SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT Domestic Relations Branch PRINT YOUR NAME STREET ADDRESS CITY, STATE AND ZIP CODE _______DRB ___________ RELATED CASES: 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 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 is the proper place 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 Center (revised 10/2016) 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 about the separation: [CHECK ALL THAT APPLY] The separation has been mutual and voluntary, and without cohabitation. The separation has continued without interruption or cohabitation for a period of one year or more immediately before filing this Complaint. 5. 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 my 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 NAME YOU WOULD LIKE THE COURT TO RESTORE Marital Property & Marital Debt 6. I state the following about property from my marriage: [CHECK ONE] My spouse and I have no marital property. My spouse and I have an 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 a written agreement resolving all of our marital property issues and I am not asking the Court to divide or distribute any marital property. DC Bar Pro Bono Center (revised 10/2016) Complaint for Legal Separation Page 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com  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. 7. I state the following about debt from my marriage: [CHECK ONE] My spouse and I have no marital debt. My spouse and I have an agreement resolving all of our marital debt issues and I am not asking the Court to assign responsibility for any marital debt. 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 any marital debt. 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 8. I state the following about my need for alimony from my spouse: [CHECK ONE] I need permanent and/or temporary 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 Center (revised 10/2016) 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. 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 11. I have included the following attachment(s): [CHECK ALL THAT APPLY] No attachments Attachment A (Marital Property and/or Marital Debt) Attachment B (Child Custody) Attachment C (Child Support) DC Bar Pro Bono Center (revised 10/2016) Complaint for Legal Separation Page 4 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Request for Relief I RESPECTFULLY REQUEST that the Court grant me a Legal Separation and [CHECK ALL THAT APPLY] Divide marital property and/or assign marital debts in a manner tha