Separation Divorce

Plaintiff Name (Person Filing for Divorce)

Date of Birth

Email

Phone Number

Current Address Ex: 123 Main Street, Apt 4

City

State PennsylvaniaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zipcode

County of Residence

How long have you lived at this address? 1234567891011121314151617181920

Year(s) Month(s) Week(s) Day(s)

Place of Birth

Race American Indian or Alaska NativeAsianBlack or African AmericanHispanicMiddle Eastern or North AfricanNative Hawaiian or other Pacific IslanderWhite1920

Number of this marriage? 1st2nd3rd4th5th6th7th8th9th10th

Your Occupation

Are You in the Military? Are You in the Military? Yes No

Defendant Name (Spouse of Person Filing for Divorce)

Date of Birth

Email

Phone Number

Spouse's Current Address Ex: 123 Main Street, Apt 4

City

State PennsylvaniaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zipcode

County of Residence

How long have they lived at this address? 1234567891011121314151617181920

Year(s) Month(s) Week(s) Day(s)

Spouse's Place of Birth

Spouse's Race American Indian or Alaska NativeAsianBlack or African AmericanHispanicMiddle Eastern or North AfricanNative Hawaiian or other Pacific IslanderWhite

Number of this marriage? 1st2nd3rd4th5th6th7th8th9th10th

Spouse's Occupation

The date of separation was ON or AFTER December 5, 2016, and my spouse and I have continued to live separate and apart for a period of at least ONE year. The date of separation was ON or AFTER December 5, 2016, and my spouse and I have continued to live separate and apart for a period of at least ONE year. Yes No

Is Your Spouse in the Military? Is Your Spouse in the Military? Yes No

Date of Separation

Date of Marriage

Place of Marriage?

Was there a Civil Ceremony? Was there a Civil Ceremony? Yes No

Was there a Religious Ceremony? Was there a Religious Ceremony? Yes No

Number of Children Born to this Marriage? 012345689710

Number of Children Under 18 years old? 012345689710

Is the Wife of this Marriage Currently Pregnant? Is the Wife of this Marriage Currently Pregnant? Yes No

Wife's Maiden Name

Has a Divorce Been Previously Filed Anywhere in the US? Has a Divorce Been Previously Filed Anywhere in the US? Yes No

If So, Where? PennsylvaniaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming