DIV806 State ENG Rev 5/19www.mncourts.gov/formsPage 1 of 36State of Minnesota District CourtCounty of: Select County Judicial District: Court File Number: Assigned Judge: Case Type: Dissolution with Children In Re the Marriage of: Name of Petitioner (first, middle, last)and Name of Respondent (first, middle, last)Stipulated Findings of Fact, Conclusions of Law, Order for and Judgment, Judgment and Decree (Minn. Gen. R. Prac. 308.04) A. This proceeding for dissolution of marriage came before the undersigned judge of district court on: (date) at (location)in the State of Minnesota. Petitioner did did not appear.Respondent did did not appear. appeared as attorney for .B. Petitioner Petitioneris NOT represented by an attorney ORis represented by the following attorney: C.is NOT represented by an attorney OR is represented by the following attorney: Respondent RespondentD. Service of the Summons and Petition for Dissolution of Marriage: Respondent was personally served on Respondent signed an Admission of Service on Respondent was served by alternate means as ordered by the court as follows: OR OR By mailing the Summons and Petition to Respondent at the address(es) stated in the Order for Service by Alternate Means on this date: American LegalNet, Inc. www.FormsWorkFlow.com DIV806 State ENG Rev 5/19www.mncourts.gov/formsPage 2 of 36E. Petitioner was served with an Answer and Counterpetition: YES NO IF YES, Petitioner was served with the Answer and Counterpetition on Month Day Year F. Petitioner and Respondent have reached an agreement for marital termination resolving all issues in this case. Petitioner prepared the Stipulated Findings of Fact, Conclusions of Law, Order of Judgment and Judgment and Decree and incorporated the stipulated facts and terms of the parties' agreement. Respondent and Petitioner have signed an Acknowledgment regarding this agreement, which is included in this document. Findings of Fact1. Information about the PetitionerFull Name: First Middle LastAddress where you live: Street Address Apt. No. City County State Zip CodeMailing 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 LastPetitioner's social security number is listed on Confidential Form 11.1 and submitted along with the Petition.2. Information about the RespondentFull Name: First Middle Last American LegalNet, Inc. www.FormsWorkFlow.com DIV806 State ENG Rev 5/19www.mncourts.gov/formsPage 3 of 36Address: 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 Last3. Our Marriage 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 NOb. 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 NOb. 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 Situation American LegalNet, Inc. www.FormsWorkFlow.com DIV806 State ENG Rev 5/19www.mncourts.gov/formsPage 4 of 36a. Do the Petitioner and Respondent live together at this time? YES NO8. Other Proceedingsa. Has a separate court case for marriage dissolution, legal separation, custody, paternity or annulment already been started by Petitioner or Respondent in Minnesota or elsewhere? YES NOb. Has a County started a Support case involving the Petitioner and the Respondent or their children? YES NO9. Protection or Harassment Ordera. Is an Order for Protection or a Harassment/Restraining Order in effect regarding Petitioner and Respondent? YES NO10. Child Protection Court Casea. Is a child protection case involving Petitioner and Respondent's children taking place in Minnesota or another state? YES NO11. Children Petitioner and Respondent Have Together (Joint Children) "Child" means a living person under the age 18, or under age 20 and still in high school.a. Are there any children born to or adopted by Petitioner and Respondent together, either before or during the marriage? YES NOb. Has each child born to or adopted by Petitioner and Respondent together lived in Minnesota for the past six (6) months? YES NO12. Adult Dependent ChildrenSupport can be ordered for a joint child over age 18 who cannot support him/herself because of a physical or mental condition.a. Is there an adult joint child born to or adopted by Petitioner and Respondent who is not able to support him/herself because of a physical or mental condition? YES NO13. Pregnancya. Is Petitioner pregnant? YES NOb. Is Respondent pregnant? YES NO14. Petitioner's Children from Other Relationship (Non-Joint Children)a. Does Petitioner have minor children born prior to the marriage from another marriage or relationship? YES NO American LegalNet, Inc. www.FormsWorkFlow.com DIV806 State ENG Rev 5/19www.mncourts.gov/formsPage 5 of 36b. Has Petitioner given birth, since marrying Respondent, to a minor child who is not a child of the Respondent? YES NO15. Respondent's Children from Other Relationship (Non-Joint Children)a. Does Respondent have minor children born prior to the marriage from another marriage or relationship? YES NOb. Has Respondent given birth, since marrying Petitioner, to a minor child who is not a child of the Petitioner? YES NO16. Custody It is in the child's best interests and we agree that legal custody be granted as follows: (check one) Joint legal custody to both parents Sole legal custody to Petitioner Respondent It is in the child's best interests and we agree that physical custody be granted as follows: (check one) Joint physical custody to both parents Sole physical custody to Petitioner Respondent17. Parenting Timea. It is in the best interests of the children that:Petitioner's parenting time with the joint children be: (check one) unsupervised supervised reservedIf parenting time is unsupervised for both parents, skip to Question 18.For supervised parenting time answer b and c. For reserved parenting time, answer d. b. (Option 1) Supervision is necessary because unsupervised parenting time is likely to endanger the child's physical or emotional health or impair the child's emotional development. The circumstances supporting this finding are: (Option 2) We agree that supervised parenting time is necessary because: c. It is in the best interests of the children that supervision of parenting time be arranged as follows: (State who should supervise Petitioner's parenting time, and if there is a cost involved, who should pay the cost and any other important details) American LegalNet, Inc. www.FormsWorkFlow.com DIV806 State ENG Rev 5/19www.mncourts.gov/formsPage 6 of 36d. We agree that Petitioner's parenting time should be reserved because: Respondent's parenting time with the joint children be: (check one) unsupervised supervised reservedFor supervised parenting time answer b and c. For reserved parenting time, answer d. b. (Option 1) Supervision is necessary because unsupervised parenting time is likely to endanger the child's physical or emotional health or impair the child's emotional development. The circumstances supporting this finding are: (Option 2) We agree that supervised parenting time is necessary because: c. It is in the best interests of the children that supervision of parenting time be arranged as follows: (State who should supervise Respondent's parenting time, and if there is a cost involved, who should pay the cost and any other important details) d. We agree that Respondent's