Circuit Court for City or County Name Street Address Apt # Case No. vs. Name Street Address Apt # ( City State Zip Code Area Code ) Telephone City State Zip Code ( Area Code ) Telephone Plaintiff (CC-DR 21) I, Name Defendant COMPLAINT FOR LIMITED DIVORCE , representing myself, state that: The Defendant and I were married on in City/County/State where Married Month Day Year 1. in a civil religious ceremony. 2. Check all that apply: I have lived in Maryland since: Month/Year My spouse has lived in Maryland since: Month/Year 3. Check all that apply: (See paragraph 13) The grounds for divorce occurred in the State of Maryland. The grounds for divorce occurred outside the State of Maryland and I or my spouse have been a resident for at least six (6) months prior to the date of the filing of this Complaint. Check one: We have no children together (skip paragraphs 6 through 10) or My spouse and I are the parents of the following child(ren): Name Name Name Date of Birth Date of Birth Date of Birth Name Name Name Date of Birth Date of Birth Date of Birth 4. 5. I know of the following related cases concerning the child(ren) or parties (such as domestic violence, paternity, divorce, custody, visitation, termination of parental rights, adoption or other cases): Court Case No. Kind of Case Year Filed Results or Status (if you know) CC-DR 21 (Rev. 10/2015) Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 6. I have been a party, witness, or otherwise involved in the following cases about custody or visitation of the child(ren): State Court Case No. Date of Child Custody Determination Attach the most recent court order for the above-referenced court cases. 7. I know of the following people, not parties to this case, who have physical custody of, or claim rights of legal custody or physical custody of, or visitation with the child(ren): Name Current Address Name Current Address Name Current Address 8. 9. The child(ren) are currently living with: Name The child(ren) have lived in the following places, with the persons indicated during the last five years: Time Period Place Name(s)/Current Address of Person(s) with whom Child Lived 10. It is in the best interests of the child(ren) that I have (check all that apply): joint joint sole physical custody of sole legal custody of Name of Children Name of Children Name of Children . . . . visitation with 11. 12. I am am not seeking alimony because (You do not have to complete paragraph 12 if you are not asking the court to make decisions about your property). My spouse and/or I have the following property (check all that apply): Motor vehicle(s) Bank account(s) and investment(s) Furniture Family Use Personal Property Other: My grounds for limited divorce are (check all that apply): Cruelty/Excessively Vicious Conduct Against Me - My spouse has persistently treated me cruelly and has engaged in excessively vicious conduct rendering continuation of the marital relationship impossible if I am to preserve my health, safety, and self-respect. Cruelty/Excessively Vicious Conduct Against My Children - My spouse has persistently treated my minor child(ren) cruelly and has engaged in excessively vicious conduct against them rendering continuation of the marital relationship impossible if I am to preserve my minor child(ren)'s health, safety, and self-respect. Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 13. CC-DR 21 (Rev. 10/2015) Actual Desertion - On or about Month/Day/Year , my spouse, without just cause or reason, abandoned and deserted me, with the intention of ending our marriage. This abandonment has continued without interruption up to and including the time of filing of this complaint. Constructive Desertion - My spouse's actions have terminated the husband and wife relationship and made it impossible for me to continue the marriage and preserve my health, safety, or self-respect, and since these actions occurred, I have not had sexual intercourse with my spouse. Separation - From on or about , my spouse and I have lived separate and Month/Day/Year apart from one another in separate residences, without interruption, without sexual intercourse, with the express purpose and intent of ending our marriage. FOR THESE REASONS, I request (check all that apply): x A Limited Divorce. Joint Sole physical custody of the minor child(ren) and reasonable child support. Joint Sole legal custody of the minor child(ren) and reasonable child support. Visitation with the minor child(ren). Child support (attach Form DR 30 or DR 31). Health insurance for the child(ren). Health insurance for me. Use and possession of the family home for up to three years from the date of the limited divorce. Use and possession of the family use personal property for up to three years from the date of the limited divorce. Transfer of family use personal property. Alimony (attach Form DR 31). Resolution of personal property issues. x Any other appropriate relief. I, solemnly affirm under the penalties of perjury, that the Name contents of this document are true to the best of my knowledge, information, and belief. Date Signature CC-DR 21 (Rev. 10/2015) Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com