Default Divorce Forms SET A

(Texas Divorce, No Children, Opposite-Sex Spouses)

Use these instructions & forms if:

• you have a Texas divorce, you don’t think your spouse will par-

ticipate in the divorce process, you and your spouse do not have

any children together who are under 18 or still in high school,

and you have an opposite-sex marriage.

This packet includes:

Note: You may not need all of the forms listed or you may need ad-

ditional forms. Get more information at www.TexasLawHelp.org.

Talk to a lawyer if you have questions.

1. Instructions for a DEFAULT Divorce without Children

2. Original Petition for Divorce

3. Civil Case Information Sheet

4. Information on Suit Affecting the Family Relationship

5. Statement of Inability to Afford Payment of Court Costs

6. Final Decree of Divorce

7. Certificate of Last Known Address

8. Military Status Affidavit

9. Notice of Current Address

10.Affidavit for Prove-Up of Default Divorce Without Children

Instructions & Forms for a Default Divorce without Children

These instructions explain the basic steps in a default divorce without

children. Each step includes a link to the form or forms needed for that

step. Click on the step to expand it with more information.

“Default” means you have your spouse served with the initial divorce papers

and your spouse does not file an answer with the court. If your spouse is

served and defaults (does not file an answer with the court), you can finish

your divorce without your spouse.

Use these instructions if:

• you don’t think your spouse will participate in the divorce process - and -

• you and your spouse do not have any minor children together.

Have you read the Frequently Asked Questions and related Articles?

These instructions are part of this TexasLawHelp.org toolkit: I need a

divorce. We do not have minor children. Before getting started, it’s

important to read the Frequently Asked Questions and Articles included in

the Toolkit.

WARNING! These instructions provide general information and are not a

substitute for the advice and help of a lawyer.

You can print these instructions to use as a checklist.

To print out both instructions and forms, click here (for opposite-sex

couples) or here (for same-sex couples).

Checklist Steps

Step 1: Determine where to file your divorce.

It’s important to file for divorce in the correct county. If you file in the wrong

county, your case will be dismissed and you will lose your filing fee.

You can file for divorce in the county where you live or the county where your

spouse lives as long as you or your spouse meets the residency

requirements below.

• You can file for divorce in the county where you live as long as:

• you have lived in that county for at least the last 90 days - and -

• you have lived in Texas for at least the last 6 months.

• Or, you can file for divorce in the county where your spouse lives as long

as:

• your spouse has lived in that county for at least the last 90 days - and -

• your spouse has lived in Texas for at least the last 6 months.

If neither you nor your spouse meet the residency requirements, talk with a

lawyer.

Read the Frequently Asked Questions, FAQs: Filing a Divorce without

Children, for additional information.

Step 2: Fill out the starting forms.

Fill out an Original Petition for Divorce form.

• Use this version if you have an opposite-sex marriage: Original Petition

for Divorce (Set A)

• Use this version if you have a same-sex marriage: Original Petition for

Divorce (Set D)

The Petition asks the judge to give you a divorce. The Petition also tells

your spouse what orders you want the judge to make.

When you fill out the Petition:

o Print your answers using blue or black ink. Do not leave blanks.

o You are the petitioner and your spouse is the respondent.

o Talk to a lawyer if you have questions or need help.

Note: The Petition asks for your address. Your spouse will get a copy of

the Petition. If you are concerned about your spouse knowing your

address, call the Family Violence Legal Line at 800-374-4673 for free

advice.

Fill out these additional starting forms:

• Civil Case Information Sheet (NOTE: the Texas Supreme Court has

repealed the rule requiring the civil case information sheet, so you

may not need this form. If you are filing paper documents in person at the

clerk's office, you should complete it and bring it anyway, however.).

• Information on Suit Affecting the Family Relationship

Fill out this additional starting form if you can’t afford to pay the filing fee for

your case. You can call the clerk’s office ahead of time to learn the filing fee

for your divorce case. Learn more here: Court Fees and Fee Waivers.

• Statement of Inability to Afford Payment of Court Costs

Make copies:

• Make 2 copies of your completed Original Petition for Divorce.

• Make 2 copies of the Statement of Inability to Afford Payment of Court

Courts if you are asking the court to waive court costs.

• You do not need copies of the Civil Case Information Sheet or the

Information on Suit Affecting the Family Relationship.

Step 3: File (turn in) your starting forms.

File (turn in) your completed Petition and other starting forms with the court.

You need to find out if your county has standing orders. If it does, you will

need to attach a copy of the standing orders to your petition.

• To file your forms online, go to E-File Texas and follow the instructions.

• To file your divorce forms in person, take the Petition and additional

starting forms (and copies) to the district clerk’s office in the county you

have determined is the correct county to file your divorce.

At the clerk’s office:

o Turn in your Petition and other starting forms (and copies).

o Tell the clerk you want to have your spouse served in person. This

means a sheriff, constable or private process server will deliver the

initial divorce papers to your spouse in person. (Remember: If your

spouse will agree to sign the necessary court forms, you do not need

to have your spouse served. Follow these instructions

instead: Instructions & Forms for an Agreed Divorce without

Children in the checklist directly above.

o Pay the filing fee and issuance fee(or file your completed Statement of

Inability to Afford Payment of Court Costs if you cannot afford the fee).

You can call the clerk’s office ahead of time to learn the filing fee for

your case.

o Ask the clerk if there is a local standing order that you need to follow or

attach to any of your documents.

o Ask the clerk if there are local rules or procedures you need to know

about for your divorce.

o The clerk will write your “Cause Number” and “Court Number” at the top

of the first page of your Petition. (Write these numbers at the top of any

document you file in your divorce case.)

o The clerk will “file-stamp” your copies with the date and time. The clerk

will keep the original and give one copy back to you.

o The clerk will print a form called a “citation.” The citation tells your

spouse that you have filed for divorce. The citation also tells your

spouse that unless he or she files an answer with the court you will be

able to finish your divorce by default (without your spouse). The clerk

will attach the other copy of your Petition to the citation. The citation

with a copy of your Petition attached are the “initial divorce papers”

that must be served on your spouse by a constable, sheriff or private

process server. Read Step 4 for instructions.

Step 4: Have your spouse served.

You must have your spouse served with the initial divorce papers.

To have your spouse served in person:

• send the initial court papers to a constable, sheriff or private process

server in the county where your spouse lives or works,

• include the service fee (call first to learn the fee) or a file-stamped copy of

your Statement of Inability to Afford Payment of Court Costs,

• also include a self-addressed and stamped envelope.

The constable, sheriff or private process server will:

• give the initial divorce papers to your spouse,

• complete a Return of Service form that says when and where your spouse

was served,

• send the completed Return of Service to you or the court.

The completed Return of Service is proof your spouse was served. Your

spouse will NOT have to sign anything.

If the Return of Service is sent to you, file it at the clerk’s office. The Return of

Service must be on file for at least 10 days before you can finish your case,

not counting the day it is filed or the day you go to court to finish your case.

NOTE: Getting your spouse served in person is best. However, there are

other ways to get someone served. To learn about more, read: How to Serve

the Initial Divorce Papers. If you have questions, you can use Ask a

Question to chat with a lawyer or law student online.

Step 5: Fill out the Final Decree of Divorce and other ending forms.

Fill out a Final Decree of Divorce form (called Decree for short).

• Use this form if you have an opposite-sex marriage: Final Decree of

Divorce (Set A)

• Use this form if you have a same-sex marriage: Final Decree of Divorce

(Set D)

You will ask the judge to sign this form when it’s time to finish your case. Fill it

out completely (except for the judge’s signature).

Note about retirement benefits: If you are dividing retirement benefits (other

than an IRA), you must also complete a form called a Qualified Domestic

Relations Order (QDRO). TexasLawHelp.org does not provide QDRO forms.

You may contact the employer or retirement plan administrator to see if they

have a sample QDRO form. If not, you should hire a lawyer to draft the QDRO

form. If you use the employer or plan administrator’s form, you should still

have a lawyer review it to make sure you are not giving up important benefits.

You should have the QDRO prepared before you go to court, so the judge can

sign it when you finish your divorce. Learn more here: Dividing Retirement

Benefits Upon Divorce - Fact Sheet.

Step 6: Have the Final Decree of Divorce form reviewed (if possible).

Some counties require this document to be reviewed by an attorney, while

others do not. You should speak with the district clerk's office in your county

regarding local requirements. Even if it's not required, it’s a good idea to have

a family law lawyer review your completed Final Decree of Divorce form.

Family law lawyers specialize in cases involving families, such as divorce

cases.

You can hire a family law lawyer just to review your forms. This is called

“limited scope representation.” You may also be able to talk with a lawyer for

free at a legal clinic. If you need help finding a lawyer, you can:

• Use our Legal Help Directory to search for a lawyer referral service, legal

aid office or self-help center in your area.

• Check our Legal Events and Clinics page for free legal clinics in your

area.

• Use Ask a Question to chat online with a lawyer or law student.

Step 7: Wait the required waiting periods.

Wait the waiting periods that apply to your case.

• 60-day waiting period – In almost all cases, you must wait at least 60

days before you can finish your divorce.

When counting the 60 days, find the day you filed your Original Petition for

Divorce on a calendar, and then count out 60 more days (including

weekends and holidays). If the 60th day falls on a weekend or holiday, go

to the next business day. Note: When counting the 60 day waiting period,

don’t count the day you filed your Original Petition for Divorce. Day 1 is the

next day.

There are only two exceptions to the 60-day waiting period.

1. If your spouse has been convicted of or received deferred adjudication

for a crime involving family violence against you or a member of your

household, the 60-day waiting period is waived.

2. If you have an active protective order or an active magistrate’s order

for emergency protection against your spouse because of family

violence during your marriage, the 60-day waiting period is waived.

Note: You can always wait longer than 60 days, but your divorce cannot

be finished in fewer than 60 days unless one of these exceptions applies.

• 20 + day waiting period – From the day your spouse is served, your

spouse must have at least 20 days plus the next Monday at 10 a.m. to file

an Answer. Find the day your spouse was served on a calendar, count out

20 more days, then go to the next Monday. This is the last day of your

spouse’s answer period. However, if your spouse files an answer any time

before you finish your divorce it will still count. The 20 + day waiting period

may or may not fall within the 60-day waiting period.

• 10 + day waiting period – The constable, sheriff, private process server

should have completed a Return of Service form stating when your spouse

was served. The Return of Service form must be on file with the court for

at least 10 days before you can finish your case. Important: When

counting the 10 day waiting period, do not count the day the Return of

Service is filed with the court and do not count the day you go to court to

finish your case.

Step 8: Determine if your divorce can be finished by default.

Call the clerk’s office to find out if your spouse filed an answer.

If your spouse filed an answer, you CANNOT finish your divorce by default.

• If your spouse filed an answer and will now agree to sign your completed

Final Decree of Divorce, you can finish your case by agreement.

• If your spouse filed an answer and will not agree to sign your completed

Final Decree of Divorce, your case is contested. To finish a contested

divorce, you must set a contested final hearing. You must give your

spouse at least 45 days’ notice of the final hearing. Read this article to

learn more: How to Set a Contested Final Hearing (Family

Law). Remember: It’s always best to have a lawyer if your case is

contested.

If your spouse has NOT filed an answer, you CAN finish your divorce by

default as long as all of the following are true.

• Your spouse was successfully served by a constable, sheriff or private

process server.

• A Return of Service form (stating when and where your spouse was

served) has been on file with the clerk’s office for at least 10 days (not

counting the day it was filed or the day you go to court).

• The 20 + day waiting period for your spouse to file an answer has passed.

• The 60-day waiting period has passed.

• If your spouse was served by publication, you hired a lawyer to be the

“attorney ad litem” for your spouse, and the lawyer was not able to find

your spouse.

• Your spouse has not filed an answer and does not file an answer before

you finish your divorce. (Remember, your spouse can file an answer up

until the time you finish your divorce, even if the 20 + day waiting period

has already passed.

If you CAN finish your divorce by default, fill out these additional forms and

make 1 copy of each form:

• Certificate of Last Known Mailing Address

• Military Status Declaration (If your case is filed in Harris County, fill out

a Military Status Affidavit instead. Sign it in front of a notary.)

Step 9: Go to court to finish your divorce.

If your spouse does not file an answer and the waiting periods have passed

you can go to court to finish your divorce by default.

• Call the clerk’s office to learn when and where the court hears uncontested

cases.

• Call the clerk’s office again the day before you plan to go to court to make

sure that your spouse has not filed an answer. If your spouse has filed an

answer, you will not be able to finish your case by default. Go back to Step

• Bring these papers with you to the courthouse on the day you plan to finish

your case:

• file-stamped copy of your Original Petition for Divorce.

• file-stamped copy of the Return of Service form showing when and

where your spouse was served.

• Final Decree of Divorce form completely filled out and signed by you.

• Certificate of Last Known Mailing Address form and 1 copy.

• Military Status Declaration (or Military Status Affidavit) and 1 copy.

• Sample Testimony

• Any additional documents needed for your specific case, such as a

Qualified Domestic Relations Order (QDRO) if you are dividing a

retirement account.

• When you get to the courthouse, go to the clerk’s office.

• Ask the clerk if you need the court file or docket sheet (list of what has

been filed in your case).

• Ask the clerk to check one more time to see if your spouse has filed an

answer. If your spouse (or the OAG) has filed an answer, you will not

be able to finish your case by default. Go back to Step 8.

• Print and read through the sample testimony (found below). You must read

this testimony to the judge when you go to court to finish your divorce.

Make sure everything in the sample testimony is true for you. If not, talk to

a lawyer. Remember, everything you say in court must be true and correct.

You can be charged with a crime for lying in court.

• Read the article Tips for the Courtroom for more information about going

to Court.

• Some courts will let you finalize your divorce without going to court if you

complete an Affidavit for Prove-Up of Default Divorce without Children and

file it with your decree.

• File the Certificate of Last Known Mailing Address and the Military

Status Declaration (or Military Status Affidavit). Ask the clerk to file

stamp your copy of each form. Bring a file-stamped copy of each form

with you to court.

• When you get to the courtroom, tell the clerk you are there and give the

clerk your paperwork. Sit down until the judge calls your case.

• When the judge calls your case, walk to the front of the courtroom and

stand in front of the judge’s bench. The judge will have you raise your right

hand and swear to tell the truth. The judge may ask you questions or may

ask you to read your testimony. Have your sample testimony ready. The

judge will listen to what you say and review your papers. If everything is in

order the judge will sign your Final Decree of Divorce.

If you would like to appear virtually, you may need to file a motion for use of

emergency procedures. Read Virtual Court.

NOTE: Some judges may allow the use of an affidavit to satisfy the prove-up

requirements in a divorce, but it is more likely to see this in agreed divorces. If

you’d like to see if the judge will accept an affidavit in place of short testimony

you should contact the court coordinator (remembering that they cannot give

you legal advice). Some judges may not accept prove-up affidavits.

Additionally, some judges will only accept prove-up affidavits for divorces with

no children.

TexasLawHelp offers a general affidavit form and a guided general

affidavit form. If you need to find and draft legal documents because you

cannot hire an attorney (after trying), you can review this presentation on

finding and formatting forms from the Harris County Law Library. An

affidavit must be sworn in front of a notary. Everything in the affidavit must be

true and correct. You can be charged with a crime for lying to the court.

See Texas Penal Code 37.

Step 10: File (turn in) the signed Final Decree of Divorce.

After the judge signs your Final Decree of Divorce, go back to the clerk’s

office.

• File (turn in) the Final Decree of Divorce and any other orders signed by

the judge. Your divorce is NOT final until you do so.

• Get a certified copy of your Final Decree of Divorce and any other orders

signed by the judge from the clerk while you are there. The clerk may

charge a fee for the certified copies.

• If your name was changed, get at least 3 certified copies of your Final

Decree of Divorce to take to the agencies listed in Step 11. The clerk may

charge a fee for the certified copies.

Step 11: After your divorce is finished.

Send a file-stamped copy of your Final Decree of Divorce and any other

orders signed by the judge to your spouse.

Follow these additional steps if they apply:

• If your name was changed, take a certified copy of your Final Decree of

Divorce to the following agencies:

• Your local Social Security Administration (SSA) office to change your

social security card.

• Your local Department of Public Safety (DPS) office to change your

driver’s license or state identification card.

• Your County Voter Registrar to change your voter registration card.

(For more information, contact the Texas Secretary of State.)

• Contact the U.S. State Department to change your name on your

passport.

• Transfer car titles. If a vehicle (not already in your name alone) is awarded

to you, give a certified copy of the Final Decree of Divorce to your county

tax office and apply for title. The vehicle identification number (VIN) must

be listed in your divorce decree.

• File deeds to transfer title to real property (house or land) at the property

records office in the county where the property is located.

• If the judge signed a QDRO dividing a retirement account, send a certified

copy of the QDRO to the administrator of the retirement plan by certified

mail return receipt requested. If this isn’t done, you won’t get your

share of the retirement funds.

• Revise your will, insurance policies and all financial account beneficiary

designations as needed.

NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA.

FM-DivA-100 Original Petition for Divorce [Set A] (Rev. 09-2021)

Original Petition for Divorce

Print your answers.

My name is: __________________________________________________________________________.

First Middle Last

I am the Petitioner, the person asking for a divorce.

The last three numbers of my driver’s license number are: ___ ___ ___. My driver’s license was

issued in (State) ________________________.

or I do not have a driver’s license number.

The last three numbers of my social security number are: ___ ___ ___.

or I do not have a social security number.

My spouse’s name is: __________________________________________________________________.

First Middle Last

My spouse is the Respondent.

1. Discovery

1A. Discovery Level.

The discovery level in this case, if needed, is: (Check one box.)

Level 1. (Check here if you and your spouse have less than $250,000 in property.)

Level 2. (All other couples check here.)

1B. Required Initial Disclosures

I understand that spouses in a divorce must usually exchange initial disclosures of the

information and material described in Texas Rules of Civil Procedure, Rule 194.2.

Check all that apply.

I believe my spouse and I will agree to waive the exchange of initial disclosures.

This action involves domestic violence and is exempt from the required initial disclosure

requirement.

Cause Number:

(The Clerk’s office will fill in the Cause Number and Court Number when you file this form.)

In the Matter of the Marriage of

Petitioner:

In the ______________

(Court Number)

District Court

County Court at Law

County, Texas

Print first, middle and last name of the spouse filing for divorce.

And

Respondent:

Print first, middle and last name of other spouse.

FM-DivA-100 Original Petition for Divorce [Divorce Set A] (Rev. 09-2021)

2. Legal Notice (Check one box.)

I think my spouse will sign a Waiver of Service (or Answer). Do not send a sheriff, constable, or

process server to serve my spouse with a copy of this Petition for Divorce at this time.

I will have a sheriff, constable, process server or clerk serve my spouse with this Petition for Divorce

here:

_________________________________________________________________________________.

Street Address City State Zip

If this is a work address, name of business: ______________________________________________.

I ask the clerk to issue a Citation of Service (the form necessary to provide legal notice to my spouse by

“Official Service of Process”). I understand that I will need to pay the fee (or file a Statement of Inability

to Afford Payment of Court Costs if am unable to pay the fee) and arrange for service.

I cannot find my spouse. I ask that my spouse be served by posting or publication. I understand I must

file an Affidavit for Citation by Posting or Affidavit for Citation by Publication depending on my case. If

my spouse and I have property, I understand I must also hire a lawyer to serve as attorney ad litem for

my spouse.

3. Jurisdiction

3A. County Residence Requirement

(Check all boxes that apply.)

I have lived in this county for the last 90 days.

My spouse has lived in this county for the last 90 days.

I am serving in the armed forces or other government service

outside of Texas, but this county has been the home county of

either my spouse or me for at least 90 days.

I have accompanied my spouse who is serving in the armed forces

or other government service outside of Texas, but this county has been the home county of either my

spouse or me for at least 90 days.

3B. Texas Residence Requirement

(Check all boxes that apply.)

I have lived in Texas for the last six months.

My spouse has lived in Texas for the last six months.

I am serving in the armed forces or other government service outside of Texas, but Texas is the home

state of either my spouse or me and has been for at least 6 months.

I have accompanied my spouse who is serving in the armed forces or other government service outside

of Texas, but Texas is the home state of either my spouse or me and has been for at least 6 months.

3C. Personal Jurisdiction over Spouse

(Check one box.)

My spouse lives in Texas.

My spouse does not live in Texas.

(If your spouse does not live in Texas, check any boxes that apply below.)

My spouse agrees that a Texas court can make orders in this divorce, including orders dividing our

property and debts. My spouse will file a Waiver of Service (or Answer).

Note: You cannot file for divorce in

Texas until you or your spouse has lived

in the county where you are asking for a

divorce for at least the last 90 days and

in Texas for at least the last six months.

There are special rules for military

families and others who are absent from

the state due to government service.

Get more information at

www.TexasLawHelp.org

FM-DivA-100 Original Petition for Divorce [Divorce Set A] (Rev. 09-2021)

Texas is the last state where we lived together as a married couple. This Petition for Divorce is filed

less than two years after we separated.

4. Dates of Marriage and Separation

My spouse and I got married on or about: __________________________________________________.

Month Day Year

We stopped living together as spouses on or about: __________________________________________.

Month Day Year

5. Grounds for Divorce

I ask the Court to grant me a divorce. The marriage has become insupportable due to discord or conflict of

personalities that destroys the legitimate ends of the marital relationship and prevents any reasonable

expectation of reconciliation.

6. No Children Together

My spouse and I do not have any biological or adopted

children together who are under 18 years old or still in high

school.

7. Is the Wife Pregnant?

(Check one box.)

The wife in this marriage is not pregnant.

The wife in this marriage is pregnant. I understand that I cannot finish the divorce until after the child is

born.

(If the wife is pregnant, also check one box below.)

The husband is the father of this child. I ask the court to include orders for custody, visitation, child

support and medical support for the child in the Final Decree of Divorce.

The husband is not the father of this child. I understand that paternity of the child must be

established before I can finish the divorce. (Get information about establishing paternity at

www.TexasLawHelp.org.)

8. Did the Wife Have a Child with Another Partner while Married to the Husband?

(Check one box. Fill in the requested information, if applicable.)

The wife did not have a child with another man while married to the husband.

The wife did have a child with another man while married to the husband. All of the children born

during the marriage that are not the Husband’s adopted or biological children are named below:

Child’s name

Age

Date of Birth

Sex

Note: Talk to a lawyer if you have an adult disabled

child who is not capable of supporting him or herself

because of the disability. You or your spouse could be

entitled to receive child support.

FM-DivA-100 Original Petition for Divorce [Divorce Set A] (Rev. 09-2021)

(If the wife had a child or children with another man during the marriage, check one box below,)

Paternity of the child(ren) named above has not been established. I understand that paternity of

the child(ren) must be established before I can finish my divorce.

(Get information about establishing

paternity at www.TexasLawHelp.org.)

Paternity of the child(ren) named above has been established: (Check one box.)

A court order has established that another man is the biological father and/or the Husband is

not the biological father of the child(ren) listed above. I understand I must attach a file-stamped

copy of the court order to my Final Decree of Divorce.

An Acknowledgement of Paternity was signed by the biological father and a Denial of Paternity

was signed by the Husband for the child(ren) listed above. I understand I must attach a copy of

these documents to my Final Decree of Divorce.

9. Protective Order Statement (Check the appropriate boxes below. Fill in the requested information.)

9A. No Protective Order

I do not have a protective order against my spouse and I have not asked for one.

My spouse does not have a protective order against me and has not asked for one.

9B. Pending Protective Order

I have filed paperwork at the courthouse asking for a protective order against my spouse, but a

judge has not decided if I should get it. I asked for a protective order on ____________________

Date Filed

in ______________ County, ___________. The cause number is _________________________.

County State Cause Number

If I get a protective order, I will file a copy of it before any hearings in this divorce.

My spouse has filed paperwork asking for a protective order against me, but a judge has not

decided if my spouse will get it. My spouse asked for a protective order on _________________

Date Filed

in _______________ County, ___________. The cause number is ________________________.

County State Cause Number

If my spouse gets a protective order, I will file a copy of it before any hearings in this divorce.

9C. Protective Order in Place

I do have a protective order against my spouse. I got the protective order in

____________________________ County, ______________________ on _________________.

County State Date Ordered

The cause number for the protective order is _________________________________________.

Cause Number

Either I have attached a copy of the protective order to this petition or I will file a copy of it with the

court before any hearings in this divorce.

My spouse does have a protective order against me. The protective order was made in

_____________________________ County, _____________________ on __________________.

County State Date Ordered

The cause number for the protective order is __________________________________________.

Cause Number

Note: You must provide information about any protective order or pending application for protective order

involving you and your spouse or a child of either you or your spouse. This includes information about any:

(1) family violence protective order, (2) sexual assault, sexual abuse, trafficking or stalking protective order; or

(3) emergency protective order issued after an arrest. You must also attach to this petition a copy of any

protective order (even if it’s expired) in which one spouse or child of either spouse was the applicant or victim

and the other spouse was the respondent or defendant. If your divorce petition does not accurately reflect

whether there is a protective order against either spouse, the Court may require you to file an amended petition.

FM-DivA-100 Original Petition for Divorce [Divorce Set A] (Rev. 09-2021)

Either I have attached a copy of the protective order to this petition or I will file a copy of it with the

court before any hearings in this divorce.

10. Waiver of Waiting Period Based on Family Violence (Check only if applicable.)

I ask the Court to waive the 60-day waiting period for divorce because: (Check one box.)

My spouse has been convicted of or received deferred adjudication for a crime involving family

violence against me or a member of my household.

I have an active protective order or an active magistrate’s order for emergency protection against

my spouse because of family violence during our marriage. The order includes a finding that my

spouse committed family violence.

11. Property and Debt

Note: It is very important to talk with lawyer if you or your spouse has a house, land, business, retirement funds,

other valuable property or debt. Getting advice from a lawyer now can save you time and money in the long run.

About community property: Texas is a community property state. This means that any new property that either

spouse gets from the minute they are married until the minute the judge grants the divorce is probably community

property, even if the property is only in one spouse’s name.

About separate property: Property owned by a spouse before the marriage is that spouse’s separate property.

In addition, if either spouse receives a gift, an inheritance, or a recovery for personal injuries that occurred during

the marriage (not including a recovery for lost wages or medical expenses); it is that spouse’s separate property.

There are exceptions to these general rules. If you have questions talk to a lawyer.

About retirement: Retirement funds (such as 401k, pension, profit sharing, stock option plans and IRAs) earned

by either spouse during the marriage are usually considered to be community property that can be divided by the

court. This is true even if you or your spouse has not yet retired. If you want the Court to divide retirement funds

(other than an IRA), you will need to have the Court sign an additional form, usually called a “Qualified Domestic

Relations Order” (QDRO), to make the division effective. You should have the QDRO prepared before you go to

court, so the judge can sign it when you finish your divorce. A QDRO form is not included with this divorce set.

You may be able to get a sample QDRO form from the employer or retirement fund administrator. If not, you

should hire a lawyer to draft the QDRO form. If you use the employer or retirement fund administrator’s QDRO

form, you should still have a lawyer review it to make sure you are not giving up important benefits. Note: If you

and your spouse plan to keep your own retirement funds or do not have retirement funds, you do not need a

QDRO.

About debt: A creditor’s right to collect a debt is not affected by a divorce decree. So, if the Court orders your

spouse to pay a debt (such as a mortgage) that is in both of your names but your spouse doesn’t pay it, the

creditor can still seek payment from you. Ask a lawyer how to protect yourself in this situation.

11A. Community Property and Debt

If my spouse and I can agree about how to divide the property and debts we got during our marriage, I ask

the Court to approve our agreement. If we cannot agree, I ask the Court to divide our community property

and debts according to Texas law.

11B. Separate Property

I own the following separate property. I owned this property before I was married or I received this property

as a gift or inheritance during my marriage or I received this property as recovery for personal injuries that

occurred during the marriage (not including any recovery for lost wages or medical expenses). I ask the

Court to confirm this property as my separate property.

(Fill in all lines. If you have no property to list in a particular category, write “none.”)

House or land located at ________________________________________________________________

Street Address City State Zip

Note: You MUST attach a copy of any protective order issued for you against your spouse or issued for your spouse

against you, no matter when the protective order was issued.

FM-DivA-100 Original Petition for Divorce [Divorce Set A] (Rev. 09-2021)

Cars, trucks, motorcycles, or other vehicles

Year

Make

Model

Vehicle Identification No. [VIN]-

Other money or personal property that I owned before I was married, received as a gift or inheritance

during my marriage or property I purchased during my marriage with separate property funds:

Money I received as recovery for personal injuries that occurred during the marriage that was not for lost

wages or medical expenses:

12. Name Change

(Check one box.)

I am NOT asking the Court to change my name.

I ask the Court to change my name back to a name I used before my marriage. I am not asking the

court to change my name to avoid criminal prosecution or creditors. I ask that my name be changed to:

_________________________________________________________________________________.

First Middle Last

13. Request for Judgment

I ask the Court to grant my divorce. I also ask the Court to make the other orders I have asked for in this

Petition and any other orders to which I am entitled.

Petitioner’s Name

Date

→

Petitioner’s Signature

Phone

Mailing Address City State Zip

Email Address:

Fax (if any)

I understand that I must notify the Court and my spouse’s attorney (or my spouse if my spouse

does not have an attorney) in writing if my mailing address or email address changes during these

divorce proceedings. If I don’t, any notices about this case including the dates and times of

hearings will be sent to me at the mailing address or email address above.

Note: You cannot use this form to change your name to anything other

than a name you used before you got married.

FM-DivA-100 Original Petition for Divorce [Divorce Set A] (Rev. 09-2021)

Note: For a referral to a lawyer call your local lawyer referral service or the State Bar of Texas Lawyer Referral

Information Service at 800-252-9690.

For information about free and low-cost legal help in your county go to www.TexasLawHelp.org or call the Legal

Aid office serving your area:

Legal Aid of Northwest Texas 888-529-5277 (serves Dallas / Ft. Worth area, and Northwest Texas)

Lone Star Legal Aid 800-733-8394 (serves Houston area & East Texas)

Texas Rio Grande Legal Aid 888-988-9996 (serves Austin / San Antonio area, El Paso area, and South Texas)

If you have been the victim of family violence, or if at any time you feel unsafe, get help by calling the:

National Domestic Violence Hotline at 800-799-SAFE (7233) or

Texas Family Violence Legal Line at 800-374-HOPE (4673) or

Crime Victims at 888-343-4414.

(e.g., John Smith v. All American Insurance Co; In re Mary Ann Jones; In the Matter of the Estate of George Jackson)

A civil case information sheet must be completed and submitted when an original petition or application is filed to initiate a new civil, family law, probate, or mental

health case or when a post-judgment petition for modification or motion for enforcement is filed in a family law case. The information should be the best available at

the time of filing. This sheet, approved by the Texas Judicial Council, is intended to collect information that will be used for statistical purposes only. It neither replaces

nor supplements the filings or service of pleading or other documents as required by law or rule. The sheet does not constitute a discovery request, response, or

supplementation, and it is not admissible at trial.

1. Contact information for person completing case information sheet:

Names of parties in case:

Person or entity completing sheet is:

Name:

_____________________________

Address:

_____________________________

City/State/Zip:

_____________________________

Signature:

_____________________________

Email:

____________________________

Telephone:

____________________________

Fax:

____________________________

State Bar No:

____________________________

Plaintiff(s)/Petitioner(s):

_________________________________

Defendant(s)/Respondent(s):

_________________________________

[Attach additional page as necessary to list all parties]

Attorney for Plaintiff/Petitioner

Pro Se Plaintiff/Petitioner

Title IV-D Agency

Other: _________________________

Additional Parties in Child Support Case:

Custodial Parent:

_________________________________

Non-Custodial Parent:

_________________________________

Presumed Father:

_________________________________

2. Indicate case type, or identify the most important issue in the case (select only 1):

Civil

Family Law

Contract

Injury or Damage

Real Property

Marriage Relationship

Post-judgment Actions

(non-Title IV-D)

Debt/Contract

Consumer/DTPA

Debt/Contract

Fraud/Misrepresentation

Other Debt/Contract:

____________________

Foreclosure

Home Equity—Expedited

Other Foreclosure

Franchise

Insurance

Landlord/Tenant

Non-Competition

Partnership

Other Contract:

______________________

Assault/Battery

Construction

Defamation

Malpractice

Accounting

Legal

Medical

Other Professional

Liability:

_______________

Motor Vehicle Accident

Premises

Product Liability

Asbestos/Silica

Other Product Liability

List Product:

_________________

Other Injury or Damage:

_________________

Eminent Domain/

Condemnation

Partition

Quiet Title

Trespass to Try Title

Other Property:

____________________

Annulment

Declare Marriage Void

Divorce

With Children

No Children

Enforcement

Modification—Custody

Modification—Other

Title IV-D

Enforcement/Modification

Paternity

Reciprocals (UIFSA)

Support Order

Related to Criminal

Matters

Other Family Law

Parent-Child Relationship

Expunction

Judgment Nisi

Non-Disclosure

Seizure/Forfeiture

Writ of Habeas Corpus—

Pre-indictment

Other: _______________

Enforce Foreign

Judgment

Habeas Corpus

Name Change

Protective Order

Removal of Disabilities

of Minority

Other:

__________________



Adoption/Adoption with

Termination

Child Protection

Child Support

Custody or Visitation

Gestational Parenting

Grandparent Access

Parentage/Paternity

Termination of Parental

Rights

Other Parent-Child:

_____________________

Employment

Other Civil

Discrimination

Retaliation

Termination

Workers’ Compensation

Other Employment:

______________________

Administrative Appeal

Antitrust/Unfair

Competition

Code Violations

Foreign Judgment

Intellectual Property

Lawyer Discipline

Perpetuate Testimony

Securities/Stock

Tortious Interference

Other: _______________

Tax

Probate & Mental Health

Tax Appraisal

Tax Delinquency

Other Tax

Probate/Wills/Intestate Administration

Dependent Administration

Independent Administration

Other Estate Proceedings

Guardianship—Adult

Guardianship—Minor

Mental Health

 Other: ____________________

3. Indicate procedure or remedy, if applicable (may select more than 1):

Appeal from Municipal or Justice Court

Arbitration-related

Attachment

Bill of Review

Certiorari

Class Action

Declaratory Judgment

Garnishment

Interpleader

License

Mandamus

Post-judgment

Prejudgment Remedy

Protective Order

Receiver

Sequestration

Temporary Restraining Order/Injunction

Turnover

CIVIL CASE INFORMATION SHEET

CAUSE NUMBER (FOR CLERK USE ONLY): _______________________________ COURT (FOR CLERK USE ONLY): ______________________

STYLED ___________________________________________________________________________________________________

INFORMATION ON SUIT AFFECTING THE FAMILY RELATIONSHIP

(EXCLUDING ADOPTIONS)

SECTION I GENERAL INFORMATION (REQUIRED) S

TATE

ILE

UMBER

1a. COUNTY __________________________ 1b. COURT NO. ________________________

1c. CAUSE NO. ________________________ 1d. DATE OF ORDER (mm/dd/yyyy) _________

2. TYPE OF ORDER (CHECK ALL THAT APPLY):

DIVORCE/ANNULMENT WITH CHILDREN (Se

. 1,2

AND

3) DIVORCE/ANNULMENT WITHOUT CHILDREN (Sec 1

AND

ESTABLISHMENT OF COURT OF CONTINUING JURISDICTION (S

AND

(Court Order Establishing Paternity, Conservatorship, Child Support or Termination of Parental Rights)

CHANGE IN THE NAME OF THE CHILD (S

AND

ROVIDE PRIOR AND NEW NAME OF CHILD IN SECTION

TRANSFER OF COURT OR CONTINUING JURISDICTION (S

1,3

AND INFORMATION BELOW

)

TRANSFER TO: COUNTY __________ COURT NO. ________ STATE COURT ID# ______________

NAME OF ATTORNEY FOR PETITIONER

TELEPHONE NUMBER

(including area code)

CURRENT MAILING ADDRESS

(

STREET AND NUMBER OR P

O BOX

CITY

STATE

ZIP

)

SECTION

2 (

IF APPLICABLE

)

REPORT OF DIVORCE OR ANNULMENT OF MARRIAGE

ETITIONER

4. N

AME

(

FIRST MIDDLE LAST SUFFIX

) 5.

MAIDEN LAST NAME

(

NAME BEFORE

MARRIAGE

)

PLACE OF BIRTH

(

CITY AND STATE OR FOREIGN COUNTRY

) 7.

RACE

DATE OF BIRTH

(mm/dd/yyyy)

USUAL RESIDENCE STREET NAME

NUMBER CITY STATE ZIP

RESPONDENT

10. N

AME

(

FIRST MIDDLE LAST SUFFIX

) 11.

MAIDEN LAST NAME

(

NAME BEFORE

MARRIAGE

)

12.

PLACE OF BIRTH

(

CITY AND STATE OR FOREIGN COUNTRY

) 13.

RACE

14.

DATE OF BIRTH

(mm/dd/yyyy)

15.

USUAL RESIDENCE

(

STREET AND NUMBER CITY

STATE

ZIP

)

16.

NUMBER OF MINOR CHILDREN

17.

DATE OF MARRIAGE

(mm/dd/yyyy) 18.

PLACE OF MARRIAGE

(

CITY AND STATE OR FOREIGN COUNTRY

)

SECTION

3 (

IF APPLICABLE

)

CHILDREN AFFECTED BY THIS SUIT

CHILD

19a.

CHILD CURRENT NAME

(

FIRST MIDDLE LAST SUFFIX

)

19b.

DATE OF BIRTH

(mm/dd/yyyy) 19c.

SEX

19d.

BIRTHPLACE

(

CITY

COUNTY AND STATE

)

19e.

PRIOR NAME OF CHILD

(

FIRST MIDDLE LAST SUFFIX

) –

IF APPLICABLE

CHILD

20a.

CHILD CURRENT NAME

(

FIRST MIDDLE LAST SUFFIX

)

20b.

DATE OF BIRTH

(mm/dd/yyyy) 20c.

SEX

20d.

BIRTHPLACE

(

CITY

COUNTY AND STATE

)

20e.

PRIOR NAME OF CHILD

(

FIRST MIDDLE LAST SUFFIX

) –

IF APPLICABLE

CHILD

21a.

CHILD CURRENT NAME

(

FIRST MIDDLE LAST SUFFIX

)

21b.

DATE OF BIRTH

(mm/dd/yyyy) 21c.

SEX

21d.

BIRTHPLACE

(

CITY

COUNTY AND STATE

)

21e.

PRIOR NAME OF CHILD

(

FIRST MIDDLE LAST SUFFIX

) –

IF APPLICABLE

ADDITIONAL CHILDREN LISTED ON BACK OF THE FORM

I CERTIFY THAT THE ABOVE ORDER WAS GRANTED ON THE DATE AND PLACE AS STATED

. _____________________________________

SIGNATURE OF THE CLERK OF THE COURT

WARNING: This is a governmental document. Texas Penal Code, Section 37.10, specifies penalties for making false

entries or providing false information in this document.

Texas Department of State Health Services - Vital Statistics

DDITIONAL CHILDREN AFFECTED BY THIS SUIT FROM SECTION

3 (

IF APPLICABLE

)

CHILD

23a.

CHILD CURRENT NAME

(

FIRST MIDDLE LAST SUFFIX

)

23b.

DATE OF BIRTH

(mm/dd/yyyy) 23c.

SEX

23d.

BIRTHPLACE

(

CITY

COUNTY AND STATE

)

23e.

PRIOR NAME OF CHILD

IRST MIDDLE LAST SUFFIX

) –

IF APPLICABLE

CHILD

24a.

CHILD CURRENT NAME

IRST MIDDLE LAST SUFFIX

)

24b.

DATE OF BIRTH

(mm/dd/yyyy) 24c.

SEX

24d.

BIRTHPLACE

(

CITY

COUNTY AND STATE

)

24e.

PRIOR NAME OF CHILD

IRST MIDDLE LAST SUFFIX

) –

IF APPLICABLE

CHILD

25a.

CHILD CURRENT NAME

IRST MIDDLE LAST SUFFIX

)

25b.

DATE OF BIRTH

(mm/dd/yyyy) 25c.

SEX

25d.

BIRTHPLACE

(

CITY

COUNTY AND STATE

)

25e.

PRIOR NAME OF CHILD

IRST MIDDLE LAST SUFFIX

) –

IF APPLICABLE

Instructions for Completing the Suit Affecting Parent Child Relationship Form

GENERAL REQUIREMENT:

All divorces/annulments (with or without children) and all suits affecting the parent-child relationship must be reported through the clerk of the

court to the State Vital Statistics Unit (VSU).

Consolidated reporting by petitioners, attorneys, and the courts is designed to make mandatory reporting more efficient, timely, and improve

the quality of reporting. However, this reporting system is only as good or timely as you make it; therefore, your attention in completing and

filing this report is critical.

Legal basis for this reporting is contained in Health and Safety Code §194.002 and Texas Family Code §§108.001-.002 and 108.004.

For information concerning reporting or questions about this form, contact field services at fieldserv[email protected] or by phone at 512-

776- .

SECTION 1 GENERAL INFORMATION (REQUIRED)

This section must be completed for each report filed.

1a – d. Enter the required information to identify the court proceeding.

2. Check the type of suit being reported. This determines also which sections of the form must be completed. If more than one type of

order applies, check all that apply. Transfers from one jurisdiction to another must be reported in this section (if court number is unknown,

specify “unknown”).

3a – c. Complete the attorney information to assist in questions or follow up. If case was pro se, please enter the information of the

person completing this form.

SECTION 2 (IF APPLICABLE) REPORT OF DIVORCE OR ANNULMENT OF MARRIAGE

All divorces/annulments must be reported, even if there were no minor children. All information is required.

4-9. Report the Petitioner’s information including maiden name (if applicable ).

10-15. Report the Respondent’s information, including maiden name (if applicable ).

16. Report the number of minor children affected by this divorce; if none, record “0.” This number must correspond to the listing of

children in Section 3.

17-18. Enter the date and place of the marriage being dissolved.

SECTION 3 (IF APPLICABLE) CHILDREN AFFECTED BY THIS SUIT

Every child affected by the suit being reported must be listed, and all items concerning that child must be completed. If more than three children are

affected, check the “additional children listed on back of form” box, and continue to list the additional children. If more than 6 children complete

section 3 on another form, label it “continuation” and attached the continuation form to the original form.

Texas Department of State Health Services - Vital Statistics VS-165 REV

pg. 1 of 12 Approved by the Supreme Court of Texas in Misc. Docket No. 22-9090

NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA

AVISO: ESTE DOCUMENTO CONTIENE INFORMACIÓN

CONFIDENCIAL

Statement of Inability to Afford Payment

of Court Costs or an Appeal Bond

Declaración sobre Incapacidad de Pago de Costas

de Tribunal o de una Fianza de Apelación

Cause Number

Número de Caso

____________________________

The Clerk’s office will fill in the Cause Number when you file this form.

El Secretario del Tribunal anotará el Número de Caso cuando usted presente este

formulario.

_________________________________

Copy information listed at the top left of

the petition here.

Copie aquí la información ubicada en la

parte superior izquierda del escrito de la

demanda.

Copy information listed at the top right of the petition here.

Copie aquí la información ubicada en la parte superior derecha del escrito de la

demanda.



District Court

Tribunal de Distrito

 County Court

Tribunal del Condado

 County Court at Law

Tribunal Estatutario

 Justice Court

Juzgado de Paz

 Probate Court

Juzgado Sucesorio

Court Number

Número del Tribunal

___________________________,Texas

County

Condado

pg. 2 of 12 Approved by the Supreme Court of Texas in Misc. Docket No. 22-9090

1. Your Information / Su Información

 My full legal name is / Mi nombre legal completo es

_______________________________________________________________

First Middle Last / Nombre de Pila Segundo Nombre Apellido

 My date of birth is / Mi fecha de nacimiento es

_______________________________________________________________

Month Day Year / Mes Día Año

 My address is / Mi dirección es

Home / Domicilio ____________________________________________

Mailing / Dirección Postal _____________________________________

 My phone number / Mi número telefónico ____________________________

 My email I check often / Mi correo electrónico que reviso con frecuencia

______________________________________________________________

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pg. 3 of 12 Approved by the Supreme Court of Texas in Misc. Docket No. 22-9090

2. About My Dependents / Mis Dependientes

“The people who depend on me financially are listed below.” Use initials only for

children under 18. If needed, attach a separate piece of paper to list more

dependents.

“Las personas a continuación dependen económicamente de mí.” Use iniciales para

los menores de 18 años y, si es necesario, anexe una hoja por separado para

enumerar a todos sus dependientes.

Name

Nombre

Age

Edad

Relationship to me

Parentesco Conmigo

3. Are you represented by Legal Aid? ¿Está siendo representado por alguna

entidad de asistencia legal?

Check only one box. Seleccione solo una casilla.

 I am being represented in this case for free by an attorney who works for a legal

aid provider or who received my case through a legal aid provider. I have attached

the certificate the legal aid provider gave me as “Exhibit: Legal Aid Certificate.”

Me está representando gratuitamente un abogado que trabaja para una entidad

de asistencia legal o que recibió mi caso de una entidad de asistencia legal. El

certificado que la entidad de asistencia legal me entregó lo adjunto bajo el título,

“Anexo: Certificado de Asistencia Legal.”

or / o

 I am not represented by legal aid.

No me está representando ninguna entidad de asistencia legal.

pg. 4 of 12 Approved by the Supreme Court of Texas in Misc. Docket No. 22-9090

4. Public Benefits / Beneficios de Asistencia Pública



Do you or any of your dependents receive public benefits?

¿Recibe usted o sus dependientes beneficios de asistencia pública?



Yes / Sí



No / No

 If you answered yes, check all that apply and attach proof to this form, such as

a copy of an eligibility form or check.

Si respondió con un Sí, marque todas las casillas que apliquen y adjunte a

este formulario comprobantes, tales como una copia de la carta autorizando

que reciba estos beneficios o una copia del cheque que recibe.



Food stamps/SNAP

Cupones de comida/SNAP



TANF

 Medicaid

 CHIP

 SSI/SSDI

 WIC



Lifeline



Public Housing or Section 8 Housing

Asistencia de Vivienda / Programa de

Vivienda bajo Sección 8

 Low-Income Home Energy

Assistance

Asistencia con Energía

Eléctrica

 Community Care via HHS

Ayuda Comunitaria bajo HHS

 LIS in Medicare (“Extra Help”)

Subsidio Adicional de Medicare

bajo el Programa LIS

 Needs-based VA Pension

Pensión para Veteranos de Guerra en

función a necesidades



Child Care Assistance under

Child Care and Development

Block Grant

Asistencia con Guardería bajo

el Programa CCDBG



County Assistance, County Health

Care, or General Assistance (GA)

Asistencia del Condado, Asistencia

Médica del Condado, o Asistencia

General (GA)



Other / Otros beneficios

________________________



Other / Otros beneficios

________________________

pg. 5 of 12 Approved by the Supreme Court of Texas in Misc. Docket No. 22-9090

5. What are your monthly income sources? ¿Cuáles son sus fuentes de

ingresos mensuales?

 My take-home pay is $_______ in monthly wages.

Mi pago neto es $_______ en sueldo mensual.

 I work as a ______________ (your job title) for ________________ (your

employer).

Yo trabajo como ________________ (título de su puesto) para

___________________ (compañía o jefe).

 $__________ is my total monthly income / son mis ingresos totales al mes.

These are my income sources. Estas son mis fuentes de ingresos.

 $____________ in unemployment / en beneficios de desempleo.

I have been unemployed since ____________ (date).

He estado desempleado desde ______________ (indique fecha).

 $____________ in public benefits / en beneficios de Asistencia Pública.

 $____________ from people in my household other than my spouse / de

ingresos de otras personas en mi hogar que no son de mi cónyuge.

 $____________ from retirement or pension / de jubilación o pensión.

 $____________ from tips or bonus / de propinas o bonos.

 $____________ from disability / de discapacidad.

 $____________ from worker’s comp / de compensación al trabajador.

 $____________ from social security / de seguro social.

pg. 6 of 12 Approved by the Supreme Court of Texas in Misc. Docket No. 22-9090

 $____________ from military housing / de vivienda militar.

 $____________ from dividends, interest, or royalties / de dividendos,

intereses, o regalías.

 $____________ from child or spousal support / de manutención de

menores o manutención conyugal recibida.

 Answer only if your spouse is not your opponent. Responda tan sólo si su

ccónyuge no es parte contraria en esta causa legal.$____________ from

my spouse’s income / de ingresos de mi cónyuge.

 $____________ from other jobs/sources of income / de otros trabajos/

fuentes de ingresos.

Describe / describa:

____________________________________________________

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pg. 7 of 12 Approved by the Supreme Court of Texas in Misc. Docket No. 22-9090

6. What is the value of your assets or property? ¿Cuál es el valor de sus bienes

o propiedades?

My property includes:

Mis bienes incluyen:

Value / Valor

The value is the amount the item would sell

for less the amount you still owe on it, if

anything.

El valor de sus bienes es la cantidad por la

que la propiedad o pertenencia se

vendería, menos el monto que aún se

adeuda, si lo hubiera.

 Cash

Dinero en efectivo

 Bank accounts, other financial assets

Cuentas bancarias, otros bienes financieros

 Cars and boats (make and year)

Automóviles, lanchas (modelo y año)

 Other property like jewelry, stocks, land, a second house. (Do not list your

homestead.)

Otros bienes como joyas, acciones, terrenos, una segunda casa. (No indique su

hogar familiar.)

Total Value of Property

Valor Total de Sus Bienes

pg. 8 of 12 Approved by the Supreme Court of Texas in Misc. Docket No. 22-9090

7. What are your monthly expenses that are not deducted from your paycheck?

¿Cuáles son sus gastos mensuales que no son descontados de su cheque de

sueldo?

My monthly expenses are:

Mis gastos mensuales son:

Amount

Cantidad



Rent/house payments; maintenance

Alquiler/hipoteca; mantenimiento de

casa

 Food and household supplies

Alimentos y artículos para el hogar



Utilities and telephone

Luz, gas, agua y teléfono



Clothing and laundry

Ropa y lavado de ropa



Medical and dental expenses

Gastos médicos y dentales



Insurance (life, health, auto, etc.)

Seguros (de vida, médico,

de automóvil etc.)



School and childcare

Escuelas y guarderías



Transportation, auto repair, gas

Transportación, reparaciones de auto-

móviles, gasolina



Child/Spousal support

Manutención a Menores/Manutención

Conyugal



Debt payments to (list):

Pagos por deudas hechas a (indíquelos):

 Wages withheld by court order

Sueldo retenido por orden judicial

 Other expenses (list):

Otros gastos (indíquelos):

Total Monthly Expenses

Gastos Totales Mensuales

pg. 9 of 12 Approved by the Supreme Court of Texas in Misc. Docket No. 22-9090

8. Are there debts or other facts explaining your financial situation?

¿Hay deudas u otros factores que expliquen su situación económica?

My debts include (list debt and amount owed):

Mis duedas incluyen (indique deuda y la cantidad que debe):

If you want the court to consider other facts, such as unusual medical expenses,

family emergencies, etc., attach another page to this form labeled “Exhibit: Additional

Supporting Facts.”

Si usted desea que el tribunal considere otros factores, tales como gastos médicos

excepcionales, emergencias familiares, etc., adjunte al formulario otra hoja con esta

información y bajo el título, “Anexo: Información Adicional de Apoyo.”

9. Ability to Pay Court Costs. Declaración sobre su Habilidad de

Pagar Costas de Tribunal

Check only one box. Seleccione tan solo una casilla.

 I cannot afford to pay court costs. No puedo pagar las costas de tribunal.

 I cannot furnish an appeal bond or pay a cash deposit to appeal a justice court

decision, and I cannot afford to pay court costs.

No puedo aportar una fianza de apelación ni pagar un depósito en efectivo

para apelar la decisión judicial de un magistrado, y no puedo pagar costas de

tribunal.

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pg. 10 of 12 Approved by the Supreme Court of Texas in Misc. Docket No. 22-9090

10. Declaration/Affidavit. Declaración Escrita Bajo Juramento.

Fill out only one box. If you fill out the Declaration, you will not need to sign the form

in front of a notary public. If you do not want to list your address for privacy or safety

concerns, take the form and photo identification, and fill out the Affidavit box in front of

a notary public.

Llene tan solo una opción. Si usted llena la Declaración, no necesitará firmar el

formulario ante un notario. Si usted no quiere que aparezca su domicilio en el

documento para conservar su privacidad o por motivos de su seguridad, lleve el

formulario y una identificación con fotografía y llene la sección de la Declaración

Escrita Bajo Juramento ante un Notario.

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pg. 11 of 12 Approved by the Supreme Court of Texas in Misc. Docket No. 22-9090

Option 1 / Opción 1

Declaration: I declare under penalty of perjury that the foregoing is true

and correct.

Declaración: Yo declaro bajo pena de perjurio que la información a

continuación es correcta y verdadera.

 My name is / Mi nombre es

________________________________________________________

 My date of birth is / Mi fecha de nacimiento es

________/________/________

 My address is / Mi domicilio es

________________________________________________________

Street, city, zip, country

Calle y número, ciudad, estado, código postal, pais

 _______________________________________________________

Signature

Firma

 _______________________________________________________

Date (month, day, year)

Fecha (mes, día, año)

 _______________________________________________________

County, state

Condado, estado

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pg. 12 of 12 Approved by the Supreme Court of Texas in Misc. Docket No. 22-9090

Option 2 / Opción 2

Affidavit: I swear under penalty of perjury that the foregoing is true and

correct.

Declaración Escrita Bajo Juramento: Yo juro bajo pena de perjurio,

que lo que precede es correcto y verdadero.

You fill out this section.

Usted llena esta sección.

 ______________________________________________________

Your printed name

Su nombre en letra de molde

 ________________________________________________________

Your signature

Su firma

The notary fills out this section.

El Notario llena esta sección.

 ______________________________________________________

Subscribed before me this day of

Juramentado y suscrito ante mí el día de hoy del mes de

____________________________, 20____

____________________________________________________________

NOTARY

NOTARIO

NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA.

FM-DivA-201 Final Decree of Divorce [Divorce Set A] (Rev. 11-2021) Page 1 of 9

Final Decree of Divorce

A hearing took place on ____________________________.

Date

There was no jury. Neither the husband nor wife asked for a jury.

1. Appearances

Petitioner

The Petitioner’s name is: ______________________________________________________________.

First Middle Last

The Petitioner is the: (Check one box.) husband. wife.

(Check one box.)

The Petitioner was present, self-represented, and announced ready for trial.

The Petitioner was present, self-represented, and agreed to the terms of this Final Decree of Divorce

(called “Decree” throughout this document).

The Petitioner was not present but has signed on page 9 agreeing to the terms of this Decree.

Respondent

The Respondent’s name is: ____________________________________________________________.

First Middle Last

The Respondent is the: (Check one box.) husband. wife.

(Check one box.)

The Respondent was present, self-represented, and announced ready for trial.

The Respondent was present, self-represented, and agreed to the terms of this Decree.

The Respondent was not present, but filed an Answer or Waiver of Service and has signed on page

9 agreeing to the terms of this Decree.

The Respondent was not present, but filed a Global Waiver that waived Respondent’s right to notice

of this hearing and did not otherwise appear.

The Respondent was not present, but was served and has defaulted. The Petitioner has filed a

Certificate of Last Known Address and a Military Status Affidavit.

Cause Number:

Print cause number and other court information exactly as the court assigned.

In the Matter of the Marriage of

Petitioner:

In the ______________

(Court Number)

District Court

County Court at Law

Print first, middle and last name of the spouse filing for divorce.

And

Respondent:

County,

Print first, middle and last name of other spouse.

Texas

FM-DivA-201 Final Decree of Divorce [Divorce Set A] (Rev. 11-2021) Page 2 of 9

2. Record (The Court fills out this section.)

A Court reporter recorded today’s hearing.

A Court reporter did not record today’s hearing because the parties agreed not to make a record.

A Statement of the Evidence was signed by the Court.

3. Jurisdiction

The Court heard evidence and finds that it has jurisdiction over this case and the parties, that the

residency and notice requirements have been met, and the Petition for Divorce meets all legal

requirements. The Court further finds that:

(Check one box.)

it has been at least 60 days since the Petition for Divorce was filed.

the 60 day waiting period is not required because: (Check one box.)

Petitioner has an active Protective Order under Title 4 of the Texas Family Code, or an active

magistrate’s order for emergency protection under Article 17.292 of the Texas Code of Criminal

Procedure against Respondent because Respondent committed family violence during the

marriage.

Respondent has a final conviction or has received deferred adjudication for a crime involving

family violence against Petitioner or a member of Petitioner’s household.

4. Family Violence Statement

It has been represented to the Court that: (

Check ONLY the option that applies to the situation.)

There has been no pattern of child neglect or family violence by any party to this case within two

years preceding the filing of this case or during the pendency of this case.

There has been family violence (Check all that apply.):

while the divorce was pending

during the two years prior to the filing of this lawsuit.

5. Dates of Marriage and Separation (Check ONLY the option that applies to the situation.):

The date of marriage was on or about: _______________________________________________.

Month Day Year

This was an informal (common law) marriage.

6. Divorce

IT IS ORDERED that the Petitioner and the Respondent are divorced.

7. Children

7A. No Children Together

The Court finds that the spouses do not have any biological or adopted children together who are under

18 years old, or over 18 years old and still in high school.

FM-DivA-201 Final Decree of Divorce [Divorce Set A] (Rev. 11-2021) Page 3 of 9

7B. Wife Not Pregnant

The Court finds that the wife is not pregnant.

7C. Did the wife have a child with another man while married to the husband?

(Check one box.)

The Court finds that the wife did not have children with another man while married to the husband.

The Court finds that the wife did have a child or children with another man while married to the

husband. All of the children born during the marriage that are not the husband’s adopted or biological

children are named below:

Child’s name

Sex

Date of Birth

If the wife had a child with another man while married to the husband, check one box below and attach

copy of court order or Acknowledgement and Denial of Paternity for each child.

The Court further finds that paternity of each child listed above has been established,

A court order has established that another man is the biological father and/or the husband is not

the biological father of the child(ren) listed above. A copy of the court order is attached to this

Decree as Exhibit ___.

An Acknowledgement of Paternity was signed by the biological father and a Denial of Paternity

was signed by the husband for the child(ren) listed above. A copy of each Acknowledgment and

Denial of Paternity is attached to this Decree as Exhibit(s) ________.

8. Property and Debt

(Fill in all lines. If there is no property to declare in a particular category, write “none”.)

The Court finds that the following is a just and right division of the parties’ property and debt.

8A. Husband’s Separate Property

The Court confirms that the husband owns the following property as his separate property:

1. House or Land located at: __________________________________________________________

Street Address City State Zip

Husband owned this property before marriage.

Husband received this property as a gift or inheritance.

2. Cars, trucks, motorcycles or other vehicles Husband owned these vehicles before marriage or

received them as a gift or inheritance during the marriage:

Year

Make

Model

Vehicle Identification No. [VIN]

3. Other Money or Property Confirmed as Husband’s Separate Property

Husband owned the following money or property before the marriage or inherited or received the

money or property as a gift during the marriage:

FM-DivA-201 Final Decree of Divorce [Divorce Set A] (Rev. 11-2021) Page 4 of 9

Husband received the following money recovery for personal injuries that occurred during the

marriage that is not for lost wages or medical expenses:

8B. Husband’s Community Property

The Court ORDERS that the husband is awarded the following community property as his sole and

separate property and wife is divested of (loses) all right, title, interest and claim in and to that property.

wife is ORDERED to sign any deeds or documents needed to transfer any property listed below to the

husband. Husband is responsible for preparing the documents.

1. All property in husband’s care, custody or control, or in husband’s name, that this Decree does not

give to the wife.

2. House or land located at:

Street Address City State Zip

Legal Description:

Note: The legal description is on the deed you received when you became an owner of the house or land.

It is also available at the county clerk’s office in the county where the house or land is located. Do NOT

use the legal description listed on your property tax bill because it is usually incomplete. IT IS VERY

IMPORTANT THAT THIS INFORMATION IS CORRECT. If you are not absolutely sure, talk to a lawyer.

3. All cash and money in any bank or other financial institution listed in husband’s name alone.

4. Any insurance policy that covers husband’s life.

5. Husband’s cars, trucks, motorcycles or other vehicles listed below:

Year

Make

Model

Vehicle Identification No. [VIN]

6. Husband will also keep the following property:

8C. Wife’s Separate Property

The Court confirms that wife owns the following property as her separate property:

1. House or Land located at:

__________________________________________________________________________

Street Address City State Zip

Wife owned this property before marriage.

Wife received this property as a gift or inheritance.

2. Cars, trucks, motorcycles or other vehicles Wife owned these vehicles before marriage or

received them as a gift or inheritance during the marriage:

Year

Make

Model

Vehicle Identification No. [VIN]

FM-DivA-201 Final Decree of Divorce [Divorce Set A] (Rev. 11-2021) Page 5 of 9

3. Other Money or Property Confirmed as Wife’s Separate Property

Wife owned the following money or personal property before the marriage or inherited or received the

money or property as a gift during the marriage:

Wife received the following money recovery for personal injuries that occurred during the marriage

that was not for lost wages or medical expenses:

8D. Wife’s Community Property

The Court ORDERS that the wife is awarded the following property as her sole and separate property and

Husband is divested of (loses) all right, title, interest and claim in and to that property. Husband is

ORDERED to sign any deeds or documents needed to transfer any property listed below to the wife.

Wife is responsible for preparing the documents.

1. All property in wife’s care, custody or control, or in wife’s name, that this Decree does not give to the

Husband.

2. House or land located at:

Street Address City State Zip

Legal Description:

Note: The legal description is on the deed you received when you became an owner of the house or land.

It is also available at the county clerk’s office in the county where the house or land is located. Do NOT

use the legal description listed on your property tax bill because it is usually incomplete. IT IS VERY

IMPORTANT THAT THIS INFORMATION IS CORRECT. If you are not absolutely sure, talk to a lawyer.

3. All cash and money in any bank or other financial institution listed in wife’s name alone.

4. Any insurance policy that covers wife’s life.

5. Wife’s cars, trucks, motorcycles, or other vehicles listed below:

Year

Make

Model

Vehicle Identification No. [VIN]

6. Wife will also keep the following property:

FM-DivA-201 Final Decree of Divorce [Divorce Set A] (Rev. 11-2021) Page 6 of 9

8E. Retirement Funds in Husband’s Name

(For example: pension, retirement, 401(k), 403(b), employee stock ownership, profit sharing, thrift,

Keogh, and stock option plans, as well as individual retirement accounts (IRAs), annuities and variable

annuity life insurance benefits.)

The Court makes the following orders regarding retirement funds in husband’s name.

(Check 8E(1) or 8E(2).)

8E(1) Husband is awarded 100% of all retirement funds in husband’s name alone, including but not

limited to all rights to any pension, retirement, military retirement, 401(k), 403(b), employee

stock ownership, profit sharing, thrift, Keogh, and stock option plans in husband’s name

alone, along with 100% of any individual retirement accounts (IRAs), annuities, and variable

annuity life insurance in husband’s name alone.

8E(2) The following retirement funds in husband’s name are divided between husband and wife:

(It is very important to list the exact name and account number of any retirement fund the Court is dividing.)

Formal Name of Retirement Fund

Account Number

The Court ORDERS that the portion of each retirement fund listed above accrued between

the date of the marriage _____/_____/________ and the date this Final Decree of Divorce is

signed by the Court:

(Check one.)

is awarded 50% to husband and 50% to wife and as more specifically described in

the Qualified Domestic Relations Order signed by the Court.

is awarded ______% to husband and ______% to wife and as more specifically

described in the Qualified Domestic Relations Order signed by the Court.

is awarded $ __________________ to wife and the remainder to husband and as

more specifically described in the Qualified Domestic Relations Order signed by

the Court.

other:

The Court ORDERS that husband is awarded all retirement funds in husband’s name alone

that are not specifically awarded to wife above.

A Qualified Domestic Relations Order was signed by the Court on the same day this

Final Decree of Divorce was signed by the Court.

The Court checks this box, if applicable.

FM-DivA-201 Final Decree of Divorce [Divorce Set A] (Rev. 11-2021) Page 7 of 9

8F. Retirement Funds in Wife’s Name

(For example: pension, retirement, 401(k), 403(b), employee stock ownership, profit sharing, thrift,

Keogh, and stock option plans, as well as individual retirement accounts (IRAs), annuities and variable

annuity life insurance benefits.)

The Court makes the following orders regarding retirement funds in wife’s name.

(Check 8F(1) or 8F(2).)

8F(1) Wife is awarded 100% of all retirement funds in wife’s name alone, including all rights to any

pension, retirement, military retirement, 401(k), 403(b), employee stock ownership, profit

sharing, thrift, Keogh, and stock option plans in wife’s name alone, along with 100% of any

individual retirement accounts (IRAs), annuities, and variable annuity life insurance in wife’s

name alone.

8F(2) The following retirement funds in wife’s name are divided between husband and wife:

(It is very important to list the exact name and account number of any retirement fund the Court is dividing.)

Formal Name of Retirement Fund

Account Number

The Court ORDERS that the portion of each retirement fund listed above accrued between

the date of the marriage _____/_____/________ and the date this Final Decree of Divorce is

signed by the Court:

(Check one.)

is awarded 50% to wife and 50% to husband and as more specifically described in

the Qualified Domestic Relations Order signed by the Court.

is awarded ______% to wife and ______% to husband and as more specifically

described in the Qualified Domestic Relations Order signed by the Court.

is awarded $ __________________ to husband and the remainder to wife and as

more specifically described in the Qualified Domestic Relations Order signed by

the Court.

other:

The Court ORDERS that wife is awarded all retirement funds in wife’s name alone that are

not specifically awarded to husband above.

A Qualified Domestic Relations Order was signed by the Court on the same day this Final

Decree of Divorce was signed by the Court.

The Court checks this box, if applicable.

FM-DivA-201 Final Decree of Divorce [Divorce Set A] (Rev. 11-2021) Page 8 of 9

8G. Debts to Husband

The Court ORDERS husband to pay the debts listed below:

1. All debts, taxes, bills, liens, and other charges, past, present and future, that are in husband’s name

alone unless this Decree requires otherwise.

2. Any debt husband incurred after separation. Date of separation: ____________________________.

Month Day Year

3. The balance due on any loan or mortgage for the real property (house or land) that this Decree gives

to husband alone.

4. The balance due on any loan for any vehicles that this Decree gives to husband alone.

5. All other debts listed below, which are not in husband’s name alone:

(such as credit cards, student

loans, medical bills, income taxes)

8H. Debts to Wife

The Court ORDERS wife to pay the debts listed below:

1. All debts, taxes, bills, liens, and other charges, present and future, that are in wife’s name alone

unless this Decree requires otherwise.

2. Any debt wife incurred after separation. Date of separation: ________________________________.

Month Day Year

3. The balance due on any loan or mortgage for the real property that this Decree gives to wife alone.

4. The balance due on any loan for any vehicles that this Decree gives to wife alone.

5. All other debts listed below, which are not in wife’s name alone:

(such as credit cards, student loans, medical bills, income taxes)

9. Muniment of Title

This Decree shall serve as a muniment of title to transfer ownership of all property awarded to any party

in this Final Decree of Divorce.

(A “muniment of title” creates an official record of ownership transfer.)

10. Name Change

The Court ORDERS the name of the: (Check all boxes that apply.)

Husband changed back to a name used before marriage, as it appears below:

________________________________________________________________________________

First Middle Last

Wife changed back to a name used before marriage, as it appears below:

________________________________________________________________________________

First Middle Last

FM-DivA-201 Final Decree of Divorce [Divorce Set A] (Rev. 11-2021) Page 9 of 9

11. Court Costs

The costs of court shall be paid by the spouse who incurred them to the extent the party is required to pay

such costs. A spouse who filed a Statement of Inability to Afford Payment of Court Costs or Affidavit of

Indigency or Declaration of Indigency that was not successfully contested is not required to pay court

costs.

12. Other Orders

The court has the right to make other orders, if needed, to clarify or enforce the orders above.

13. Final Orders

Any orders requested that do not appear above are denied.

This Decree is a final judgment that disposes of all claims and all parties and is appealable.

Date of Judgment

Judge’s Signature

Judge’s Printed Name

By signing below, the Petitioner agrees to this Final Decree of Divorce in form and substance.

Petitioner’s Signature

Phone number

Petitioner’s Name (print)

Date

Mailing

Address:

Email:

Fax (if available)

By signing below, the Respondent agrees to this Final Decree of Divorce in form and substance.

Respondent’s Signature

Phone number

Respondent’s Name (print)

Date

Mailing

Address:

Email:

Fax: (if available)

NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA.

PR-DJ-110 Certificate of Last Known Address (07-2020)

Case No: _____________________________________________________

(Print court information exactly as it appears on your Petition)

In the (check one):

District County Justice Court of:

County, Texas

Certificate of Last Known Mailing Address

My name is: .

First Middle Last

2. I am the Petitioner in this case.

3. The Respondent’s name is: .

First Middle Last

4. I certify that the last known mailing address I have for the Respondent is:

Address City State Zip Country

Respectfully submitted,

Your Signature

Date

Your Printed Name

Phone

Your Mailing Address City State Zip

Email Address:

Fax # (if available)

NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA.

PR-DJ-111 Military Status Affidavit (07-2020)

Page 1 of 2

Case No: ________________________________________________________

(Print court information exactly as it appears on your Petition)

In the

(check one):

District County Justice Court of:

County, Texas

Military Status Affidavit

THE STATE OF TEXAS

COUNTY OF ________________________

The person who signed this affidavit appeared, in person, before me, the undersigned

notary, and stated under oath:

“My name is: _________________________________________________________________.

First Middle Last

“I am above the age of 18 years.

“I am fully competent to make this affidavit.

“The facts stated in this affidavit are within my personal knowledge and are true and correct.

“I am the Petitioner in this case.

“The Respondent is: ___________________________________________________________.

First Middle Last

“I submitted a record request using the Department of Defense personnel locator

website, https://scra.dmdc.osd.mil/scra/, also known as the Defense Manpower Data

Center (DMDC) database.

“The search results showed that the Respondent is not on active duty in any of the

armed forces. I have attached a true and correct copy of the DMDC verification to this

affidavit.

(If you check this box, you must attach a copy of the DMDC verification.

You can print a copy of the DMDC verification from this web address:

https://scra.dmdc.osd.mil/scra/.)

PR-DJ-111 Military Status Affidavit (07-2020)

Page 2 of 2

“I believe the Respondent may be in the military. Therefore, I contacted the following

military locator services:

Military Locator Service Contacted Results

Air Force: 210-565-2660

Navy: 866-827-5672

Marines: 800-268-3710

I know that the Respondent is not now in the military because:

____________________________________________________________________________

I do not know if the Respondent is in the military now.

______________________________________________

Your Signature (Do not sign until you are in front of a notary.)

State of Texas

County of ___________________________

SIGNED under oath before me on _________________________, 20______, by

____________________________________________________________________________.

PRINT the first and last names of the person who signed this affidavit.

___________________________________________

Notary Public, State of Texas

(Notary’s seal must be included.)

NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA.

FM-DivAD-404 Notice of Current Address [SETS A and D] (Rev. 08-2021) Page 1 of 2

Notice of Current Address

I, , am a party in this case.

Print your full name

My current address is:

PRINT your name and information.

Name:

Telephone:

Email:

Fax number

(if available)

Mailing

Address:

Check only if applicable.

This is a new address and the purpose of this Notice is to update my address for the records

of the Court and other parties.

Respectfully submitted,

Your Signature

Date

Your printed name

Cause Number:

In the Matter of the Marriage of

Petitioner:

In the

______________

(Court Number)

District Court

County Court at Law

County, Texas

Print first, middle and last name of the spouse who filed for divorce.

And

Respondent:

Print first, middle and last name of other spouse.

FM-DivAD-404 Notice of Current Address [SETS A and D] (Rev. 08-2021) Page 2 of 2

Certificate of Service

I will give a copy of this document to the other party’s attorney or the party (if the party does not

have an attorney) on the same day this document is filed with (turned in to) the Court as follows:

If I file this document electronically, I will send a copy of it to the party or the party’s attorney

through the electronic file manager if possible. If not possible, I will give a copy to the party or

the party’s attorney in person, by mail, by commercial delivery service, by fax, or by email.

If I file a paper copy of this document, I will give a copy of it to the other party or the other party’s

attorney in person, by mail, by commercial delivery service, by fax, or by email.

Your Signature

Date

NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA.

FM-DivA-501 – Affidavit for Prove-Up of Default Divorce without Children - (Rev. 11-2021)

Page 1 of 2

Cause Number:

Print court information exactly as it appears on the Original Petition for Divorce.

In the Matter of the Marriage of

In the

(Court Number)

Print first, middle and last name of the spouse filing for divorce.

and

Respondent:

Print first, middle and last name of other spouse.

County

Texas

Affidavit for Prove-Up of Default Divorce Without Children

My name is ____________________________________.

I am above the age of eighteen years, and I am fully competent to make this affidavit.

The facts stated in this affidavit are within my personal knowledge and are true and correct.

I am presently married to ______________________________________________.

Before I filed this divorce suit, I was a domiciliary of Texas for the preceding six-month period

and a resident of this county for the preceding ninety-day period.

We ceased to live together as spouses on or about [date] ________________________.

I filed this divorce at least 60 days ago, on ___________________________ [date].

My spouse has been served.

The return of service has been on file for at least 10 days.

My spouse has not appeared at any hearings or filed any documents in this case.

We were married on or about [date] __________________________, and we ceased to live

together as spouses on or about [date] __________________________.

Our marriage has become insupportable because of a discord or conflict of personalities that

destroys the legitimate ends of the marriage relationship.

There is no reasonable expectation of reconciliation.

There are no children born or adopted during this marriage.

No other child is expected at this time. I am not pregnant.

There has been no family violence or abuse within two years before or during this suit.

FM-DivA-501 – Affidavit for Prove-Up of Default Divorce without Children - (Rev. 11-2021)

Page 2 of 2

There is no bankruptcy proceeding affecting this suit.

The final decree of divorce, which is on file with this Court, includes a division of our property

and debts.

The terms of the division in the decree are just and right. I believe the property division in the

decree is fair and equitable to both my spouse and me.

I am requesting a name change to _______________________________________.

I am asking the court to grant a divorce and approve all the agreements we have entered into.

Verification (Party must sign in front of a notary below.)

I am the Petitioner. I swear under oath that the facts stated in this Affidavit are true and correct.

ONLY sign in front of a notary!

Signature of Affiant

[Notary Stamps Here]

Notary’s Signature

Notary fills out below.

State of

(Print name of state where this petition is notarized)

County of

(Print the name of the county where this Petition is notarized)

Sworn to and subscribed before me, the undersigned notary, on this date:

(Print name of person who is signing this Petition. NOT the notary’s name.)