COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT Domestic Relations Branch ________________________________________ PRINT YOUR NAME ________________________________________ STREET ADDRESS ________________________________________ CITY, STATE AND ZIP CODE SUBSTITUTE ADDRESS: CHECK BOX IF YOU HAVE WRITTEN SOMEONE ELSE’S ADDRESS BECAUSE YOU FEAR HARASSMENT OR HARM. PLAINTIFF, v. ________________________________________ PRINT YOUR SPOUSE’S NAME DR _____________________ Related Cases: _____________________________ _____________________________ ________________________________________ STREET ADDRESS ________________________________________ CITY, STATE AND ZIP CODE DEFENDANT. COMPLAINT FOR LEGAL SEPARATION Action Involving Child Support yes no I, _________________________________, am the Plaintiff in this case and state that PRINT YOUR NAME 1. This Court has the authority to decide my request for legal separation and related issues because [CHECK ALL THAT APPLY] I have been a resident of the District of Columbia for more than six months immediately before filing this Complaint. My spouse has been a resident of the District of Columbia for more than six months immediately before filing this Complaint. DC Bar Pro Bono Program (revised 9-2011) Complaint for Legal Separation Page 1 of 7 American LegalNet, Inc. www.FormsWorkFlow.com 2. My spouse and I were married [CHECK ONE] by ceremony on ______________________, in ______________________________. DATE CITY AND STATE by common law on or about ___________________, in _______________________. DATE CITY AND STATE 3. My spouse and I separated on or about _________________________________________. DATE 4. I state the following with regard to my married name: [CHECK ONE] I did not change my name when I married my spouse. I changed name when I married my spouse. I do not wish to return to a former name. I changed my name when I married my spouse and I now wish to return to my birth name or another legal name I used before my marriage. I have no illegal or fraudulent reason for making this request. The former name I want restored is: _______________________________________________________________________. PRINT THE FORMER NAME YOU WOULD LIKE THE COURT TO RESTORE Marital Property & Marital Debt 5. I state the following about property from my marriage: [CHECK ONE] My spouse and I have no marital property. My spouse and I may have marital property, but I am not asking the Court to divide or distribute it. My spouse and I have a written agreement resolving all of our marital property issues and I am not asking the Court to divide or distribute any marital property. My spouse and I have marital property that I am asking the Court to divide or distribute, and I have completed and attached the additional information required on Attachment A, which I incorporate into this Complaint. I am not sure if my spouse and I have marital property. DC Bar Pro Bono Program (revised 9-2011) Complaint for Legal Separation Page 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com 6. I state the following about debt from my marriage: [CHECK ONE] My spouse and I have no marital debt. My spouse and I may have marital debt, but I am not asking the Court to assign responsibility for it. My spouse and I have a written agreement resolving all of our marital debt issues and I am not asking the Court to assign responsibility for it. My spouse and I have marital debt that I am asking the Court to assign responsibility for, and I have completed and attached the additional information required on Attachment A, which I incorporate into this Complaint. I am not sure if my spouse and I have marital debt. Alimony 7. I state the following about my need for temporary financial support from my spouse until the time the Court grants my legal separation: [CHECK ONE] I need temporary financial support and will file a separate motion (“Motion for Temporary Alimony”) asking the Court to grant this request. I do not want temporary financial support at this time. 8. I state the following about alimony: [CHECK ONE] I need alimony from my spouse and I believe my spouse has the ability to pay alimony to me. I do not want my spouse to pay alimony to me. Custody 9. I state the following about our child(ren) who are under the age of 18: [CHECK ONE] My spouse and I do not have any children together (through birth or adoption) who are under the age of 18. My spouse and I do have children together (through birth or adoption) who are under the age of 18, but I am not asking the court to decide custody at this time. DC Bar Pro Bono Program (revised 9-2011) Complaint for Legal Separation Page 3 of 7 American LegalNet, Inc. www.FormsWorkFlow.com My spouse and I do have children together (through birth or adoption) who are under the age of 18, and we have a written agreement about custody; I am not asking the court to decide custody at this time. My spouse and I do have children together (through birth or adoption) who are under the age of 18, and I am asking the court to decide custody. I have completed and attached the additional information required on Attachment B, which I incorporate into this Complaint. Child Support 10. My spouse has the legal obligation to contribute to the support of our child(ren) who are 21 years old or younger or who are adult disabled children. 11. I state the following about my request for child support: [CHECK ONE] My spouse and I do not have any children together (through birth or adoption), or our children together are over the age of 21 years and are not adult disabled children. My spouse and I do have children together (through birth or adoption) who are under the age of 21 or who are adult disabled children, but I am not asking the Court to award child support at this time. My spouse and I do have children together (through birth or adoption) who are under the age of 21 or who are adult disabled children, and we have an agreement regarding child support; that agreement is consistent with the Child Support Guideline of the District of Columbia and/or it is fair and just. My spouse and I do have children together (through birth or adoption) who are under the age of 21 or who are adult disabled children, and I am asking the Court to award child support, and I have completed and attached the additional information required on Attachment C, which I incorporate into this Complaint. Attachments 12. I have included the following attachment(s): No attachments Attachment A (Marital Property and/or Marital Debt) Attachment B (Child Custody) Attachment C (Child Support) DC Bar Pro Bono Program (revised 9-2011) Complaint for Legal Separation Page 4 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Request for Relief I RESPECTFULLY REQUEST that [CHECK ALL THAT APPLY] The Court grant me a Legal Separation. The Court divide marital property and/or assign marital debts in a manner that is equitable, just and reasonable. The Court award alimony in a manner that is fair and just. The Court award custody in the best interests of the child(ren). The Court hold a hearing on my request for child support within 45 days of filing and issue a Notice of Hearing and Order Directing Appearance (“NHODA”) to the other parent with the date and time of the hearing. The Court award child support according to the Child Support Guideline of the District of Columbia and other applicable laws, including: current child support (support starting today and continuing into the future) retroactive child support (support for time before today) medical support The Court include our Settlement Agreement as a part of its order. not include our Settlement Agreement as a part of its order. The Court restore me to my former name. I ALSO REQUEST that the Court award any other relief it considers fair and proper. [CHECK ONE] I do not know of any proceedings in the District of Columbia or in any state or territory involving the same claim or subject matter as this case. I do know of proceedings in the District of Columbia or in any state or territory involving the same claim or subject matter as this case, as listed on the first page of this Complaint (“Related Cases”). DC Bar Pro Bono Program (revised 9-2011) Complaint for Legal Separation Page 5 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Respectfully Submitted, ____________________________________ SIGN YOUR NAME ___________________________________________ STREET ADDRESS ___________________________________________ CITY, STATE AND ZIP CODE ___________________________________________ TELEPHONE NUMBER SUBSTITUTE ADDRESS: CHECK BOX IF YOU HAVE WRITTEN SOMEONE ELSE’S ADDRESS BECAUSE YOU FEAR HARASSMENT OR HARM. I, _________________________________, solemnly swear or affirm under criminal penalties for the making of a false statement that I have read the foregoing Complaint for Legal Separation and that the factual statements made in it are true to the best of my personal knowledge, information and belief. ___________________________________, Plaintiff ________________________ SIGN YOUR NAME DATE ___________________________________ PRINT YOUR NAME DC Bar Pro Bono Program (revised 9-2011) Complaint for Legal Separation Page 6 of 7 American LegalNet, Inc. www.FormsWorkFlow.com RULE 4 CERTIFICATE OF SERVICE WHEN YOU FILE YOUR COMPLAINT, THE FAMILY COURT CENTRAL INTAKE CENTER WILL GIVE YOU A SUMMONS THAT YOU MUST SERVE ON THE OTHER PARTY WITH A COPY OF YOUR COMPLAINT. YOU MUST SERVE THE OTHER PARTY BEFORE THE SUMMONS EXPIRES IN 60 DAYS. IF YOU ARE UNABLE TO SERVE THE OTHER PARTY WITHIN THE 60 DAYS, YOU CAN ASK THE FAMILY COURT CENTRAL INTAKE CENTER TO GIVE YOU ANOTHER SUMMONS. THE SECOND SUMMONS IS CALLED AN “ALIAS SUMMONS.” YOU MUST ASK FOR THE ALIAS SUMMONS BEFORE THE FIRST SUMMONS EXPIRES. HERE ARE THE WAYS YOU CAN SERVE YOUR COMPLAINT AND THE SUMMONS: by having someone else, who is over 18 years old and not a party to the case (NOT you), hand it to the other party; or by having someone else, who is over 18 years old and not a party to the case (NOT you), leave a copy at the other party’s home with a person of suitable age and discretion who lives there; or by mailing it to the other party by certified mail, return receipt requested. IF THE RETURN RECEIPT (“GREEN CARD”) COMES BACK TO YOU, FILE IT WITH THE FAMILY COURT CENTRAL INTAKE CENTER BY ATTACHING IT TO AN “AFFIDAVIT OF RETURN OF SERVICE BY CERTIFIED MAIL.” AFTER YOU SERVE THE OTHER PARTY, YOU MUST COMPLETE THE CERTIFICATE OF SERVICE PORTION FOUND AT THE BOTTOM OF THE SUMMONS AND FILE IT WITH THE FAMILY COURT CENTRAL INTAKE CENTER. DC Bar Pro Bono Program (revised 9-2011) Complaint for Legal Separation Page 7 of 7 American LegalNet, Inc. www.FormsWorkFlow.com