Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. COMPLAINT FOR DIVORCE PURSUANT TO G.L. c. 208 § 1B , Plaintiff , Defendant V. 1. Plaintiff who resides at (County) (City/Town) (Street Address) was lawfully married to the defendant who now resides at (State) (Street Address) (Zip) 2. (Zip) (State) (County) (City/Town) on The parties were married at (Date) on and last lived together at (Date) 3. The minor or dependent child(ren) of this marriage is/are: (name of child and date of birth) (name of child and date of birth) (name of child and date of birth) (name of child and date of birth) 4. Plaintiff certifies that no previous action for divorce, annulment or affirmation of marriage, separate support, desertion, living apart for justifiable cause, or custody of child(ren) has been brought by either party against the other except: 5. an irretrievable breakdown of the marriage under G.L. c. 208 § 1B On or about occurred and continues to exist. (Date) 6. Wherefore, plaintiff requests that the Court: grant a divorce on the ground of irretrievable breakdown. grant plaintiff defendant custody of the above-named child(ren). prohibit defendant from imposing any restraint on plaintiff's personal liberty. order a suitable amount for support of insurance. plaintiff and/or above-named child(ren) with suitable provision for health order conveyance of the real estate located at standing in the name of as recorded with the Registry of Deeds, Book Page . allow plaintiff to resume former name of . Date (Signature of attorney or plaintiff, if pro se) (Print name) (Street address) (City/Town) (State) (Zip) Tel. No. CJ-D 101B (4/07) American LegalNet, Inc. www.FormsWorkFlow.com B.B.O. # C. G. F