IN THE CI RC UIT CO URT O F TH E NINETEE N TH J UDI CIAL CI RC UIT LAKE COUNTY, ILLINOIS ) ) _______________________________________ ) Petitioner, ) vs. ) Gen No. __ ______________ ) ) _______________________________________ ) Respondent. ) RESPONSE TO PETITION FOR DISSOLUT I ON OF MARRIAGE I, , the Respo ndent , repr esen ting my self, respon d as f ollows Name to the allegati ons in the petition for dissol ution of marri age. Part A. J u risdicti on 1. Petitioner a. Age - S admits S denie s S unable t o ans w er b. Residenc e - S ad mit s S deni es S unable to ans w er c. Occupation - S admits S de ni es S un able to ans w er 2. Res pon dent a. Age - S admits S denie s S unable t o ans w er b. Residenc e - S ad mit s S deni es S unable to ans w er c. Occupation - S admits S de ni es S un able to ans w er 3. Marri age a. Date married - S admits S de nies S u n a bl e to an swer b. Place married - S admits S de nies S u n a bl e to an swer . 4. Resi de ncy S a. Residence Requirement - Petitioner - S admits S denies S unable to answer S b. Residence Requirement - Res pondent - S admits S denie s S unable t o. 5. Other Procee din g s S a. No other Petition is pending - S admits S denies S unable to answer S b. Another Petition is pending - S admits S denies S unable to answer Part B. C h ildre n/ Related Cases 1. Children ( Respon d to all par a gr aphs c h ecked in the Petitio n): S a. We have no child(ren) together - S admits S denies S unable to ans w er S b. Petitioners pregnancy status - S admits S denies S unable to answer S c. Respondents pregnancy status - S admits S denies S unable to answer ( If no chil d(ren), ski p to Part B , par a gr aph 4 ). American LegalNet, Inc. www.USCourtForms.com Page 1 of 3 174- CSR 201 ( 03/04) >>>> 2 S d. Children of the marriage - S admits S denies S unable to answer S with the following correction(s) : . 2. Cust od y ( Res p on d only to t h e par a gr aph check e d in Petitio n ): S a. Temporary and permanent sole custody of child(ren) - S admits S denies S unable to answer S b. Temporary and permanent joint custody of child(ren) - S admits S denies S unable to ans w er 3. Visit a ti on ( Res po n d only to the par a gr aph c heck e d in Peti ti on ): S a. Deny/Restrict visitation - S admits S denies S unable to answer S b. Grant visitation - S admits S denies S unable to answer 4. Othe r pendin g cas e s - S admits S de ni es S un able to ans w er . Part C. Support (Respond only to the par a graph checked in Petition ) : 1. S a. Respondents employmen t - S ad mit s S deni es S unable to ans w er S b. Respondents ability to contribute - S admits S de nies S u n a bl e to an swer 2. Mainten ance (s upport) for Petitioner - S admits S de nie s S u n abl e to Part D. Property 1. Marital property and debts - S admits S denie s S unable t o ans w er 2. Petitioners non - mari tal propert y - S ad mit s S deni es S unable to ans w er 3. Respo nde nts non-m arital property - S admits S de ni es S un able to ans w er Part E. Grounds for Dissol u tio n of Marriage 1. (Res pond to all par a gr aphs checked in the Petiti on) S a. Irreconcilable Differences (separated in excess of 2 years) - S admits S denies S unable to ans w er S b. Irreconcilabl e Di fferenc e s (separated in excess of 6 mont hs with 2 year waiver) - S admits S denie s S unable t o answer S c. Physical or Men t al Cr uelt y - S admits S deni es S un able t o answer S d. Other Grounds per 750 ILCS 5/401 - S admits S denies S unable to answer Part F. Parties A rrangements (Respond o nly if paragraph checked o n petition) 1. Arrange ments - S admits S de nie s S un abl e to answer Part G. Relief Requested 1. FO R THESE REASONS, I request (chec k all th at apply) : S a. A dismissal of the Petition for Dissolution of Marriage. S b. Sole custody of the minor child(ren). S c. Joint legal custody of the minor child(ren) with S Petitioner S Respondent to be the residen tia l cust odial paren t. American LegalNet, Inc. www.USCourtForms.com Page 2 of 3 174- CSR 201 ( 09/04) >>>> 3 S d. Visitation with the minor child(ren) S e. Child support S f. A fair division of the property or its value acquired during the marriage S g. Maintenance to the Petitioner be S granted S barred S reserved S h. Maintenance to the Respondent be S granted S waived S reserved S i. A change back to my former name be granted Full Former Name S j. Any other appropriate relief. Part H. Additional Facts 1. Respondent states the following additional facts in response to the Petition: (Attach additional pages as needed) Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure,* the undersigned certifies that the statements set fo rth in this instrument are true and correct. Date S ignature P rinted Name * Any person who makes a false statement, material to the issue or point in qu estion, which he does not believe to be true, in any document certified by such person in acco rdance with 735 ILCS 5/1-109 shall be guilty of a Class 3 felony punishable by two (2) to five (5) years imprisonme nt and/or a $10,000.00 fine. Distribution : (3 Copies) U Original to Circuit Clerks Office U Petitioner U Respondent American LegalNet, Inc. www.USCourtForms.com Page 3 of 3 174- CSR201 (09/04)