DIV502 State ENG Rev 10/17www.mncourts.gov/formsPage 1 of 19State of Minnesota District CourtCounty of: Select County Judicial District: Court File Number: Assigned Judge: Case Type: Dissolution without Children In Re the Marriage of: Name of Petitioner (first, middle, last)and Name of Respondent (first, middle, last)Answer and CounterpetitionANSWER1. The following paragraphs of the Petition for Dissolution of Marriage are TRUE: 2. The following paragraphs of the Petition for Dissolution of Marriage are NOT TRUE: 3. The following paragraphs of the Petition for Dissolution of Marriage are PARTLY TRUE AND PARTLY NOT TRUE: 4. I do not know if the following paragraphs of the Petition for Dissolution of Marriage are TRUE OR NOT TRUE: COUNTERPETITION1. Information about the PetitionerFull Name: First Middle LastAddress where you live: Street Address Apt. No. City County State Zip Code American LegalNet, Inc. www.FormsWorkFlow.com DIV502 State ENG Rev 10/17www.mncourts.gov/formsPage 2 of 19Mailing address: Same as above address OR Street Address Apt. No. City County State Zip Code Date of Birth:List all of Petitioner's former or other names or write "None": First Middle Last First Middle Last2. Information about the RespondentFull Name: First Middle LastAddress: Street Address Apt. No. City County State Zip CodeMailing address: Same as above address OR Street Address Apt. No. City County State Zip Code Respondent's Date of Birth:List all of Respondent's former or other names or write "None": First Middle Last First Middle LastRespondent's social security number is listed on Confidential Form 11.1 and submitted along with the Answer.3. Our Marriage American LegalNet, Inc. www.FormsWorkFlow.com DIV502 State ENG Rev 10/17www.mncourts.gov/formsPage 3 of 19 Petitioner and Respondent were married on (month, day, year) in the City of , County of, State , Country of.4. 180 Day Requirementa. Has Petitioner been living in Minnesota for the past six (6) months? YES NO UNKNOWNb. Has Respondent been living in Minnesota for the past six (6) months? YES NOc. Petitioner and Respondent were married in Minnesota, but neither Petitioner nor Respondent reside in Minnesota, nor reside in a jurisdiction that will allow us to maintain an action for dissolution because of the sex or sexual orientation of the Petitioner and Respondent. YES NO5. Armed Forcesa. Is Petitioner an active duty member of the armed forces? YES NO UNKNOWNb. Is Respondent an active duty member of the armed forces? YES NO6. Marriage Cannot be SavedThere has been an irretrievable breakdown of my marriage relationship with Respondent and the marriage cannot be saved.7. Physical Living Situationa. Do the Petitioner and Respondent live together at this time? YES NO8. Other Proceedingsa. Has a separate court case for marriage dissolution, legal separation, or annulment already been started by Petitioner or Respondent in Minnesota or elsewhere? YES NO9. Protection or Harassment Ordera. Is an Order for Protection or a Harassment/Restraining Order in effect regarding Petitioner and Respondent? YES NO10. Children "Minor" children are under age 18, or under age 20 and still in high school. American LegalNet, Inc. www.FormsWorkFlow.com DIV502 State ENG Rev 10/17www.mncourts.gov/formsPage 4 of 19a. Do Petitioner and Respondent have minor children together? YES NOb. Do Petitioner and Respondent have any adult dependent children who are not able to support themselves because of a physical or mental condition? YES NOc. Has either Petitioner or Respondent given birth during the marriage to a child who is not a child of the other spouse? YES NOd. Is either spouse pregnant? YES NO UNKNOWN11. Public Assistance from the State of MinnesotaNote: If either party is receiving public assistance from the State of Minnesota or applies for it after this proceeding is started, the Petitioner must give notice of this marriage dissolution action to the Public Authority office for the county paying for the assistance. a. Does Petitioner receive public assistance from the State of Minnesota? YES NO UNKNOWNb. Does Respondent receive public assistance from the State of Minnesota? YES NO12. Schoola. Is Petitioner currently enrolled in school? YES NO UNKNOWNb. Is Respondent currently enrolled in school? YES NO13. Supplemental Security Income (SSI)Supplemental Security Income (SSI) is a Federal income supplement program. It is available to low-income people if they are over age 65, or blind or disabled.a. Does Petitioner receive Supplemental Security Income (SSI)? YES NO UNKNOWNb. Does Respondent receive Supplemental Security Income (SSI)? YES NO14. Petitioner's Employmenta. Is Petitioner employed? YES NO UNKNOWNb. Is Petitioner self-employed? YES NO UNKNOWN Current Employment: (If Petitioner has more than two jobs at this time, use an attachment for the additional jobs. Name of Petitioner's Employer (If self-employed, list name and business address) Address American LegalNet, Inc. www.FormsWorkFlow.com DIV502 State ENG Rev 10/17www.mncourts.gov/formsPage 5 of 19 City State Zip Code Name of Petitioner's Employer (If self-employed, list name and business address) Address City State Zip Code15. Petitioner's IncomeNOTE: This question asks for monthly income. If paid weekly, multiply your weekly income by 4.33 to get monthly income. If paid every two weeks, multiply by 2.17 to get monthly income. If paid twice a month, multiply by 2. If Petitioner has no income in a category, enter zero (0). Do not list public assistance benefits as income (e.g., MFIP, GA, SSI). a. Petitioner's current tax filing status is: Married Single Number of Exemptions: Respondent has no information about Petitioner's income OR Respondent does not have detailed information about Petitioner's income, but has good Respondent has detailed information about Petitioner's income. (If this is true, fill out the income information below.) reason to believe that Petitioner's pay is per week month year, with bonuses, overtime or or commissions in the additional amount of per week month yearThis is Petitioner's Net Income (after taxes and deductions) or Gross income (before taxes and deductions.) OR b. Petitioner has income from the following sources:Source of Income Amount Per Month (or zero) before deductions/taxesSelf Employment Income Net Monthly Revenues per month.If Petitioner is self employed, calculate net monthly revenues as follows: (Annual gross revenues minus annual ordinary and necessary business expenses) divided by 12 = Net Monthly Revenue. Also, attach Schedule C from last year's tax return to this Petition, if available. Job with per month.Your monthly income from a job = Hourly wage x Hours worked per week x 4.33 (weeks per month) American LegalNet, Inc. www.FormsWorkFlow.com DIV502 State ENG Rev 10/17www.mncourts.gov/formsPage 6 of 19 Second job with per month.If Petitioner has a job or jobs, answer the questions in the table for each job. If Petitioner has more than 2 jobs, attach another sheet of paper to give the information for the other jobs. Questions about Current Jobs Is Petitioner paid by the hour or salaried? What is the average number of hours the Petitioner works per week? How much overtime pay does Petitioner receive per week on average? 1st Job Does Petitioner receive bonuses? hourly salary hourly salary 2nd Job hours hours $ $ Yes No 1st Job Yes No 2nd Job If Yes, how much was received in bonuses last year? $ How much is expected this year? $ If Yes, how much was received in bonuses last year? $ How much is expected this year? $Petitioner's Other Sources of Income:Unemployment per month.Social Security (SSDI or RSDI) per month.Supplemental Security Income (SSI) per month.MFIP per month.General Assistance per month.Investments or Rental Income per month.Pension per month.Worker's Compensation per month. Other per month.Add all of the above: Total monthly income $0.00 per month. c. Petitioner's deductions from monthly gross income: (Provide the total from all jobs, self-employment and other sources if income.) This question asks for monthly deductions. If paid weekly, multiply the deductions shown on pay stub by 4.33 to get monthly deductions