DIV802 State ENG Rev 11/18www.mncourts.gov/formsPage 1 of 22State of Minnesota District CourtCounty of: Select County Judicial District: Court File Number: Assigned Judge: Case Type: Dissolution with Children In Re the Marriage of: Name of Petitioner (first, middle, last)and Name of Respondent (first, middle, last)Petition For Dissolution Of Marriage With Children1. Information about the PetitionerFull Name: First Middle LastAddress where you live: Street Address Apt. No. City County State Zip CodeMailing address: Same as above address OR Street Address Apt. No. City County State Zip Code Date of Birth:List all of Petitioner's former or other names or write "None": First Middle Last First Middle LastPetitioner's social security number is listed on Confidential Form 11.1 and submitted along with the Petition. American LegalNet, Inc. www.FormsWorkFlow.com DIV802 State ENG Rev 11/18www.mncourts.gov/formsPage 2 of 222. Information about the RespondentFull Name: First Middle LastAddress: Street Address Apt. No. City County State Zip Code Respondent's address is unknown to Petitioner. Respondent's Date of Birth:List all of Respondent's former or other names or write "None": First Middle Last First Middle Last3. Our Marriage Petitioner and Respondent were married on (month, day, year) in the City of , County of, State , Country of.4. 180 Day Requirementa. Has Petitioner been living in Minnesota for the past six (6) months? YES NOb. Has Respondent been living in Minnesota for the past six (6) months? YES NO UNKNOWNc. Petitioner and Respondent were married in Minnesota, but neither Petitioner nor Respondent reside in Minnesota, nor reside in a jurisdiction that will allow us to maintain an action for dissolution because of the sex or sexual orientation of the Petitioner and Respondent. YES NO5. Armed Forcesa. Is Petitioner an active duty member of the armed forces? YES NOb. Is Respondent an active duty member of the armed forces? YES NO UNKNOWN American LegalNet, Inc. www.FormsWorkFlow.com DIV802 State ENG Rev 11/18www.mncourts.gov/formsPage 3 of 226. Marriage Cannot be SavedThere has been an irretrievable breakdown of my marriage relationship with Respondent and the marriage cannot be saved.7. Physical Living Situationa. Do the Petitioner and Respondent 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 or Respondent in Minnesota or elsewhere? YES NOb. Has a County started a Support case involving the Petitioner and the Respondent or their children? YES NO9. Protection or Harassment Ordera. Is an Order for Protection or a Harassment/Restraining Order in effect regarding Petitioner and Respondent? YES NO10. Child Protection Court Casea. Is a child protection case involving Petitioner and Respondent's children taking place in Minnesota or another state? YES NO11. Children Petitioner and Respondent Have Together (Joint Children) "Child" means a living person under the age 18, or under age 20 and still in high school.a. Are there any children born to or adopted by Petitioner and Respondent together, either before or during the marriage? YES NOb. Has each child born to or adopted by Petitioner and Respondent together lived in Minnesota for the past six (6) months? YES NO12. Adult Dependent Childrena. Is there an adult joint child born to or adopted by Petitioner and Respondent who is not able to support him/herself because of a physical or mental condition? YES NO13. Pregnancya. Is Petitioner pregnant? YES NO American LegalNet, Inc. www.FormsWorkFlow.com DIV802 State ENG Rev 11/18www.mncourts.gov/formsPage 4 of 22b. Is Respondent pregnant? YES NO14. Petitioner's Children from Other Relationship (Non-Joint Children)a. Does Petitioner have minor children born prior to the marriage from another marriage or relationship? YES NOb. Has Petitioner given birth, since marrying Respondent, to a minor child who is not a child of the Respondent? YES NO15. Respondent's Children from Other Relationship (Non-Joint Children)a. Does Respondent have minor children born prior to the marriage from another marriage or relationship? YES NO UNKNOWNb. Has Respondent given birth, since marrying Petitioner, to a minor child who is not a child of the Petitioner? YES NO16. Custody It is in the child's best interests that legal custody be granted as follows: (check one) Joint legal custody to both parents Sole legal custody to Petitioner Respondent It is in the child's best interests that physical custody be granted as follows: (check one) Joint physical custody to both parents Sole physical custody to Petitioner Respondent17. Parenting TimePetitioner'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 reservedRespondent's parenting time with the joint children should be: (check one) unsupervised supervised reserved18. Public Assistance from the State of MinnesotaIf either party is receiving public assistance from the State of Minnesota or applies for it after this proceeding is started, the Petitioner must give notice of this marriage dissolution action to the Public Authority in the county paying for the assistance.a. Does Petitioner receive public assistance from the State of Minnesota? YES NOb. Does Respondent receive public assistance from the State of Minnesota? YES NO UNKNOWN American LegalNet, Inc. www.FormsWorkFlow.com DIV802 State ENG Rev 11/18www.mncourts.gov/formsPage 5 of 22c. Do the joint children of the parties receive public assistance from the State of Minnesota? YES NO UNKNOWN19. 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. Does Petitioner receive Supplemental Security Income (SSI)? YES NOb. Does Respondent receive Supplemental Security Income (SSI)? YES NOc. Do any of the joint children of the parties receive Supplemental Security Income (SSI)? YES NO20. SchoolIs Petitioner currently enrolled in school? YES NOIs Respondent currently enrolled in school? YES NO UNKNOWN21. Petitioner's Employmenta. Is Petitioner employed? YES NOb. Is Petitioner self-employed? YES NOc. Is Petitioner working at least 40 hours per week? YES NOd. Current Employment: (If Petitioner has more than two jobs at this time, use an attachment for the additional jobs.) Name of Petitioner's Employer (If self-employed, list name and business address) Address City State Zip Code Name of Petitioner's Employer (If self-employed, list name and business address) Address City State Zip Code American LegalNet, Inc. www.FormsWorkFlow.com DIV802 State ENG Rev 11/18www.mncourts.gov/formsPage 6 of 22 Questions about Current Jobs Are you paid by the hour or do you have a salary? What is the average number of hours you work per week? How much overtime pay do you receive per week on average? 1st Job Do you receive bonuses? hourly salary hourly salary 2nd Job hours hours Yes No If Yes, how much did you receive in bonuses last year? How much do you expect to receive this year? If Yes, how much did you receive in bonuses last year? How much do you expect to receive this year? 22. Petitioner's IncomeNOTE: There is a separate form called Financial Affidavit which you must fill out, serve on your spouse, and file with the court at the time you file this Petition. You must include proof of your income with the Financial Affidavit. If you do not have income in a category, enter zero (0). Do not list public assistance benefits as income (e.g., MFIP, GA, SSI). Source of Income Amount Per Month (or zero) before deductions/taxesSelf Employment Income per month.Self Employment income means gross receipts minus costs of goods sold, minus ordinary and necessary business expenses. Include Schedule C from last year's tax return to this Petition. Job with per month.Your monthly income from a job = Hourly wage x Hours worked per week x 4.33 (weeks per month) Second job with per month. Third job with per month.Commissions from all jo