IN THE CIRCUIT COURT OF ST. LOUIS COUNTY, MISSOURI In re the Marriage of _________________ (First) Petitioner, _____________ (Middle) ____________________ (Last) _________ (Jr./Sr./III) _____________ (Middle) ____________________ (Last) _________ (Jr./Sr./III) -and_________________ (First) Respondent. Parties Case No. ____________ Division No. ____________ Judgment of Legal Separation 1. As used herein, “Wife” refers to Petitioner and “Husband” refers to Respondent. As used herein, “Husband” refers to Petitioner and “Wife” refers to Respondent. 2. Appearances (Check all that apply) Respondent remains in default as to the pleadings. Petitioner appears in Petitioner appears by Guardian ad Litem person. attorney. appears in person. Respondent appears in Respondent appears by Cause submitted upon affidavit of Petitioner. person. attorney. Cause submitted upon Third Party _____________ Third Party ___________ affidavit of Respondent. appears in person. appears by attorney. 3. The last four digits of Petitioner’s Social Security Number are ___________ and the last four digits of Respondent’s Social Security Number are ___________. 4. Respondent is not on active duty in the armed services of the United States now or any time since the filing of the petition herein. Respondent is on active duty in the armed services of the United States, but has waived his or her rights pursuant to the Servicemembers Civil Relief Act of 2003. Jurisdiction 5. Thirty (30) days have elapsed since the filing of the petition herein. 6. The court has personal jurisdiction over Respondent. The court does not have personal jurisdiction over Respondent. 7. Petitioner has been a resident of the State of Missouri for at least ninety (90) days immediately prior to the filing of the petition herein. Respondent has been a resident of the State of Missouri for at least ninety (90) days immediately prior to the filing of the petition herein. Marriage 8. The parties were married on _____________________, and the marriage was registered in ______________________________________________________________________. 9. The parties separated on or about ________________________. 10. There is a reasonable likelihood that the marriage of the parties can be preserved, and the marriage is therefore not irretrievably broken. Children 11. Wife is not now pregnant. Form CCFC188-11/09 Judgment of Legal Separation – Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com 12. There are no unemancipated children born or adopted of the marriage. There is/are ___________ unemancipated living child(ren) born or adopted of the marriage, hereinafter referred to as “minor child(ren)”. The name(s) and age(s) of the minor child(ren) are: Name of Child Age It is therefore ordered, adjudged and decreed that: 13. The Petitioner and Respondent are legally separated. Maintenance 14. Maintenance to Petitioner No maintenance is to be paid to Petitioner by Respondent. This order is not subject to modification. Respondent is ordered to pay to Petitioner the sum of ____________ per month as and for maintenance. Said maintenance is _______ subject to modification. __________________________________________________________________________________________ The court lacks jurisdiction to enter any orders with respect to maintenance of Petitioner. 15. Maintenance to Respondent No maintenance is to be paid to Respondent by Petitioner. This order is not subject to modification. Petitioner is ordered to pay to Respondent the sum of ____________ per month as and for maintenance. Said maintenance is _______ subject to modification. __________________________________________________________________________________________ The court lacks jurisdiction to enter any orders with respect to maintenance of Respondent. 16. Wage Assignment for Maintenance (If maintenance is to be paid by either party) Income withholding shall be prepared by the obligee and issued by the Circuit Clerk upon the effective date of this order. Income withholding shall not issue for the following reason(s): _________________________________________________________________________________________. Child Custody (If there are unemancipated children) 17. The court does NOT have jurisdiction over the custody arrangements of the minor child(ren) pursuant to the Uniform Child Custody Jurisdiction and Enforcement Act, RSMo. §452.700 et. seq. and therefore enters no further orders with respect to the custodial arrangements of the minor child(ren). The court has jurisdiction over the custody arrangements of the minor child(ren) pursuant to the Uniform Child Custody Jurisdiction and Enforcement Act, RSMo. §452.700 et. seq. The court approves the provisions of Part A of the parenting plan marked exhibit _________ pertaining to the custodial arrangements of the minor child(ren) and finds that the custodial arrangements contained in said parenting plan are in the best interests of the minor child(ren). Therefore, the court orders the provisions of Part A of the said parenting plan pertaining to the custodial arrangements of the minor child(ren) and incorporates by reference all of the terms Form CCFC188-11/09 Judgment of Legal Separation – Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com and conditions pertaining to the custodial arrangements of the minor child(ren) set forth in Part A of said parenting plan as if fully set forth herein. The sheriff or other law enforcement officers shall enforce the rights of any person to custody or visitation pursuant to RSMo. §452.425. __________________________________________________________________________________________ Child Support (If there are unemancipated children) 18. The court does not have jurisdiction to enter any orders with respect to the support of the minor child(ren). The court orders the provisions of Part B of the parenting plan marked exhibit _________ , pertaining to the support of the minor child(ren) and incorporates by reference all of the terms and conditions set forth in Part B of said parenting plan as if fully set forth herein. Marital and Nonmarital Property and Marital Debt 19. Division of Property The parties have entered into a separation agreement marked exhibit ___________ which is found to be not unconscionable. Said separation agreement is incorporated herein and the parties are ordered to perform the terms and conditions set forth therein as well as such further and other orders contained in this judgment. The parties have not entered into a separation agreement. All marital and non-marital property and marital debt are divided in exhibit ___________. Said division is fair and equitable and the parties are ordered to perform the terms and conditions set forth therein. 20. Real Property The legal description of the real property or properties divided herein is more fully set forth in Exhibit(s) _________________ which is incorporated into and made a part of this judgment. If the recording fee is paid by Petitioner/Respondent, the Circuit Clerk is ordered to record a certified copy of this judgment with the Recorder of Deeds in the following county or counties where the real property or properties is located: _________________________________________________________________________________ 21. Pension and Retirement Plans The court intends its judgment to be a qualified domestic relations order and retains jurisdiction for the purpose of establishing or maintaining this order as a qualified domestic relations order or to revise or conform its terms so as to effectuate the expressed intent of this order. 22. Other Orders Concerning Property and Debt ________________ is ordered to pay to ________________ the sum of ____________ as and for ______________________________________________________________________________. 23. This judgment divides all marital and nonmarital property and marital debt. No other marital or non-marital property or marital debt remains to be divided by the Court except as set forth herein. Attorney’s Fees 24. Petitioner shall pay to _____________________ the sum of _____________ as and for Respondent’s attorney’s fees in addition to the sum of _____________ previously ordered. Respondent shall pay to _____________________ the sum of _____________ as and for Petitioner’s attorney’s fees in addition to the sum of _____________ previously ordered. 25. Petitioner shall pay to _____________________ the sum of _____________ as and for Guardian ad Litem fees in addition to the sum of _____________ previously ordered. Respondent shall pay to _____________________ the sum of _____________ as and for Guardian ad Litem fees in addition to the sum of _____________ previously ordered. Form CCFC188-11/09 Judgment of Legal Separation – Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Name Change 26. Wife is granted restoration of her _____________ name of ____________________________. (Maiden or Former) (New Full Name) Other Orders 27. Other orders are as per the attached Exhibit Number___________, which is incorporated by reference as if fully set forth herein. __________________________________________________________________________________________ Court Costs 28. Court costs are to be paid from the court cost deposit(s) previously posted. Court costs are waived. Waiver of Right to Rehearing (If case is heard by a Commissioner pursuant to RSMo. §487.010 et. seq.) We, the undersigned parties, do hereby acknowledge receipt of the findings and recommendations of the commissioner, and waive the right to file a motion for rehearing in this case. (If heard by a Family Court Judge) __________________________ Judge (If heard by a Family Court Commissioner) Findings and Recommendations of Commissioner: ___________ Date __________________________ Commissioner ___________ Date Approved and Adopted as Judgment of the Court: __________________________ Judge ___________ Date A certified copy of this judgment is to be mailed to the following person(s): (Check all applicable boxes) Petitioner’s Attorney Respondent’s Attorney Guardian ad Litem ____________________________ ____________________________ ____________________________ ____________________________ (Street) ____________ ______ ______ (City) (State) (Zip) _________________________ (Telephone Number) ____________________________ (Street) ____________ ______ ______ (City) (State) (Zip) _________________________ (Telephone Number) ____________________________ (Street) ____________ ______ ______ (City) (State) (Zip) _________________________ (Telephone Number) (Signature of Petitioner’s Attorney) Petitioner ____________________________ (Signature of Petitioner) ____________________________ (Street) ____________ ______ ______ (City) (State) (Zip) _________________________ (Telephone Number) Form CCFC188-11/09 (Signature of Respondent’s Attorney) (Signature of Guardian ad Litem) Respondent ____________________________ (Signature of Respondent) ____________________________ (Street) ____________ ______ ______ (City) (State) (Zip) _________________________ (Telephone Number) Third Party ____________________________ (Signature of Third Party) ____________________________ (Street) ____________ ______ ______ (City) (State) (Zip) _________________________ (Telephone Number) Judgment of Legal Separation – Page 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com