§ Dissolution Petition
Dissolution Petition
IN THE CIRCUIT COURT OF __________________________, MISSOURI
(County where court is located)
In re the Marriage of }
}
__________ __________ __________ __________ }
(First) (Middle) (Last) (Jr./Sr./III) }
Petitioner,(Your full name should be entered } Case No.___________________________
here) } (Will be assigned when case is filed)
}
-and- }
} Division
No.___________________________
__________ __________ __________ __________ } (Will be assigned when case is filed)
(First) (Middle) (Last) (Jr./Sr./III) }
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? Throughout this entire case, you will always
be the
[ ] This is the first petition I have filed in this case. (Original “Petitioner” and your husband or wife will
Petition) always be the “Respondent”. Your husband or
[ ] This is the second petition I have filed in this case. wife is also referred to as your “ spouse”.
[ ] 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.
___________________________________________ This is the address that the
(Street) 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.
(City) (State) (Zip) Even if you do not wish to disclose the address at
which
________________ _________________________ you reside, you MUST still
(Telephone Number) (E-Mail Address) provide the court with a mailing address.
4. What are the last four numbers of your social security number? The last four digits of your social security
number are required by RSMo § 452.312.
XXX-XX-_______________________________
5. What is your spouse's mailing address? This is the address that the
court will use to send information concerning
your
___________________________________________ case to your spouse. If you do
(Street) not know your spouse's current address, you
should enter the last known address of your
_________________ ___________ ___________ husband or wife.
(City) (State) (Zip)
________________ _________________________
(Telephone Number) (E-Mail Address)
6. What are the last four numbers of your spouse's social security The last foyr digits of your spouse's social
number? security number are required by RSMo §
452.312. Do not leave
XXX-XX-_______________________________ 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 CAFC001-08/29/ This form is available for free at www.selfrepresent.mo.gov
2009
ONE and only ONE box should be checked on this page.
7. DIRECTIONS FOR SERVICE ON RESPONDENT Before your case can
How will your spouse receive legal notice of this proceeding? 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 If you check this box, you must file the
of Marriage” which is being filed with the “Petition for Dissolution of “Answer to Petition for Dissolution of
Marriage.” Therefore, do not issue a summons. Marriage" at the same time you file this
petition. The "Answer" must be singed by
your spouse in front of a notary public.
[ ] Respondent has signed a verified “Waiver of Appearance” which is If your spouse signs a “Waiver of Service
being filed with the “Petition for Dissolution of Marriage.” Therefore, and Entry of Appearance” he or she has
do not issue a summons. 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 Your spouse can either sign an answer or
therefore summons should be issued but held in the Sheriff's office for waiver within thirty days, or your spouse can
this County. If a verified “Waiver of Service and Entry of Appearance” pick up a copy of the papers in the sheriff's
is not filed within thirty (30) days, this case may office for this county within thirty days.
be dismissed without further notice to Petitioner. 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
(Street) within
thirty (30) days of the issuance of the
summons.
_________________ ___________ ___________
(City) (State) (Zip) IF YOU ARE GOING TO HAVE
YOURSPOUSE SERVED, YOU MUST FILE
[ ] Summons should be served upon Respondent at his/her place of ANOTHER COPY OF ALL YOUR
employment: DOCUMENTS IN THIS CASE TO BE
SERVED ON YOUR SPOUSE.
_______________________________ __________
(Employer's Name--if applicable) (Hours of
Employment)
___________________________________________
(Street)
_________________ ___________ ___________
(City) (State) (Zip)
[ ] Respondent cannot be served in Missouri. Therefore, service by Service by registered mail is only available if
registered mail is requested. A copy of the “Affidavit for Service by your spouse resides outside the State of
Mail” is Missouri.
attached to this form. See Missouri Supreme Court Rule 54.12(b) 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 You can only obtain service by publication if
contacting him or her. I have attempted to locate the Respondent and the whereabouts of your spouse are unknown, have been unable to do so. Therefore, service by publication will be and you cannot locate him or her by making
required. A copy of the “Affidavit for Service by Publication” is all reasonable attempts to find out where he
attached to this form. or she can be served.
Child support, maintenance or other money judgments will not be If you have service by publication, you are
allowed against Respondent if service is by publication. Publication not entitled to obtain any kind of money
must be made in the County where this matter is filed in a newspaper of judgment against your spouse for such things
general circulation. See Missouri Supreme Court Rule 54.12(c). 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 CAFC001-08/29/ This form is available for free at www.selfrepresent.mo.gov
2009
8. What is your age? ____________ You should enter your age
(Number of Years) in years on this line.
9. In what country do you currently Read each question care-
reside?___________________________________________
(Country) fully. This question requests the COUNTRY
in which you reside. It does not request the
COUNTY in which you reside.
10. In what state do you currently reside and for what length of time have You should enter state in
your resided in your state of residence?
_____________ ______ ______ ______ which you reside and the
(State of Residence) Years Months Days length of time you have
(Length of Residence in this State) 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.
11. In what county do you currently reside and for what length of time have The “City of St. Louis” is considered a
you resided in your county of residence? 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
(Name of County) Years Months Days you have been a resident of the County.
(Length of Residence in this 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?
If you are self-employed,
___________________________________________ enter a brief description of the type of
(Employer's Name or type of self-employment) work you perform such as “Landscaping” or
“Daycare” on the line for the name of your
employer. If you
___________________________________________ are self-employed you should
(Street) also enter the address information for your
self-employment.
_________________ ___________ ___________
(City) (State) (Zip)
14. What is your total monthly gross income from all sources? 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
(Total Monthly Gross Income) deducted. For a more detailed definition of
“gross income” see Missouri Supreme Court
Form No. 14.
15. Can you support yourself through the combined income from your This does not include supporting any minor
employment and income from property that you will receive in the children.
dissolution?
[ ] Yes
[ ] No
16. What is your spouse's You should enter your spouse's
age?_______________________________________________
(Number of Years) age inyears on the line.
Petition for Dissolution of Marriage--Page 3 of 12
Form CAFC001-08/29/ This form is available for free at www.selfrepresent.mo.gov
2009
17. In what country does your spouse currently reside?
____________
(Country)
18. In what state does your spouse currently reside and for what length of You should enter state in which your time has your spouse resided in his or her state of residence? husband
or wife resides and the lenght of time your
spouse has been a resident of the state. If the
time is less than four months state the
number of days your spouse has resident in
the state.
___________________ ______ ______ ______
(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 If you do not know in which county your
time has your spouse resided in his or her county of residence? 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
(Name of County) Years Months Days the length of time your
(Length of Residence in this County) spouse has been a resident of the County.
The “City of St. Louis” is considered a
County.
Not the City Not the
Country
20. If your spouse does not live in Missouri, did you and your spouse live If you and your spouse have never lived
together in Missouri during your marriage? together in the State of Missouri during your
marriage, and
[ ] Yes. he or she does not voluntarily enter
[ ] No. his or her appearance in this
[ ] Not Applicable. (My spouse currently resides in Missouri) 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 If your spouse is self-employed, enter a brief
currently work? description of the type of work he or she
performs such as “Landscaping” or
___________________________________________ “Daycare” on the line for
(Employer's Name or type of self-employment) the name of your employer. If your spouse is
self-employed you should also enter the
address
___________________________________________ information for his or her
(Street) self-employment.
_________________ ___________ ___________
(City) (State) (Zip)
23. What is your spouse's total monthly gross income from all sources? 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
(Total Gross Monthly Income) 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 CAFC001-08/29/ This form is available for free at www.selfrepresent.mo.gov
2009
24. Can your spouse support him or herself through the combined income This does not include supporting any minor
from his or her employment and income from property that he or she will children born of the marriage.
receive in the dissolution?
[ ] Yes
[ ] No
[ ] Unknown
25. Is your spouse on active duty in the military? If your spouse is on active duty in the
[ ] Yes armed forces of the United
[ ] No 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.
(You must enter a
date on this line.)
26. On what date were you You must answer this
married?_______________________________________________
(MM/DD/YYYY) question.
27. In what country, state and county did you get your marriage license? You should enter the Country, State and
County where you marriage is registered.
This is not necessarily the same as the county
_________________ ____________ where you were married.
(Country) (State) The City of St. Louis is considered a county
and is the only city in the state of Missouri
that is a county.
_________________
(Name of County)
28. On what date did you and your spouse separate? The date of separation is not necessarily the
same as the date one party moved
_________________ (You must enter out of the joint residence
(MM/DD/YYYY) a date on this line.) 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 If you answered “Yes”, then the court will not
preserved? grant a dissolution of marriage but
[ ] Yes may grant a legal separation.
[ ] No
30. Is your marriage irretrievably broken? If you answered “No”, then
[ ] Yes the court will not grant a
[ ] No dissolution of marriage but may grant a
legal separation.
31. State any arrangements which you and your spouse have made If you have unemancipated children, please
for the maintenance of the other party or the custody and support of state any arrangements you and your spouse
any children. 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? You should answer “Yes” if
[ ] Yes Wife is pregnant even if
[ ] No Husband is not the father of this child.
33. How many living children do you and your spouse have together Each one of these children should be listed in
thatwere born after the date of your marriage? your answer to Question 38 through 41.
_________________ (Do not answer Include in this number all
(Number of Children) this question “N/A” or “Not living children born to Wife during this
Applicable.” You MUST enter a marriage as a result of sexual intercourse with
number on this line.) Husband including children who are grown.
Do not include deceased children.
Petition for Dissolution of Marriage--Page 5 of 12
Form CAFC001-08/29/ This form is available for free at www.selfrepresent.mo.gov
2009
34. How many living children did you and your spouse adopt? 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 Include in this number living shildren that
“Not Applicable.” You MUST enter a were (a) born to Wife and subsequently
number on this line.) 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.
35. How many living children do you and your spouse have together that Each one of these children should be listed in
were born before the date of your marriage? your answers to Questions 38 through 41.
_________________ (Do not answer this Include in this number
(Number of Children) question “N/A” or “Not Applicable.” all living children born to wife before this
You MUST enter a number on this marriage as a result of sexual intercourse with
line.) 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.
36. How many living children did Wife have with someone other than Each one of these children should be listed in
Husband that were born after the date of their marriage? (This number your answer to Questions 38 through 41.
includes children born since the parties separated)
_________________ Include in this number
(Number of Children) (Do not answer this question “N/A” or all living children born to Wife during this
“Not Applicable.” You MUST enter a marriage as a result of sexual intercourse with
number on this line.) a man other thanHusband 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.
37. Enter the total number of children from lines 33, 34, 35, and 36. Each one of these children should be listed in
your answers to
_________________ (Do not answer this Questions 38 through 41.
(Number of Children) question “N/A” or “Not Applicable.” Add the numbers you entered on lines 33, 34,
You MUST enter a number on this 35, and 36 above and enter the total.
line.)
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 CAFC001-08/29/ This form is available for free at www.selfrepresent.mo.gov
2009
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 are the last four numbers of this child's Social Security Number? b. XXX-XX-
38c. What is the current address of this child? c.
38d. What is this child's age? d.
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
38g. Who should have legal custody of this [ ] Husband
child? NOTE: Legal custody refers to who will make [ ] Joint Husband/ Wife
the decisions concerning health, education and welfare for this child. RSMo § [ ] Third Person
452.375.1(2)
38h. Who should have physical custody of this h. [ ] Wife
child? NOTE: Physical custody refers to where this [ ] Husband
child will reside and what time this child spends with each parent. RSMo § [ ] Joint Husband/Wife
452.375.1(3) [ ] Third Person
38i. Who is the father of this child? If i. [ ] Husband
Husband is not the father ofthis child, you [ ] Other (State Name(s))
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. ____________________
38j. If this child was born prior to the j. [ ] Yes
marriage, is Husband listed as the father on [ ] No
the birth certificate? Attach a copyof the birth certificate to this petition. [ ] Not Applicable
Petition for Dissolution of Marriage--Page 7 of 12
Form CAFC001-08/29/ This form is available for free at www.selfrepresent.mo.gov
2009
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 are the last four numbers of this child's Social Security Number? b. XXX-XX-
39c. What is the current address of this child? c.
39d. What is this child's age? d.
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
39g. Who should have legal custody of this [ ] Husband
child? NOTE: Legal custody refers to who [ ] Joint Husband/Wife
will make the decisions concerning health, education and welfare for this child. [ ] Third Person
RSMo § 452.375.1(2)
h. [ ] Wife
39h. Who should have physical custody of this [ ] Husband
child? NOTE:Physical custody refers to [ ] Joint Husband/Wife
where this child will reside and what time this child spends with each parent. [ ] Third Person
RSMo § 452.375.1(3)
39i. Who is the father of this child? If i. [ ] Husband
Husband is not the father ofthis child, you [ ] Other (State Name(s))
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. ____________________
39j. If this child was born prior to the j. [ ] Yes
marriage, is Husband listed as the father on [ ] No
the birth certificate? Attach a copyof the birth certificate to this petition. [ ] Not Applicable
Petition for Dissolution of Marriage--Page 8 of 12
Form CAFC001-08/29/ This form is available for free at www.selfrepresent.mo.gov
2009
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 are the last four numbers of this child's Social Security Number? b. XXX-XX-
40c. What is the current address of this child? c.
40d. What is this child's age? d.
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
40g. Who should have legal custody of this [ ] Husband
child? NOTE: Legal custody refers to who [ ] Joint Husband/Wife
will make the decisions concerning health, education and welfare for this child. [ ] Third Person
RSMo § 452.375.1(2)
h. [ ] Wife
40h. Who should have physical custody of this [ ] Husband
child? NOTE:Physical custody refers to [ ] Joint Husband/Wife
where this child will reside and what time this child spendswith each parent. RSMo [ ] Third Person
§ 452.375.1(3)
40i. Who is the father of this child? If i. [ ] Husband
Husband is not the father ofthis child, you [ ] Other (State Name(s))
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.
40j. If this child was born prior to the j. [ ] Yes
marriage, is Husband listed as the father on [ ] No
the birth certificate? Attach a copyof the birth certificate to this petition. [ ] Not Applicable
Petition for Dissolution of Marriage--Page 9 of 12
Form CAFC001-08/29/ This form is available for free at www.selfrepresent.mo.gov
2009
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 are the last four numbers of this child's Social Security Number? b. XXX-XX-
41c. What is the current address of this child? c.
41d. What is this child's age? d.
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
41g. Who should have legal custody of this [ ] Husband
child? NOTE: Legal custody refers to who [ ] Joint Husband/Wife
will make the decisions concerning health, educationand welfare for this child. [ ] Third Person
RSMo § 452.375.1(2)
41h. Who should have physical custody of this h. [ ] Wife
child? NOTE: Physical custody refers to [ ] Husband
where this child will reside andwhat time [ ] Joint Husband/Wife
this child spends with each parent. RSMo 452.375.1(3) [ ] Third Person
41i. Who is the father of this child? If i. [ ] Husband
Husband is not the father of this child, you [ ] Other (State Name(s))
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. ____________________
41j. If this child was born prior to the j. [ ] Yes
marriage, is Husband listed as the father on [ ] No
the birth certificate? Attach acopy of the birth certificate to this petition. [ ] Not Applicable
Petition for Dissolution of Marriage--Page 10 of 12
Form CAFC001-08/29/ This form is available for free at www.selfrepresent.mo.gov
2009
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 and Enforcement Act, RSMo. § 452.700 et. seq. and under RSMo. § 454.501.
42. State all addresses at which the unemancipated children have resided during the past five years Do not leave
and the name of the person or persons with whom said children resided. these questions
blank if there are
unemancipated
children.
____________________________________________________________
____________________________________________________________
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. Have any of the unemancipated children been a victim of abuse or neglect?
[ ] Yes
[ ] No
47. If you answered “Yes” to questions 43, 44, 45 or 46, please explain.
____________________________________________________________
____________________________________________________________
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
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 CAFC001-08/29/ This form is available for free at www.selfrepresent.mo.gov
2009
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_____.
______________________________________ You must sign this petition
Notary Public in front of a Notary Public.
My Commission Expires:
______________________________________
ATTORNEY INFORMATION (May be completed by your attorney) Do not enter any information here if you
__________________________ _________________ are filing this case
Attorney--SIGN HERE Missouri Bar Number without the assistance of a lawyer.
_____________________________________________ This information may
Attorney for Petitioner--PRINT YOUR NAME HERE be completed by your attorney.
_____________________________________________ [ ] I have assisted
(Street) Petitioner in the preparation of these
_________________ ___________ ______________ pleadings, but I am not
(City) (State) (Zip) entering my appearance on
_________________ ___________ ______________ behalf of Petitioner.
(Telephone Number) (Fax Number) (Email Address)
Petition for Dissolution of Marriage--Page 12 of 12
Form CAFC001-08/29/ This form is available for free at www.selfrepresent.mo.gov
2009