IN THE ________ COURT OF _________________________, MISSOURI (Type of court) (County where court is located) If this is an amended petition, you MUST enter the Case Number. In re the Marriage of _________________ (First) _____________ (Middle) ____________________ (Last) _________ (Jr./Sr./III) Petitioner, (Your full name should be entered here) Case No. ____________ (Will be assigned when case is filed) -andDivision No. ____________ _________________ (First) _____________ (Middle) ____________________ (Last) _________ (Jr./Sr./III) (Will be assigned when case is filed) Respondent. (Enter your spouse’s full name here) Count I – Petition for Dissolution of Marriage 1. How many petitions have you filed in this case? This is the first petition I have filed in this case. (Original Petition) This is the second petition I have filed in this case. This is the third petition I have filed in this case. 2. Are you the Husband or the Wife? I am the Wife. I am the Husband. 3. What is your mailing address? If you change addresses, make sure to tell the court in writing your new address. _________________________________________________________ (Street) _________________________ (City) __________________ (State) ___________ (Zip) _________________________ (Telephone Number) Throughout this entire case, you will always be the “Petitioner” and your husband or wife will always be the “Respondent”. Your husband or wife is also referred to as your “spouse”. This is the address that the court will use to send information concerning your case to you. This address is not necessarily the same as the address at which you reside. Even if you do not wish to disclose the address at which you reside, you MUST still provide the court with a mailing address. _____________________________ (E-Mail Address) Your social security number is required by RSMo §452.312. 4. What is your social security number? ___________________________________ (Social Security Number) Question 5 should never be blank 5. What is your spouse’s mailing address? _________________________________________________________ (Street) _________________________ (City) __________________ (State) _________________________ (Telephone Number) This is the address that the court will use to send information concerning your case to your spouse. If you do not know your spouse’s current address, you should enter the last known address of your husband or wife. ___________ (Zip) _____________________________ (E-Mail Address) 6. What is your spouse’s social security number? ___________________________________ (Social Security Number) Your spouse’s social security number is required by RSMo §452.312. Do not leave this field blank. If you do not know your spouses social security number, enter “Unknown” in this field. Petition for Dissolution of Marriage – Page 1 of 12 Form CAFC001-05/2008 This form is available for free at www.courts.mo.gov American LegalNet, Inc. www.FormsWorkflow.com ONE and only ONE box should be checked on this page. 7. DIRECTIONS FOR SERVICE ON RESPONDENT How will your spouse receive legal notice of this proceeding? Before your case can proceed, your spouse must be given notice that you have filed this case. This notice can be given in one of the methods described on this page. Respondent has signed a verified “Answer to Petition for Dissolution of Marriage” which is being filed with the “Petition for Dissolution of Marriage.” Therefore, do not issue a summons. If you check this box, you must file the “Answer to Petition for Dissolution of Marriage” at the same time you file this petition. The “Answer” must be signed by your spouse in front of a notary public. Respondent has signed a verified “Waiver of Service and Entry of Appearance” which is being filed with the “Petition for Dissolution of Marriage.” Therefore, do not issue a summons. If your spouse signs a “Waiver of Service and Entry of Appearance” he or she has thirty days in which to file an answer to the petition. The “Waiver of Service and Entry of Appearance” must be signed by your spouse in front of a notary public. Respondent will voluntarily enter his/her appearance in this case and therefore summons should be issued but held in the Sheriff’s office for this County. If a verified “Waiver of Service and Entry of Appearance” is not filed within thirty (30) days, this case may be dismissed without further notice to Petitioner. Your spouse can either sign an answer or waiver within thirty days, or your spouse can pick up a copy of the papers in the sheriff’s office for this county within thirty days. If you select this option, the clerk will issue a summons which will be “held” in the Sheriff’s office. Summons should be served upon Respondent at his/her residence: Respondent may be served either at his/her place of employment or at his/her home. You should check the appropriate box. Your spouse must be served within thirty (30) days of the issuance of the summons. ________________________________________________________ (Street) _________________________ (City) __________________ (State) ___________ (Zip) Summons should be served upon Respondent at his/her place of employment: _________________________________________ (Employer’s Name - if applicable) __________________ (Hours of Employment) IF YOU ARE GOING TO HAVE YOUR SPOUSE SERVED, YOU MUST FILE ANOTHER COPY OF ALL YOUR DOCUMENTS IN THIS CASE TO BE SERVED ON YOUR SPOUSE. ________________________________________________________ (Street) _________________________ (City) __________________ (State) ___________ (Zip) Respondent cannot be served in Missouri. Therefore, service by registered mail is requested. A copy of the “Affidavit for Service by Mail” is attached to this form. See Missouri Supreme Court Rule 54.12(b) Service by registered mail is only available if your spouse resides outside the State of Missouri. If you have service by mail, you are not entitled to obtain any kind of money judgment against your spouse for such things as child support or maintenance. The whereabouts of Respondent are unknown and there is no way of contacting him or her. I have attempted to locate the Respondent and have been unable to do so. Therefore, service by publication will be required. A copy of the “Affidavit for Service by Publication” is attached to this form. Child support, maintenance or other money judgments will not be allowed against Respondent if service is by publication. Publication must be made in the County where this matter is filed in a newspaper of general circulation. See Missouri Supreme Court Rule 54.12(c). You can only obtain service by publication if the whereabouts of your spouse are unknown, and you cannot locate him or her by making all reasonable attempts to find out where he or she can be served. If you have service by publication, you are not entitled to obtain any kind of money judgment against your spouse for such things as child support or maintenance. This option should only be utilized as a last resort. Other: ______________________________________________ NOTE: Must be authorized by Supreme Court Rule or Statute. Petition for Dissolution of Marriage – Page 2 of 12 Form CAFC001-05/2008 This form is available for free at www.courts.mo.gov American LegalNet, Inc. www.FormsWorkflow.com 8. What is your birth date? You should enter your birth date in the specified format. For example, if your birth date is January 5, 1975, you should enter ‘01/05/1975’ on the line. _____________ (MM/DD/YYYY) 9. In what country do you currently reside? ______________________ (Country) 10. In what state do you currently reside and for what length of time have your resided in your state of residence? _________________________ (State of Residence) ______ ______ ______ Years Months Days (Length of Residence in this State) 11. In what county do you currently reside and for what length of time have you resided in your county of residence? _________________________ (Name of County) ______ ______ ______ Years Months Days (Length of Residence in this County) Read each question carefully. This question requests the COUNTRY in which you reside. It does not request the COUNTY in which you reside. You should enter state in which you reside and the length of time you have been a resident of the State. Missouri law requires that one party to a dissolution of marriage proceeding must have been a resident of the State of Missouri for at least ninety (90) days. If the time is less than four months, state the number of days you have resided in the state. The “City of St. Louis” is considered a County. If you live in the City of St. Louis, you should write “St. Louis City” in the blank. Also you should enter the length of time you have been a resident of the County. Not the City Not the Country (See Explanation) 12. What is your current employment status? Employed Unemployed Self-employed 13. If you are employed or self-employed, where do you currently work? _________________________________________ (Employer’s Name or type of self-employment) If you are self-employed, enter a brief description of the type of work you perform such as “Landscaping” or “Daycare” on the line for the name of your employer. If you are self-employed you should also enter the address information for your selfemployment. ________________________________________________________ (Street) _________________________ (City) __________________ (State) ___________ (Zip) 14. What is your total monthly gross income from all sources? ________________________ (Total Monthly Gross Income) 15. Can you support yourself through the combined income from your employment and income from property that you will receive in the dissolution? Yes No 16. What is your spouse’s birth date? _____________ (MM/DD/YYYY) Enter the total amount of gross income you earn each month. “Gross income” is the amount of money a person earns before anything such as taxes is deducted. For a more detailed definition of “gross income” see Missouri Supreme Court Form No. 14. This does not include supporting any minor children. You should enter your spouse’s birth date in the specified format. Petition for Dissolution of Marriage – Page 3 of 12 Form CAFC001-05/2008 This form is available for free at www.courts.mo.gov American LegalNet, Inc. www.FormsWorkflow.com 17. In what country does your spouse currently reside? ______________________ (Country) 18. In what state does your spouse currently reside and for what length of time has your spouse resided in his or her state of residence? _________________________ (State of Residence) ______ ______ ______ Years Months Days (Length of Residence in this State) 19. In what county does your spouse currently reside and for what length of time has your spouse resided in his or her county of residence? _________________________ (Name of County) Not the City Not the Country ______ ______ ______ Years Months Days (Length of Residence in this County) 20. If your spouse does not live in Missouri, did you and your spouse live together in Missouri during your marriage? Yes. No. Not Applicable. (My spouse currently resides in Missouri) You should enter state in which your husband or wife resides and the length of time your spouse has been a resident of the State. If the time is less than four months, state the number of days you have resided in the state. If you do not know in which county your spouse resides and cannot find out this information from any source such as family, friends, telephone listings, or the internet, then you should enter “Unknown”. Also you should enter the length of time your spouse has been a resident of the County. The “City of St. Louis” is considered a County. If you and your spouse have never lived together in the State of Missouri during your marriage, and he or she does not voluntarily enter his or her appearance in this proceeding, the court will lack personal jurisdiction over your spouse. This means that the court cannot award any money judgment to you. It may be better to file this case in the state where your spouse resides. You should consult a lawyer for further information. 21. What is your spouse’s current employment status? Employed Unemployed Self-employed Unknown 22. If your spouse is employed or self-employed, where does he or she currently work? _________________________________________ (Employer’s Name or type of self-employment) If your spouse is self-employed, enter a brief description of the type of work he or she performs such as “Landscaping” or “Daycare” on the line for the name of your employer. If your spouse is self-employed you should also enter the address information for his or her self-employment. ________________________________________________________ (Street) _________________________ (City) __________________ (State) ___________ (Zip) 23. What is your spouse’s total monthly gross income from all sources? ________________________ (Total Gross Monthly Income) Enter the total amount of gross income your spouse earns each month. “Gross income” is the amount of money a person earns before anything such as taxes is deducted. If you do not know the exact amount of gross monthly income for your spouse, you should enter your best estimate here. Petition for Dissolution of Marriage – Page 4 of 12 Form CAFC001-05/2008 This form is available for free at www.courts.mo.gov American LegalNet, Inc. www.FormsWorkflow.com 24. Can your spouse support him or herself through the combined income from his or her employment and income from property that he or she will receive in the dissolution? Yes No Unknown This does not include supporting any minor children born of the marriage. 25. Is your spouse on active duty in the military? Yes No You must enter If your spouse is on active duty in the armed forces of the United States, the Servicemembers Civil Relief Act (SCRA) may prevent you from obtaining a dissolution of marriage without your spouse’s consent. You should contact a lawyer about this situation prior to filing this petition. a date on this line. 26. On what date were you married? _____________ (MM/DD/YYYY) 27. In what country, state and county did you get your marriage license? _________________ (Country) _____________________ (State) ______________________ (Name of County) 28. On what date did you and your spouse separate? _____________ (MM/DD/YYYY) You must enter a date on this line. You must answer this question. This is also the county where the marriage is registered and is not necessarily the same as the county where you were married. The City of St. Louis is considered a county and is the only city in the state of Missouri that is a county. The date of separation is not necessarily the same as the date one party moved out of the joint residence of the parties. Under some circumstances, the parties may be separated and still be residing in the same residence. 29. Is there any reasonable likelihood that your marriage can be preserved? Yes No If you answered “Yes”, then the court will not grant a dissolution of marriage but may grant a legal separation. 30. Is your marriage irretrievably broken? Yes No If you answered ‘No”, then the court will not grant a dissolution of marriage but may grant a legal separation. 31. State any arrangements which you and your spouse have made for the maintenance of the other party or the custody and support of any children. If you have unemancipated children, please state any arrangements you and your spouse have concerning the support and custody of the children.Maintenance is what used to be called alimony. It refers to an amount paid by one party to the other party for his or her support. It is not the same as child support. ____________________________________________________________________ ____________________________________________________________________ 32. Is Wife pregnant? Yes No You should answer “Yes” if Wife is pregnant even if Husband is not the father of this child. 33. How many living children do you and your spouse have together that were born after the date of your marriage? Each one of these children should be listed in your answers to Questions 38 through 41. _________________ (Number of Children) Do not answer this question “N/A” or “Not Applicable.” You MUST enter a number on this line. Include in this number all living children born to Wife during this marriage as a result of sexual intercourse with Husband including children who are grown. Do not include deceased children. Petition for Dissolution of Marriage – Page 5 of 12 Form CAFC001-05/2008 This form is available for free at www.courts.mo.gov American LegalNet, Inc. www.FormsWorkflow.com 34. How many living children did you and your spouse adopt? _________________ (Number of Children) Do not answer this question “N/A” or “Not Applicable.” You MUST enter a number on this line. 35. How many living children do you and your spouse have together that were born before the date of your marriage? _________________ (Number of Children) Do not answer this question “N/A” or “Not Applicable.” You MUST enter a number on this line. 36. How many living children did Wife have with someone other than Husband that were born after the date of their marriage? (This number includes children born since the parties separated) _________________ (Number of Children) Do not answer this question “N/A” or “Not Applicable.” You MUST enter a number on this line. 37. Enter the total number of children from lines 31, 32, 33, and 34. _________________ (Number of Children) Do not answer this question “N/A” or “Not Applicable.” You MUST enter a number on this line. Each one of these children should be listed in your answers to Questions 38 through 41. Include in this number all living children that were (a) born to Wife and subsequently adopted by Husband; or (b) fathered by Husband and subsequently adopted by Wife; or (c) adopted by both parties. Include in this number children who are grown. Do not include deceased children. Each one of these children should be listed in your answers to Questions 38 through 41. Include in this number all living children born to Wife before this marriage as a result of sexual intercourse with Husband including children who are grown. You should attach a copy of the birth certificate for these children to your petition. If Husband is not listed as the father on the birth certificate, additional information may be required to be included in your petition. Each one of these children should be listed in your answers to Questions 38 through 41. Include in this number all living children born to Wife during this marriage as a result of sexual intercourse with a man other than Husband including any children who are grown. Do not include deceased children. Information in addition to the information on this petition will be required before the court may proceed with your case. Each one of these children should be listed in your answers to Questions 38 through 41. Add the numbers you entered on lines 33, 34, 35, and 36 above and enter the total. NOTE: If line 37 is zero, then you may skip Questions 38 through 49 and go directly to Question 50. INSTRUCTIONS FOR QUESTIONS 38 THROUGH 41 PERTAINING TO CHILDREN Questions 38 through 41 each have 10 subparts lettered ‘a’ through ‘j’. These subparts are arranged vertically in two columns on each page. Each of these two columns represents the information for one child. Question 38 pertains to the first child, Question 39 pertains to the second child, and so on. If you answered Question 37 with ‘0’, you should skip Questions 38 through 49 and go directly to Question 50. If you answered Question 37 with ‘1’, you should answer Question 38 for the one child you listed in your answer to Question 37 and if the child is not emancipated, you should also answer questions 42 through 49 inclusive. If you answered Question 37 with ‘2’, you should answer Questions 38 and 39 for the two children you listed in your answer to Question 37. If either of the children is not emancipated, you should also answer questions 42 through 49 inclusive. If you answered Question 37 with ‘3’, you should answer Questions 38 through 40 for the three children you listed in your answer to Question 37. If any of the children are not emancipated, you should also answer questions 42 through 49 inclusive. If you answered Question 37 with ‘4’, you should answer Questions 38 through 41 for the four children you listed in your answer to Question 37. If any of the children are not emancipated, you should also answer questions 42 through 49 inclusive. If you answered Question 37 with a number greater than ‘4’, you should answer Questions 38 through 41 for the four children you listed in your answer to Question 37. Additionally, you should attach additional pages answering all the questions asked in Question 38 for each child you have in addition to the children you have described in Questions 38 through 41. If any of the children are not emancipated, you should also answer questions 42 through 49 inclusive. You must list the children even if they are adults or if they are in someone else’s custody. You must also list each child that was born after the date of the marriage even if Husband is not the father of the child. Petition for Dissolution of Marriage – Page 6 of 12 Form CAFC001-05/2008 This form is available for free at www.courts.mo.gov American LegalNet, Inc. www.FormsWorkflow.com QUESTION 38 CHILD ONE (To be answered if the answer to question 37 is one or more) 38a. What is the full name of this child? a. 38b. What is the Social Security Number of this child? b. 38c. What is the current address of this child? c. 38d. What is the birth date of this child? d. (Format mm/dd/yyyy) 38e. Check all of the following boxes that apply: (To be answered for each child) This child is married or is on active duty in the military. This child is self-supporting, and the custodial parent has relinquished parental control over this child by express or implied consent. This child is over the age of 21, is not insolvent, and is not physically or mentally incapacitated from supporting himself or herself. This child is over the age of 18, has not yet reached the age of 21, is not insolvent, is not physically or mentally incapacitated from supporting himself or herself and one or more of the following is true: This child is not currently enrolled in or attending high school or college. This child graduated from high school, but has not been continuously enrolled in college since October 1 immediately following his or her graduation from high school. This child graduated from high school and has been continuously enrolled in college since October 1 immediately following his or her graduation from high school, but has not completed at least 12 hours each semester or completed at least 9 hours and worked 15 hours per week during the same period. (This provision does not apply to a child who has been diagnosed with a learning disability, or whose physical disability or diagnosed health problem limits the child’s ability to carry sufficient credit hours.) If the circumstances of the child manifestly dictate, the court may waive the October first deadline for enrollment. “College” means any junior college, community college, college or university at which the child attends classes regularly. As used in this form, “college” also includes any postsecondary training or schooling for which the student is assessed a fee and attends classes regularly. If you did not check any of the boxes in Question ‘38e’, you must answer the rest of the information for this child on this page (parts ‘38f’ through ‘38j’) and you must also answer questions 42 through 49 for this child. This child IS NOT emancipated and the court must make orders with respect to custody and support of this child. If you checked any of the boxes in Question ‘38e’, you do not need to answer the rest of the information for this child and questions 42 through 49 do not apply to this child. This child IS emancipated. 38f. With whom has this child primarily resided during the previous sixty days? f. g. Wife Husband Joint Husband/Wife Third Person h. Wife Husband Joint Husband/Wife Third Person 38g. Who should have legal custody of this child? NOTE: Legal custody refers to who will make the decisions concerning health, education and welfare for this child. RSMo §452.375.1(2) 38h. Who should have physical custody of this child? NOTE: Physical custody refers to where this child will reside and what time this child spends with each parent. RSMo §452.375.1(3) 38i. Who is the father of this child? If Husband is not the father of this child, you must state the name of each person who could be the father. This person(s) and this child must be joined as parties in this proceeding if Husband is not the father of this child. i. 38j. If this child was born prior to the marriage, is Husband listed as the father on the birth certificate? Attach a copy of the birth certificate to this petition. j. Husband Other (State Name(s)) ____________________ Yes No Not Applicable Petition for Dissolution of Marriage – Page 7 of 12 Form CAFC001-05/2008 This form is available for free at www.courts.mo.gov American LegalNet, Inc. www.FormsWorkflow.com QUESTION 39 CHILD TWO (To be answered if the answer to question 37 is two or more) 39a. What is the full name of this child? a. 39b. What is the Social Security Number of this child? b. 39c. What is the current address of this child? c. 39d. What is the birth date of this child? d. (Format mm/dd/yyyy) 39e. Check all of the following boxes that apply: (To be answered for each child) This child is married or is on active duty in the military. This child is self-supporting, and the custodial parent has relinquished parental control over this child by express or implied consent. This child is over the age of 21, is not insolvent, and is not physically or mentally incapacitated from supporting himself or herself. This child is over the age of 18, has not yet reached the age of 21, is not insolvent, is not physically or mentally incapacitated from supporting himself or herself and one or more of the following is true: This child is not currently enrolled in or attending high school or college. This child graduated from high school, but has not been continuously enrolled in college since October 1 immediately following his or her graduation from high school. This child graduated from high school and has been continuously enrolled in college since October 1 immediately following his or her graduation from high school, but has not completed at least 12 hours each semester or completed at least 9 hours and worked 15 hours per week during the same period. (This provision does not apply to a child who has been diagnosed with a learning disability, or whose physical disability or diagnosed health problem limits the child’s ability to carry sufficient credit hours.) If the circumstances of the child manifestly dictate, the court may waive the October first deadline for enrollment. “College” means any junior college, community college, college or university at which the child attends classes regularly. As used in this form, “college” also includes any postsecondary training or schooling for which the student is assessed a fee and attends classes regularly. If you did not check any of the boxes in Question ‘39e’, you must answer the rest of the information for this child on this page (parts ‘39f’ through ‘39j’) and you must also answer questions 42 through 49 for this child. This child IS NOT emancipated and the court must make orders with respect to custody and support of this child. If you checked any of the boxes in Question ‘39e’, you do not need to answer the rest of the information for this child and questions 42 through 49 do not apply to this child. This child IS emancipated. 39f. With whom has this child primarily resided during the previous sixty days? f. g. Wife Husband Joint Husband/Wife Third Person h. Wife Husband Joint Husband/Wife Third Person 39g. Who should have legal custody of this child? NOTE: Legal custody refers to who will make the decisions concerning health, education and welfare for this child. RSMo §452.375.1(2) 39h. Who should have physical custody of this child? NOTE: Physical custody refers to where this child will reside and what time this child spends with each parent. RSMo §452.375.1(3) 39i. Who is the father of this child? If Husband is not the father of this child, you must state the name of each person who could be the father. This person(s) and this child must be joined as parties in this proceeding if Husband is not the father of this child. i. 39j. If this child was born prior to the marriage, is Husband listed as the father on the birth certificate? Attach a copy of the birth certificate to this petition. j. Husband Other (State Name(s)) ____________________ Yes No Not Applicable Petition for Dissolution of Marriage – Page 8 of 12 Form CAFC001-05/2008 This form is available for free at www.courts.mo.gov American LegalNet, Inc. www.FormsWorkflow.com QUESTION 40 CHILD THREE (To be answered if the answer to question 37 is three or more) 40a. What is the full name of this child? a. 40b. What is the Social Security Number of this child? b. 40c. What is the current address of this child? c. 40d. What is the birth date of this child? d. (Format mm/dd/yyyy) 40e. Check all of the following boxes that apply: (To be answered for each child) This child is married or is on active duty in the military. This child is self-supporting, and the custodial parent has relinquished parental control over this child by express or implied consent. This child is over the age of 21, is not insolvent, and is not physically or mentally incapacitated from supporting himself or herself. This child is over the age of 18, has not yet reached the age of 21, is not insolvent, is not physically or mentally incapacitated from supporting himself or herself and one or more of the following is true: This child is not currently enrolled in or attending high school or college. This child graduated from high school, but has not been continuously enrolled in college since October 1 immediately following his or her graduation from high school. This child graduated from high school and has been continuously enrolled in college since October 1 immediately following his or her graduation from high school, but has not completed at least 12 hours each semester or completed at least 9 hours and worked 15 hours per week during the same period. (This provision does not apply to a child who has been diagnosed with a learning disability, or whose physical disability or diagnosed health problem limits the child’s ability to carry sufficient credit hours.) If the circumstances of the child manifestly dictate, the court may waive the October first deadline for enrollment. “College” means any junior college, community college, college or university at which the child attends classes regularly. As used in this form, “college” also includes any postsecondary training or schooling for which the student is assessed a fee and attends classes regularly. If you did not check any of the boxes in Question ‘40e’, you must answer the rest of the information for this child on this page (parts ‘40f’ through ‘40j’) and you must also answer questions 42 through 49 for this child. This child IS NOT emancipated and the court must make orders with respect to custody and support of this child. If you checked any of the boxes in Question ‘40e’, you do not need to answer the rest of the information for this child and questions 42 through 49 do not apply to this child. This child IS emancipated. 40f. With whom has this child primarily resided during the previous sixty days? f. g. Wife Husband Joint Husband/Wife Third Person h. Wife Husband Joint Husband/Wife Third Person 40g. Who should have legal custody of this child? NOTE: Legal custody refers to who will make the decisions concerning health, education and welfare for this child. RSMo §452.375.1(2) 40h. Who should have physical custody of this child? NOTE: Physical custody refers to where this child will reside and what time this child spends with each parent. RSMo §452.375.1(3) 40i. Who is the father of this child? If Husband is not the father of this child, you must state the name of each person who could be the father. This person(s) and this child must be joined as parties in this proceeding if Husband is not the father of this child. i. 40j. If this child was born prior to the marriage, is Husband listed as the father on the birth certificate? Attach a copy of the birth certificate to this petition. j. Husband Other (State Name(s)) ____________________ Yes No Not Applicable Petition for Dissolution of Marriage – Page 9 of 12 Form CAFC001-05/2008 This form is available for free at www.courts.mo.gov American LegalNet, Inc. www.FormsWorkflow.com QUESTION 41 CHILD FOUR (To be answered if the answer to question 37 is four or more) 41a. What is the full name of this child? a. 41b. What is the Social Security Number of this child? b. 41c. What is the current address of this child? c. 41d. What is the birth date of this child? d. (Format mm/dd/yyyy) 41e. Check all of the following boxes that apply: (To be answered for each child) This child is married or is on active duty in the military. This child is self-supporting, and the custodial parent has relinquished parental control over this child by express or implied consent. This child is over the age of 21, is not insolvent, and is not physically or mentally incapacitated from supporting himself or herself. This child is over the age of 18, has not yet reached the age of 21, is not insolvent, is not physically or mentally incapacitated from supporting himself or herself and one or more of the following is true: This child is not currently enrolled in or attending high school or college. This child graduated from high school, but has not been continuously enrolled in college since October 1 immediately following his or her graduation from high school. This child graduated from high school and has been continuously enrolled in college since October 1 immediately following his or her graduation from high school, but has not completed at least 12 hours each semester or completed at least 9 hours and worked 15 hours per week during the same period. (This provision does not apply to a child who has been diagnosed with a learning disability, or whose physical disability or diagnosed health problem limits the child’s ability to carry sufficient credit hours.) If the circumstances of the child manifestly dictate, the court may waive the October first deadline for enrollment. “College” means any junior college, community college, college or university at which the child attends classes regularly. As used in this form, “college” also includes any postsecondary training or schooling for which the student is assessed a fee and attends classes regularly. If you did not check any of the boxes in Question ‘41e’, you must answer the rest of the information for this child on this page (parts ‘41f’ through ‘41j’) and you must also answer questions 42 through 49 for this child. This child IS NOT emancipated and the court must make orders with respect to custody and support of this child. If you checked any of the boxes in Question ‘41e’, you do not need to answer the rest of the information for this child and questions 42 through 49 do not apply to this child. This child IS emancipated. 41f. With whom has this child primarily resided during the previous sixty days? f. g. Wife Husband Joint Husband/Wife Third Person h. Wife Husband Joint Husband/Wife Third Person 41g. Who should have legal custody of this child? NOTE: Legal custody refers to who will make the decisions concerning health, education and welfare for this child. RSMo §452.375.1(2) 41h. Who should have physical custody of this child? NOTE: Physical custody refers to where this child will reside and what time this child spends with each parent. RSMo §452.375.1(3) 41i. Who is the father of this child? If Husband is not the father of this child, you must state the name of each person who could be the father. This person(s) and this child must be joined as parties in this proceeding if Husband is not the father of this child. i. 41j. If this child was born prior to the marriage, is Husband listed as the father on the birth certificate? Attach a copy of the birth certificate to this petition. j. Husband Other (State Name(s)) ____________________ Yes No Not Applicable Petition for Dissolution of Marriage – Page 10 of 12 Form CAFC001-05/2008 This form is available for free at www.courts.mo.gov American LegalNet, Inc. www.FormsWorkflow.com Additional Information about Unemancipated Children Questions 42 through 49 below pertain to all unemancipated children listed in your answers to questions 38 through 41. If there are no unemancipated children, you may skip questions 42 through 49 and go directly to question 50 on page 12 of this Petition. The information on this page is required under the Uniform Child Custody Jurisdiction Act, RSMo §452.440 et. seq. and under RSMo. §454.501. 42. State all addresses at which the unemancipated children have resided during the past six months and the name of the person with whom said children resided. ____________________________________________________________________ 43. Do you know of anyone other than you or your spouse that has physical custody of any of the unemancipated children or claims to have custody or visitation rights with respect to any of the unemancipated children? Yes No 44. Do you have any information of any other custody proceeding concerning any of the unemancipated children pending in a court of this or any other state? Yes No 45. Have you participated in any other litigation concerning the custody of any of the unemancipated children in this or any other state? Yes No 46. If you answered “Yes” to questions 43, 44 or 45, please explain. ____________________________________________________________________ ____________________________________________________________________ 47. Have any of the unemancipated children been a victim of abuse or neglect? Yes No 48. Have any orders pertaining to any of the unemancipated children been entered by the Family Support Division? Yes, I have attached a copy of the order to this petition. No Do not leave these questions blank if there are unemancipated children. ____________________________________________________________________ 49. Are you or your spouse currently receiving benefits pursuant to TANF? Yes No Unknown Petition for Dissolution of Marriage – Page 11 of 12 Form CAFC001-05/2008 This form is available for free at www.courts.mo.gov American LegalNet, Inc. www.FormsWorkflow.com 50. Are there any other allegations? ____________________________________________________________________ ____________________________________________________________________ If there are any other statements you wish to include in your petition, you should enter them here. Specific allegations of misconduct are not necessary unless and until your spouse denies that the marriage is irretrievably broken. ____________________________________________________________________ REQUEST FOR RELIEF If you are the Wife, do you want to change your name back to the name you had prior to your marriage or back to your original maiden name? Yes, I would like to change my name back to my previous married name of _________________. Yes, I would like to change my name back to my maiden name of ____________________. No, I will keep the name I have. I WOULD LIKE THE COURT TO GRANT THE FOLLOWING: A dissolution of my marriage; Custody of the child(ren) born of the marriage as stated herein (if applicable); Appropriate orders with respect to the support of the minor child(ren) (if applicable); A division of the marital property and debts (REQUIRED); And such further and other orders as the court would deem appropriate. Maintenance to be paid to me by my spouse; (Optional) Maintenance to be paid to my spouse by me; (Optional) Petitioner, of lawful age, being duly sworn on his or her oath, states that he or she is the petitioner named above and that the facts stated in the Petition for Dissolution of Marriage are true according to his or her best knowledge and belief. ►__________________________________ Petitioner – SIGN HERE __________________________________ Petitioner – PRINT YOUR NAME HERE Subscribed and sworn to this _____ day of __________________, 20____. ________________________ Notary Public You must sign this petition in front of a Notary Public. My Commission Expires: _____________________ ATTORNEY INFORMATION (May be completed by your attorney) ________________________________________ Attorney – SIGN HERE ___________________ Missouri Bar Number _________________________________________________________ Attorney for Petitioner – PRINT YOUR NAME HERE _________________________________________________________ (Street) _________________________ (City) _________________ (Telephone Number) __________________ (State) _________________ (Fax Number) ___________ (Zip) ______________________ (Email Address) Do not enter any information here if you are filing this case without the assistance of a lawyer. This information may be completed by your attorney. I have assisted Petitioner in the preparation of these pleadings, but I am not entering my appearance on behalf of Petitioner. Petition for Dissolution of Marriage – Page 12 of 12 Form CAFC001-05/2008 This form is available for free at www.courts.mo.gov American LegalNet, Inc. www.FormsWorkflow.com