Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Dissolution Of Marriage Report Form. This is a Connecticut form and can be use in Family Statewide.
Tags: Dissolution Of Marriage Report, JD-FM-181, Connecticut Statewide, Family
DISSOLUTION OF MARRIAGE
REPORT
JD-FM-181 Rev. 4-08
P.B. § 25-58
STATE OF CONNECTICUT
SUPERIOR COURT
www.jud.ct.gov
Instructions
1. To be completed by the Attorney for the Plaintiff or, if a
Self-Represented Person, by the Plaintiff.
2. Clerk to complete section 2.
PART 1 (To be completed by the Attorney for the Plaintiff or if a Self-Represented Person, by the Plaintiff)
Husband
Name of Husband (First, middle, last)
Usual Residence (Number and street)
City or Town
State
County
Birthplace (State or Foreign Country)
Wife
Name of Wife (First, middle, last)
Usual Residence (Number and street)
City or town
State
County
Birthplace (State or Foreign Country)
Place of This Marriage (City)
County
State
Marital History
Date of Marriage (Mo., Day, Year)
Approximate Date Couple Separated (Month, Year)
Number of Children Still Living
Number of Children Born Alive of This Marriage
Plaintiff
Number of Children Under 18 Years of Age
CSSD Family Services Evaluation
Wife
Husband
Yes
CSSD Family Services Mediation
No
Yes
Public Assistance Recipient
No
Amount of Assistance Monthly
No
Yes
Attorney For minor Child(ren)
Guardian Ad Litem For Minor Child(ren)
Yes
No
Yes
Attorney For Plaintiff (If Applicable) (Name)
No
Attorney's Address (If Applicable) (No., street, city, state, zip code)
Information For Statistical Purposes Only:
(To be completed by the Attorney for the Plaintiff or, if a Self-Represented Person, by the Plaintiff)
For Husband
If Previously Married,
How Many Ended By
Divorce or
Death
Annulment
For Husband
For Husband
Elementary
(0,1,2,3, thru 8)
Husband
High School
(1,2,3, or 4)
Husband
College
(1,2,3, 4 or 5+)
Husband
For Wife
For Wife
Wife
Wife
Wife
Number of This
Marriage (First,
Second, etc. specify)
For Wife
Education - Specify Highest Grade Completed
PART 2 (To be completed by the Clerk of Superior Court)
Date of Decree (Mo., Day, Year)
Type of Decree
Date Writ Returnable (Month, Year)
Decree
Absolute Divorce
County of Decree
Annulment
Docket Number
Legal Grounds for Dissolution (Specify)
FA
Case Contested
Yes
Custody of Minor Children To
No
Decree Granted To
Husband
Husband
Title of Official
Wife
Joint
Not Applicable
Signed(Clerk or Assistant Clerk)
Wife
American LegalNet, Inc.
www.FormsWorkflow.com