Rule 17.100--Form 101: Petition for Dissolution of Marriage with no Minor or Dependent Adult Children Read the Guide to Representing Yourself in an Iowa Divorce Case on the Iowa Judicial Branch website before using this form. Do not use this form if any of the following are true: You are not married. Neither you nor your spouse has lived in Iowa for the last year before filing this Petition. Petitioner or Respondent is pregnant. There are children 18 years of age or older (born or adopted) who still need support (for example, the child is in high school or college, or is disabled). There are children under the age of 18 who are children (born or adopted) of both spouses before or during the marriage, even if Petitioner or Respondent is not the natural parent. If filing electronically, you must provide any protected information in full on form 111. If filing in paper, you may use form 111 to provide any protected information in full. If you do not understand how to use this form, or if you should use this form, talk to an attorney. In the Iowa District Court for County where you are filing this Petition County In Re the Marriage of: Your current legal name Your spouse's current legal name Upon the Petition of For clerk's use only Petitioner Your full name: first, middle, last Petition for Dissolution of Marriage with no Minor or Dependent Adult Children and concerning Respondent Your spouse's full name: first, middle, last 1. Personal Information Fill in all information that you know. If you have been assaulted by your spouse and you fear for your safety, you may leave your street address, phone number, and email blank. A. Petitioner's (your) birth year and present residence: Birth year Petitioner's present street address County City State ZIP code ( ) Email address Phone number B. Respondent's (your spouse's) birth year and present residence: Birth year Respondent's present street address County City State ZIP code ( ) Email address Phone number If you need assistance to participate in court due to a disability, contact the disability coordinator at: (_______) __________________ Persons who are hearing or speech impaired may call Relay Iowa TTY (1-800-735-2942). Disability coordinators cannot provide legal advice. Disability coordinator contact information available at: http://www.iowacourts.gov/Administration/Directories/ADA_Access/ . November 2013 Rule 17.100--Form 101 Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.100--Form 101: Petition for Dissolution of Marriage with no Minor or Dependent Adult Children, continued 2. General Information About the Marriage and the Parties A. Date and location of the marriage , Month Day Year City State B. Children Check all that are true (1) (2) (3) (4) There are no children under the age of 18 who are children of both Petitioner and Respondent. There are no children under the age of 18 who were adopted or born during this marriage. There are no children 18 years of age or older who still need support. Neither Petitioner nor Respondent is pregnant. C. Petitioner's residence You cannot get a divorce in Iowa if your spouse does not live in Iowa and you have lived in Iowa for less than one year, or if you came to live in Iowa just to get a divorce. If you have questions about this, talk to an attorney. (1) The only reason that Petitioner (you are Petitioner) is living in Iowa is just to get a divorce. True False If you do not live in Iowa, or if you live in Iowa for reasons other than just to get a divorce, check "False." years and months (2) Petitioner has lived in Iowa for the last in · · county. If you have always lived in Iowa, count the time since your birth. If you have been a resident of another state, count the time since you last moved to Iowa. D. Parties' residence Check each that is true (1) (2) Petitioner has lived in Iowa for more than one year. Respondent (your spouse) is a resident of Iowa. E. Condition of the marriage Check all that are true (1) (2) (3) (4) The marriage is broken and cannot be saved. This is the only divorce case going on involving this marriage. If you did not check (2), explain in H. You should also talk to an attorney. This Petition is being filed in good faith for the purpose of ending the marriage. Counseling will not save the marriage. If counseling may save the marriage, do not check (4). November 2013 Rule 17.100--Form 101 Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.100--Form 101: Petition for Dissolution of Marriage with no Minor or Dependent Adult Children, continued F. Respondent's status Check each that is true (1) Respondent (your spouse) is in the military service. If you check (1), note that there are special rules that may prevent your case from going forward if your spouse is in the military. You should talk to an attorney. Respondent is in prison or jail at Name of facility in State . (2) G. Protective or no contact order Check one (1) (2) There is neither a "protective order" nor a "no contact order" between Petitioner (you) and Respondent (your spouse). There is a "protective order" or a "no contact order" between Petitioner and Respondent. If you check (2), fill in the following information: a. b. County and state where the order came from: County Court case number: State H. Other information: 3. Petitioner's Request A. Petitioner asks the court to: Check all that apply. The court will only consider items that are checked. (1) (2) (3) (4) (5) (6) End the marriage of Petitioner (you) and Respondent (your spouse). Fairly divide the property and the debts of the parties. Order that Respondent pay the court fees. Order that Respondent pay for Petitioner's attorney's fees before the divorce is final. If you check (4), you must file form 122. Order that Respondent pay spousal support (alimony) to Petitioner. If you check (5), you must file form 122. Change Petitioner's last name to: Name can only be changed to name on birth certificate or name used immediately prior to the marriage. Print your former or birth name (7) Other request: . November 2013 Rule 17.100--Form 101 Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.100--Form 101: Petition for Dissolution of Marriage with no Minor or Dependent Adult Children, continued 4. Attorney Help Check one A. B. An attorney did not help me prepare or fill in this paper. An attorney helped me prepare or fill in this paper. If you check B, you must fill in the following information: Name of attor