INSTRUCTIONS: DIVORCE NO CHILDREN WITHOUT AGREEMENT

1. This packet includes the following documents:

a. Appearance

b. Petition for Dissolution

c. Summons

d. Notice of Provisional Hearing

e. Order on Provisional Hearing

f. Motion for Final Hearing

g. Notice of Final Hearing

h. Decree

2. Complete the following documents according to the instructions in this packet below:

☐ Appearance

☐ Petition for Dissolution

☐ Summons

☐ Notice of Provisional Hearing-Follow the instructions, you will only fill out a small

part of this form and only if you ask for provisional orders in your petition

☐ Order on Provisional Hearing- Follow the instructions, you will only fill out a small

part of this form and only if you ask for provisional orders in your petition

3. Once your forms are completed and signed, make three (3) copies of each document.

4. Take the above completed and signed documents and copies with you to the courthouse

in the county in which you are filing for divorce (the county in which one party

currently lives and has lived for atleast three (3) months).

5. File your documents with the court Clerk. You will have to pay a fee. The fee may be

different in each county. The Clerk will stamp your forms.

6. Send the stamped copies of the forms to the other party.

7. If you filed for a provisional hearing, you will receive a notice of the date and time of the

hearing later (either by email or by mail). Read the notice telling you where to be. It

may also tell you that it is your responsibility to get a notice of the hearing to the

other party. Also, you must go to the provisional hearing. Dress nicely and do not

bring children with you.

8. Sixty days after you file your Verified Petition For Dissolution, complete, make copies

and file the following forms with the court the same way you did with the first group of

forms:

☐ Motion for Final Hearing

☐ Notice of Final Hearing

☐ Decree Of Dissolution

9. You will receive a notice of the date and time of the final hearing later (either by email or

by mail). Read the notice telling you where to be. It may also tell you that it is your

responsibility to get a notice of the hearing to the other party. Also, you must go to

the final hearing prepared to present evidence. Bring your child support worksheet

and documentation of debts, assets and income.

Dress nicely and do not bring children with you.

Page 1 of 2 Approved by the Coalition for Court Access

CCA-GF-0520-3011

STATE OF INDIANA IN THE COURT

COUNTY OF CAUSE NO.________________________________

IN RE THE MARRIAGE OF:

__________________________

Petitioner,

v.

__________________________

Respondent.

APPEARANCE BY UNREPRESENTED PERSON IN CIVIL CASE

1. My name is _________________________________ and I am:

☐ Initiating

and in this case I am not represented by a lawyer.

2. Contact information for receiving legal service of document and case information as required

by Court Rules. (NOTE: If you are the Initiating Party and this case, or a related case,

involves a protection from abuse order, a workplace violence restraining order, or a no-

contact order, you must provide an address for the purpose of legal service of documents.

But, that address should not be one that exposes your location.)

Address:

Email address:

☐ I will accept service at the above email address.

Phone:

Fax:

OR, if in a related case, you have used the Attorney General confidential address, you may

check the box below:

☐ Attorney General confidential address

3. This is a DN case type as defined in Administrative Rule 8(B)(3).

4. There are related

cases: (If yes, please indicate below)

☐ Yes

☐ No

NAME OF COUNTY IN

WHICH YOU ARE

FILING

NAME OF

COUNTY IN

WHICH YOU

ARE FILING

NAME OF COURT

IF YOU DO NOT

KNOW, LEAVE IT

BLANK

YOUR NAME

THE OTHER SPOUSE'S NAME

YOUR NAME

x

CHECK THIS BOX

YOUR ADDRESS

YOUR EMAIL ADDRESS

CHECK THIS BOX IF

YOU WANT THE

COURT TO

CONTACT YOU

ONLY BY EMAIL

YOUR PHONE NUMBER

YOUR FAX NUMBER (IF YOU HAVE ONE)

CHECK THIS BOX ONLY

IF YOU ARE USING THE

ATTORNEY GENERAL'S

CONFIDENTIAL

ADDRESS

IF THERE ARE RELATED

CASES, CHECK 'YES'. IF NOT,

CHECK 'NO.'

{

LEAVE BLANK

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CCA-GF-0520-3011

Caption and case number of related cases:

Caption: Case No.:

Additional information as required by local rule:

Signature

CERTIFICATE OF SERVICE

I hereby certify that I sent a copy of this document on ________________________ by first-

class U.S. mail, postage prepaid to ____________________________________________ at the

following address:

______________________________

Signature

IF YOU CHECKED 'YES' IN PARAGRAPH 3, FILL IN THE RELATED CASE INFORMATION BELOW. IF YOU

CHECKED 'NO' IN PARAGRAPH 3, LEAVE THIS SECTION BLANK.

INCLUDE ADDITIONAL INFORMATION HERE IF IT IS REQUIRED BY LOCAL RULE.

DATE YOU SEND TO YOUR

SPOUSE

NAME OF YOUR SPOUSE

SPOUSE'S ADDRESS

PRINT THIS FORM AND SIGN HERE

THIS SECTION TELLS

THE COURT

THAT YOU

SENT THIS

DOCUMENT TO

YOUR SPOUSE. YOU

WILL SEND THIS TO

HIM/HER AFTER

YOU TAKE THESE

TO THE

COURTHOUSE TO

FILE FOR DIVORCE.

Page 1 of 3 Approved by the Coalition for Court

Access CCA-DC-0919-1037

STATE OF INDIANA IN THE ________________ _________________ COURT

COUNTY OF ________________ CAUSE NO. _________________________________

IN RE THE MARRIAGE OF:

________________________

Petitioner,

v.

________________________

Respondent.

VERIFIED PETITION FOR DISSOLUTION OF MARRIAGE

☐With Request for Provisional Orders

The Petitioner, _________________________________, now states:

1. Petitioner’s residential address is:

_____________________________________________________________________________.

2. Respondent’s residential address is:

_____________________________________________________________________________.

3. Petitioner has been a resident of the state of _________________ for ___ years

and ____ months and a resident of ________________ County for ____ years and ____ months.

4. Respondent has been a resident of the state of ________________ for ___ years

and ____ months and a resident of ________________ County for ____ years and ____ months.

5. ___________________________________ has been a continuous resident of

______________________________________ County or stationed at a United States military

installation within the county for the last three (3) months.

6. ________________________________ has been a continuous resident of the

State of Indiana or stationed at a United States military installation within Indiana for the last six

(6) months.

7. Petitioner and Respondent were married on _____________________________,

and separated on ________________________________.

8. There are no children born of the marriage.

9. There _________ debts or assets to divide.

FOR THE SECTION ABOVE THE DOTTED LINE LOOK AT THE

OTHER FORMS YOU HAVE FILLED OUT IN THIS CASE AND

COPY THE INFORMATION HERE.

-------------------------------------------------------------------------------------------------------------------------------------

ON PAGE 2, PARAGRAPH 20 OF THIS

PETITION YOU ARE ASKED WHETHER

YOU WOULD LIKE PROVISIONAL

ORDERS. IF YOU DO, BE SURE TO

CHECK THIS BOX. IF NOT, LEAVE IT

BLANK.

YOUR NAME

YOUR ADDRESS

SPOUSE'S ADDRESS

STATE YOU LIVE IN

COUNTY YOU LIVE IN

LENGTH OF TIME IN COUNTY

LENGTH OF TIME IN STATE

STATE SPOUSE LIVES IN

COUNTY SPOUSE LIVES IN

LENGTH OF TIME IN

STATE

LENGTH OF TIME IN COUNTY

COUNTY YOU ARE FILING IN

PARTY WHO HAS LIVED IN COUNTY YOU ARE FILING

IN FOR ATLEAST THREE MONTHS

PARTY WHO HAS LIVED IN INDIANA FOR

ATLEAST SIX MONTHS

DATE MARRIED

DATE SEPARATED

CHOOSE 'ARE' OR

'ARE NOT'

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Access CCA-DC-0919-1037

10. __________________________ is pregnant.

11. This marriage has suffered an irretrievable breakdown and should be dissolved.

12. ☐I am filing this petition on my own behalf.

-OR-

☐I am the guardian of ______________________________ and am filing this

petition because ________________________________ is incapacitated. My name is

__________________________________ and my address is:

_____________________________________________________________________________

and I have attached a copy of the court order granting me authority to petition for dissolution of

marriage described in IC 29-3-9-12.2.

15. Petitioner ________ a lifetime sex or violent offender.

16. Respondent ________ a lifetime sex or violent offender.

17. Change of name:

☐ Wife would like the following former name restored

_______________________________________________.

☐ Wife does not request a name change.

18. Petitioner ________ a member of the military.

19. Respondent ________ a member of the military.

I request that this Court issue its order dissolving the marriage of the parties, and for all

other just and proper relief and until this matter is finalized:

20.

☐ I do not request any provisional orders.

-OR-

I request the following provisional orders:

☐ Temporary possession of the marital residence;

☐ Temporary division of debts;

☐ Temporary division of property;

☐ Temporary division of motor vehicles;

PETITIONER, RESPONDENT OR

NEITHER PARTY

SELECT THE

BOX THAT

IS TRUE

{

INCAPACITATED PERSON

GUARDIAN NAME

GUARDIAN ADDRESS

'IS' OR 'IS NOT'

IF WIFE WOULD LIKE HER FORMER NAME, PUT IT HERE

SELCT THE

BOX THAT

IS TRUE

{

'IS' OR 'IS NOT'

IF YOU DO NOT WANT

THE COURT TO ISSUE

ANY ORDERS BEFORE

YOUR DIVORCE IS

FINAL, CHECK THIS

BOX

IF YOU WANT THE

COURT TO ISSUE

TEMPORARY ORDERS

BEFORE YOUR

DIVORCE IS FINALIZED,

CHECK ALL THE BOXES

THAT APPLY. YOU

ALSO NEED TO CHECK

THE 'PROVISIONAL

ORDERS' BOX ON THE

FIRST PAGE.

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☐ Spousal maintenance;

☐ Restraining the parties from transferring, encumbering, concealing, or in

any way disposing any of the property of the parties;

☐ Other:

__________________________________________________________________

The undersigned affirms under penalties for perjury that the foregoing

representations and statements are true.

______________________________

Signature

CERTIFICATE OF SERVICE

I

hereby certify that I sent a copy of this document on ________________________ by

first-class U.S. mail, postage prepaid to ____________________________________________

at the following address:

______________________________

Signature

PRINT THIS FORM AND SIGN HERE

DATE MAILED

RESPONDENT (YOUR SPOUSE)

SPOUSE'S ADDRESS

PRINT THIS FORM AND SIGN HERE

STATE OF INDIANA ) IN THE COURT

)SS:

COUNTY OF ) CAUSE NO._______________________________

IN RE THE MARRIAGE OF:

__________________________

Petitioner,

v.

__________________________

Respondent.

SUMMONS

[For Dissolution of Marriage Cases Only]

The State of Indiana to Respondent:

You have been sued by your spouse for dissolution of marriage. The case is pending in

the Court named above.

If this Summons is accompanied by an Order Setting Hearing, you must appear in Court

on the date and time stated on the Order Setting Hearing. IF YOU DO NOT APPEAR,

EVIDENCE MAY BE HEARD AND A DECISION MAY BE MADE BY THE COURT. If a

Temporary Restraining Order is issued, it is effective immediately upon your receipt or

knowledge of the Order.

If you wish to retain an attorney to represent you in the matter, it is advisable to do so

before the date stated on the Notice of Provisional Hearing.

If you take no action in this case after receipt of this Summons, the Court can grant a

Dissolution of Marriage and/or make determinations that may include but not limited to any of

the following: paternity, child custody, child support, maintenance, parenting time, property (real

or personal), and other distribution of assets and debts, attorney fees and costs.

Dated: , Clerk

, County

-------------------------------------------------------------------------------------------------------------------------------------

FOR THE SECTION ABOVE THE DOTTED LINE LOOK AT THE

OTHER FORMS YOU HAVE FILLED OUT IN THIS CASE AND

COPY THE INFORMATION HERE.

YOUR SPOUSE'S NAME

YOUR SPOUSE'S ADDRESS

LEAVE BLANK

The following manner of service of Summons is hereby designated:

☐ Registered/Certified mail to be sent by the Clerk

☐ Service by Sheriff on Individual at address shown above

☐ Service by Sheriff at place of employment, (name and address of spouse’s employer)

____________________________________________________________________

_____________________________________________________________________________________

SHERIFF’S RETURN OF SERVICE OF SUMMONS

I hereby certify that I have served this summons on the ____ day of _______________, 20____.

By delivering a copy of the Summons and a copy of the complaint to the Respondent

identified on the first page of the Summons.

By leaving a copy of the Summons and a copy of the complaint/petition at:

________________________________________________________________________

which is the dwelling place or usual place of abode of the Respondent and by mailing a

copy of the Summons to the Respondent at the above address.

Other Service or Remarks: _________________________________________________.

Sheriff’s costs Sheriff

By:

Deputy

CLERK’S CERTIFICATE OF MAILING

I hereby certify that on the ______ day of _______________________, 20____, I mailed

a copy of this Summons and a copy of the Petition to the Respondent identified on the first page

of the Summons by (registered or certified mail), ______________________________________

requesting a return receipt, at the address provided by the Petitioner.

Dated:

Clerk, County

LEAVE THIS

PAGE BLANK

RETURN ON SERVICE OF SUMMONS BY MAIL

☐ I hereby certify that the attached receipt was received by me showing that the Summons

and a copy of the Petition mailed to the Respondent identified on the first page of this

Summons was accepted by the Respondent on the _____ day of

_______________________, 20____.

☐ I hereby certify that the attached return receipt was received by me showing that the

Summons and a copy of the petition was returned not accepted on the _____ day of

_______________________, 20____.

☐ I hereby certify that the attached return receipt was received by me showing that the

Summons and a copy of the Petition mailed to the Respondent identified on the first page

of this Summons was accepted by _________________________ on behalf of the

Respondent on the _____ day of _______________________, 20____.

Dated:

Clerk, County

LEAVE THIS

PAGE BLANK

Page 1 of 1 Approved by the Coalition for Court Access

CCA-DC-0719-1026

STATE OF INDIANA IN THE COURT

COUNTY OF CAUSE NO._______________________________

IN RE THE MARRIAGE OF:

__________________________

Petitioner,

v.

__________________________

Respondent.

ORDER SETTING PROVISIONAL HEARING

A Verified Petition for Dissolution of Marriage and Request for Provisional Orders has

been filed in this Court. The Court now sets this matter for a Provisional Hearing. The parties

must be prepared to present evidence in support of their petition. Failure to appear may result in

matters being decided in your absence.

IT IS SO ORDERED that this matter shall be heard on:

_____________________________________________________________________________.

Dated: ____________________________________

Judicial Officer

☐ The Clerk shall serve this pleading upon _________________________________

by certified mail at the following address (this requires an additional fee payable to the Clerk):

____________________________________________

☐ The Clerk shall have this pleading served upon ___________________________

by sheriff at the following address:

____________________________________________

Distribution:

------------------------------------------------------------------------------------------------------------------------------------

FOR THE SECTION ABOVE THE DOTTED LINE LOOK AT THE

OTHER FORMS YOU FILLED OUT IN THIS CASE AND COPY

THE INFORMATION HERE.

YOUR NAME

YOUR ADDRESS

YOUR SPOUSE'S NAME

YOUR SPOUSE'S ADDRESS

LEAVE THIS SECTION

BLANK

Page 1 of 3 Approved by the Coalition for Court Access

CCA-DC-0719-1038

STATE OF INDIANA IN THE COURT

COUNTY OF CAUSE NO._______________________________

IN RE THE MARRIAGE OF:

__________________________

Petitioner,

v.

__________________________

Respondent.

PROVISIONAL ORDER

Petitioner appears/does not appear and Respondent appears/does not appear for

provisional hearing on ______________________. The Court having been duly advised in this

matter now finds the following:

☐ Petitioner

☐ Respondent

shall have temporary possession of the marital residence.

☐

Petitioner

☐ Respondent

shall maintain medical, dental and optical insurance as

available through employment, or Health Insurance

Marketplace, or by government provided insurance for the

foll

owing persons:

________________________________________________

_____________________

___________________________

☐ Petitioner

☐ Respondent

shall pay temporary spousal maintenance to the other party as

follows:

________________________________________________

There shall be a temporary division of debts as follows:

☐

Petitioner

☐ Respondent

shall be responsible for the following debts:

________________________________________________

FOR THE SECTION ABOVE THE DOTTED LINE LOOK AT

THE OTHER FORMS YOU HAVE FILLED OUT IN THIS CASE

AND COPY THE INFORMATION HERE.

---------------------------------------------------------------------------------------------------------------------------------------

LEAVE

BLANK

Page 2 of 3 Approved by the Coalition for Court Access

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☐

Petitioner

☐ Respondent

shall be responsible for the following debts:

________________________________________________

There shall be a temporary division of property, as follows:

☐ Petitioner

☐ Respondent

shall have sole possession of the following items of

property:

________________________________________________

☐

Petitioner

☐ Respondent

shall have sole possession of the following items of

property:

________________________________________________

There shall be a temporary division of motor vehicles, as follows:

☐ Petitioner

☐ Respondent

shall have temporary possession of the following vehicles:

_______________________________________________

(

Vehicle #1, Make, Model, and Year)

_______________________________________________

(Vehicle #2, Make, Model, and Year)

☐ Petitioner

☐ Respondent

shall have temporary possession of the following vehicles:

_______________________________________________

(

Vehicle #1, Make, Model, and Year)

_______________________________________________

(Vehicle #2, Make, Model, and Year)

There shall be a temporary restraining order in effect during these proceedings:

☐ Restraining the parties from transferring, encumbering, or concealing, or

in any way disposing of any of the property of the parties;

☐ Other:

____________________________________________________________

LEAVE

BLANK

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ALL WHICH IS SO ORDERED

Judicial Officer

Distribution:

LEAVE BLANK

YOUR NAME

YOUR ADDRESS

SPOUSE'S NAME

SPOUSE'S ADDRESS

Page 1 of 1 Approved by the Coalition for Court Access

CCA-DC-0719-1028

STATE OF INDIANA IN THE COURT

COUNTY OF CAUSE NO._______________________________

IN RE THE MARRIAGE OF:

__________________________

Petitioner,

v.

__________________________

Respondent.

MOTION FOR FINAL HEARING

The Petitioner now states that sixty (60) days have passed since the last filing of the

Verified Petition for Dissolution of Marriage and requests that this matter be set for Final

Hearing on the next available hearing date.

Signature

CERTIFICATE OF SERVICE

I hereby certify that I sent a copy of this document on ________________________ by

first-class U.S. mail, postage prepaid to ____________________________________________

at the following address:

______________________________

Signature

---------------------------------------------------------------------------------------------------------------------------------

FOR THE SECTION ABOVE THE DOTTED LINE LOOK AT

THE OTHER FORMS YOU HAVE FILLED OUT IN THIS

CASE AND COPY THE INFORMATION HERE.

PRINT THIS FORM AND SIGN HERE

YOUR ADDRESS

DATE YOU MAIL

SPOUSE'S NAME

SPOUSE'S ADDRESS

PRINT THIS FORM AND SIGN HERE

Page 1 of 1 Approved by the Coalition for Court Access

CCA-DC-0719-1029

STATE OF INDIANA IN THE COURT

COUNTY OF CAUSE NO._______________________________

IN RE THE MARRIAGE OF:

__________________________

Petitioner,

v.

__________________________

Respondent.

ORDER SETTING FINAL HEARING

The Petitioner has filed a Motion for Final Hearing which the Court has considered and

now grants.

IT IS SO ORDERED that the final hearing for this matter shall be heard on:

_____________________________________________________________________________.

[The court allows ____________ for the hearing.]

Dated: ____________________________________

Judicial Officer

☐ The Clerk shall serve this pleading upon _________________________________

by certified mail at the following address (this requires an additional fee payable to the Clerk):

____________________________________________

☐ The Clerk shall have this pleading served upon ___________________________

by sheriff at the following address:

____________________________________________

Distribution:

----------------------------------------------------------------------------------------------------------------------------------

FOR THE SECTION ABOVE THE DOTTED LINE LOOK AT

THE OTHER FORMS YOU HAVE FILLED OUT IN THIS

CASE AND COPY THE INFORMATION HERE.

LEAVE

BLANK

Page 1 of 7 Approved by the Coalition for Court Access

CCA-DC-0319-1039

IN THE COURT

CAUSE NO._______________________________

STATE OF INDIANA

COUNTY OF

IN RE THE MARRIAGE OF:

__________________________

Petitioner,

v.

__________________________

Respondent.

DECREE OF DISSOLUTION OF MARRIAGE

The Court having reviewed the Verified Petition for Dissolution of Marriage and having

held a final hearing in this matter, now finds the following:

1. Petitioner and Respondent were married on _____________________________,

and separated on ________________________________.

2. ___________________________________ has been a continuous resident of

______________________________________ County for the last three months.

3. ________________________________ has been a continuous resident of the

State of Indiana for the last six months prior to the filing of the Verified Petition for

Dissolution of Marriage

4. ___________________ is pregnant.

5. Petitioner ____________ a member of the military.

6. Respondent ___________ a member of the military.

7. There are no children of the marriage.

8. Joint debt.

The division of jointly held debts shall be as follows:

☐ The parties have no outstanding debts for which they are responsible

--------------------------------------------------------------------------------------------------------------------------------------

FOR THE SECTION ABOVE THE DOTTED LINE LOOK AT

THE OTHER FORMS YOU HAVE FILLED OUT IN THIS CASE

AND COPY THE INFORMATION HERE.

MARRIAGE DATE

SEPARATION DATE

PERSON WHO HAS LIVED IN COUNTY FOR 3 MONTHS

COUNTY

PERSON WHO HAS LIVED IN STATE FOR SIX MONTHS

PETITIONER, RESPONDENT OR NEITHER PARTY

'IS' OR 'IS NOT'

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☐ Petitioner will be solely responsible for the following debts and shall hold

Respondent harmless from liability, expense, attorney’s fees, and loss which may be

incurred by Respondent arising out of Petitioner’s failure to pay such debts.

Name of Creditor Amount of Debt

_______________________________ _____________________

☐ Respondent will be solely responsible for the following debts and shall hold

Petitioner harmless from liability, expense, attorney’s fees, and loss which may be

incurred by Petitioner arising out of Respondent’s failure to pay such debts.

Name of Creditor Amount of Debt

_______________________________ _____________________

9. Individual debt.

The individual debt division shall be as follows:

Debts held in Petitioner’s name only:

☐ Petitioner shall be solely responsible for all debts held in his/her individual name,

and all debts incurred by him/her in his/her name since the date of final separation.

Petitioner agrees to hold Respondent harmless from liability, expense, attorney’s fees,

and loss which may be incurred by Respondent, arising out of Petitioner’s failure to pay

such debts.

☐ Other:

________________________________________________________________________

LEAVE

BLANK

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Debts held in Respondent’s name only:

☐ Respondent shall be solely responsible for all debts held in his/her individual

name, and all debts incurred by him/her in his/her name since the date of final

separation. Respondent agrees to hold Petitioner harmless from liability, expense,

attorney’s fees, and loss which may be incurred by Petitioner, arising out of Respondent’s

failure to pay such debts.

☐ Other:

________________________________________________________________________

10. Vehicles

The vehicle division shall be as follows:

☐ There are no vehicles to divide.

☐ Petitioner shall have possession of the following vehicle(s), and Respondent shall

execute all documents necessary to transfer title of said vehicles within a reasonable time

following the date of this Order:

________________________________________________________________________

(Vehicle #1, Make, Model and Year)

________________________________________________________________________

(Vehicle #2, Make, Model and Year)

☐ Respondent shall have possession of the following vehicle(s), and Petitioner shall

execute all documents necessary to transfer title of said vehicles within a reasonable time

following the date of this Order:

________________________________________________________________________

(Vehicle #1, Make, Model and Year)

________________________________________________________________________

(Vehicle #2, Make, Model and Year)

LEAVE

BLANK

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CCA-DC-0319-1039

☐ All outstanding debts related to the above listed vehicles has been allocated

above.

11. Personal property.

The parties’ personal property division shall be as follows:

☐ The parties have divided all items of personal property.

☐ Petitioner shall have sole possession of the following items of personal property:

________________________________________________________________________

☐ Respondent shall have sole possession of the following items of personal

property:

________________________________________________________________________

12. Marital Residence.

☐ The parties are owners of real estate located at

_______________________________________________________________________,

and:

☐ Petitioner shall retain/take possession and shall become the sole owner of

☐ Respondent said real estate

☐ Petitioner shall vacate the marital residence by ___________________ ____

☐ Respondent

LEAVE

BLANK

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CCA-DC-0319-1039

☐ Petitioner shall be responsible for all payments related to property, taxes and

☐ Respondent homeowners insurance and shall receive the deductions for

mortgage interest and taxes.

☐ Petitioner shall transfer, by Quitclaim Deed, ______ interest in said real

☐ Respondent estate to the party retaining possession of the marital residence by

______________________________.

☐ Petitioner will refinance the mortgage debt related to the marital

☐ Respondent residence and make good faith effort to obtain a release of the

other party on said debt on the earliest possible date. Upon release

of the other party from mortgage debt, the other party shall

transfer, by Quitclaim Deed, his/her interest in said real estate.

The party assuming responsibility for mortgage agrees to hold the

other party harmless from all liability, expense, attorney fees, loss

or damages which may be a result of a failure to make payments

on said mortgage debt.

☐ Other ______________________________________________________

______________________________________________________

☐ The parties are jointly responsible on a lease for a residence located at

________________________________________________________________________

and

☐ Petitioner shall retain possession of the leased premises, be responsible for

☐ Respondent the remaining rental payment and fees due under said lease, and

LEAVE

BLANK

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agrees to hold the other party harmless for all liability, expense,

attorney fees, loss or damage which may be a result of the failure

to make required payments under said lease.

☐ Petitioner shall vacate the leased residence by ________________________.

☐ Respondent

☐ Other ______________________________________________________

______________________________________________________

13. Change of names.

☐ Petitioner .would like the following former name restored and is not a lifetime sex

or violent offender or Petitioner has complied with I.C. 31-15-2-19; Petitioner shall

hereinafter be known as:

_________________________________________________________

☐ Respondent would like the following former name restored and is not a lifetime

sex or violent offender or Respondent has complied with I.C. 31-15-2-19; Respondent

shall hereinafter be known as:

_________________________________________________________

☐ Neither Petitioner nor Respondent requests a name change.

14. The marriage has suffered an irretrievable breakdown and should be dissolved.

15. Findings of the Court

The Court, having held a hearing during which both parties appeared and presented

evidence, now finds that the property distribution provisions of this order:

☐ constitute a presumptive equal division of marital property and is therefore just

reasonable.

☐ do not constitute the presumptive equal division of marital property, however are,

for the reasons set forth below, just and reasonable:

LEAVE

BLANK

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______________________________________________________________________________

IT IS THEREFORE ORDERED by the Court that the parties’ marriage is hereby

dissolved.

Date: _____________________________ __________________________________________

Judicial Officer

Distribution:

Petitioner’s Name and Mailing Address: Respondent’s Name and Mailing Address:

_________________________________ __________________________________

YOUR NAME

YOUR ADDRESS

SPOUSE'S NAME

SPOUSE'S ADDRESS

LEAVE BLANK