DIV1702 State ENG Rev 5/19www.mncourts.gov/formsPage 1 of 38State of Minnesota District CourtCounty of: Select County Judicial District: Court File Number: Case Type: Dissolution with Children In Re the Marriage of: Name of Petitioner A (first, middle, last)and Name of Petitioner B (first, middle, last)Joint Petition, Agreement, and Judgment and Decree for Marriage Dissolution With Children1. Information about Petitioner A:Full Name: First Middle LastAddress: Street Address Apt. No. City County State Zip Code Date of Birth:Petitioner A's former or other names or write "None"": First Middle Last First Middle LastPetitioner A's social security number is listed on Confidential Form 11.1 and submitted along with the Joint Petition.2. Information about Petitioner B:Full Name: First Middle LastAddress: Street Address Apt. No. American LegalNet, Inc. www.FormsWorkFlow.com DIV1702 State ENG Rev 5/19www.mncourts.gov/formsPage 2 of 38 City County State Zip Code Date of Birth:Petitioner B's former or other names or write "None"": First Middle Last First Middle LastPetitioner B's social security number is listed on Confidential Form 11.1 and submitted along with the Joint Petition.3. Our Marriage Petitioners were married on (month, day, year) in the City of , County of, State of , Country of.4. 180 Day Requirementa. Petitioner A has been living in Minnesota for the past six (6) months: YES NOb. Petitioner B has been living in Minnesota for the past six (6) months: YES NOc. Petitioners were married in Minnesota, but neither Petitioner A nor Petitioner B reside in Minnesota, nor reside in a jurisdiction that will maintain an action for dissolution because of the sex or sexual orientation of the Petitioners. YES NO5. Armed Forcesa. Petitioner A is an active duty member of the armed forces: YES NOb. Petitioner B is an active duty member of the armed forces: YES NO6. Marriage Cannot be SavedThere has been an irretrievable breakdown of our marriage relationship.7. Physical Living SituationDo the Petitioner A and Petitioner B live together at this time? YES NO8. Other Proceedingsa. Has a separate court case for marriage dissolution, legal separation, custody, paternity or annulment already been started by Petitioner A or Petitioner B in Minnesota or elsewhere? YES NO American LegalNet, Inc. www.FormsWorkFlow.com DIV1702 State ENG Rev 5/19www.mncourts.gov/formsPage 3 of 38b. Has a County started a Support case involving the Petitioner A and the Petitioner B or their children? YES NO9. Protection or Harassment Ordera. An Order for Protection or a Harassment/Restraining Order in effect regarding Petitioner A and Petitioner B: YES NO10. Child Protection Casea. Has a child protection case involving Petitioner A and Petitioner B's children taken place in Minnesota or another state? YES NO11. Children Petitioner A and Petitioner B have Together (Joint Children) "Child" means a living person under the age 18, or under age 20 and still in high school.a. List all joint children born before the marriage or born or adopted during the marriage. If there are no joint children, or if a spouse is not currently pregnant, you are using the wrong form. Use Joint Petition, Agreement and Judgment and Decree Without Children. Full Name of ChildDate of BirthAgeChild Currently Lives With Petitioner A Petitioner B Both parentsOR (write in name) Petitioner A Petitioner B Both parentsOR (write in name) Petitioner A Petitioner B Both parentsOR (write in name) Petitioner A Petitioner B Both parentsOR (write in name) American LegalNet, Inc. www.FormsWorkFlow.com DIV1702 State ENG Rev 5/19www.mncourts.gov/formsPage 4 of 38 Petitioner A Petitioner B Both parentsOR (write in name)The social security number of the children are listed on Confidential Form 11.1 and submitted along with the Joint Petition. If a child is living with someone other than a parent, write the child's address below:Address : Street Address Apt. No. City County State Zip Codeb. Has each child born to or adopted by Petitioner A and Petitioner B together lived in Minnesota for the past six (6) months? YES NO12. Adult Dependent Children: Child support may be ordered for a joint child over the age of 18 who cannot support him/herself because of a physical or mental condition.a. Is there an adult joint child born to or adopted by Petitioner A and Petitioner B who is not able to support him/herself because of a physical or mental condition? YES NO13. Pregnancya. Is Petitioner A pregnant? YES NOb. Is Petitioner B pregnant? YES NO14. Petitioner A's Children from Other Relationship (Non-joint Children)a. Does Petitioner A have minor children born prior to the marriage from another marriage or relationship? YES NOb. Has Petitioner A given birth during the marriage to a minor child who is not a child of Petitioner B? YES NO15. Petitioner B's Children from Other Relationship (Non-joint Children)a. Does Petitioner B have minor children born prior to the marriage from another marriage or relationship? YES NOb. Has Petitioner B given birth during the marriage to a minor child who is not a child of Petitioner A? YES NO16. Custody American LegalNet, Inc. www.FormsWorkFlow.com DIV1702 State ENG Rev 5/19www.mncourts.gov/formsPage 5 of 38It is in the child's best interests and we agree that legal custody be granted as follows: (check one) Joint legal custody to both parents Sole legal custody to Petitioner A Petitioner B It is in the child's best interests and we agree that physical custody be granted as follows: (check one) Joint physical custody to both parents Sole physical custody to Petitioner A Petitioner B17. Parenting TimePetitioner A's parenting time with the joint children should be: (check one)If parenting time is unsupervised for both parents, skip to Question 18. unsupervised supervised reservedFor supervised parenting time answer a and b. For reserved parenting time, answer c. (Option 1) Supervision is necessary because unsupervised parenting time is likely to endanger the child's physical or emotional health or impair the child's emotional development. The circumstances supporting this finding are: (Option 2) We agree that supervised parenting time is necessary because It is in the best interests of the children that Petitioner A's parenting time be supervised as follows: (State who should supervise the parenting time, and if there is a cost involved, who should pay the cost and any other important details) c. We agree that Petitioner A's parenting time should be reserved because: Petitioner B's parenting time with the joint children should be: (check one) unsupervised supervised reservedFor supervised parenting time answer a and b. For reserved parenting time, answer c. (Option 1) Supervision is necessary because unsupervised parenting time is likely to endanger the child's physical or emotional health or impair the child's emotional development. The circumstances supporting this finding are: (Option 2) We agree that supervised parenting time is necessary because American LegalNet, Inc. www.FormsWorkFlow.com DIV1702 State ENG Rev 5/19www.mncourts.gov/formsPage 6 of 38 b. It is in the best interests of the children that Petitioner B's parenting time be supervised as follows: (State who should supervise the parenting time, and if there is a cost involved, who should pay the cost and any other important details) c. We agree that Petitioner B's parenting time should be reserved because: 18. Public AssistanceIf either party is receiving public assistance from the State of Minnesota or applies for it after this proceeding is started, notice of this marriage dissolution action must be given to the county's collections and support office. See Minn. Stat. 518A.44.a. Petitioner A receives public assistance from the State of Minnesota: YES NOb. Petitioner B receives public assistance from the State of Minnesota: YES NOc. The joint children of the parties receive public assistance from the State of Minnesota: YES NO19. Supplemental Security Income (SSI)Supplemental Security Income (SSI) is a Federal income supplement program. It is available to low-income people if they are over age 65, or blind or disabled.a. Petitioner A receives