife filing this Joint Petition for Summary Dissolution. I have read this Joint Petition for Summary Dissolution of Marriage. I know and understand the contents of this Joint Petition. I know the contents of this Joint Petition are true to the best of my knowledge and belief. I have fully and honestly disclosed all income, debts, cash, and property, including pensions, 401K and retirement accounts, to my Husband before completing this Joint Petition. If I am asking for a name change, I am not asking for the name change in order to avoid any responsibilities. I understand that the right to receive spousal maintenance is specifically reserved. This means that Husband or Wife may, at some future time, seek to receive some spousal support maintenance from the other, depending on the circumstances of each. I understand that this Joint Petition does not dissolve the marriage unless it is found to qualify for the Summary Dissolution of Marriage Process. I also understand that I am still married and this Joint Petition is not effective until the court administrator has entered judgment in the official record. I ask for a decree dissolving my marriage according to the terms in this Joint Petition. I understand that this petition includes all the agreements between Husband and Wife and the court will not enforce any agreements not included.

(6)

(7)

(8)

(9)

(10) (11)

DIV202

State

ENG

Rev 10/08

www.mncourts.gov/forms

Page 12 of 13

Dated:
Wife's Signature (Sign only in front of notary public or court administrator.)

Name: Subscribed and sworn to before me Date:
Notary Public \ Deputy Court Administrator

Mailing Address: City/State/Zip: Telephone:

WARNING!! DO NOT ASSUME THIS DISSOLUTION IS FINAL UNTIL YOU HAVE RECEIVED WRITTEN NOTICE FROM THE COURT ADMINISTRATOR THAT JUDGMENT HAS BEEN ENTERED AND YOUR MARRIAGE IS DISSOLVED.

DIV202

State

ENG

Rev 10/08

www.mncourts.gov/forms

Page 13 of 13