[Caption, Introduction, see Captions, Prayers, Etc.]

We, ________[name], Husband, and ________[name], Wife, make the following statements:

1. We both are requesting a dissolution of our marriage.

2. Husband is a resident of County of ________, State of ________, and has been a resident since ________[Date]. Wife is a resident of ________ County, State of ________, and has been a resident since ________[Date].

3. We were married to each other on ________[date] in the City of ________, County of ________, State or Country of ________.

4. Our marriage is ________[irretrievably broken or has serious, permanent differences or as statutorily authorized].

5. Together, we have no minor or dependent children and Wife is not pregnant.

6. We have made a marital settlement agreement dividing our property and our bills. We are satisfied with this agreement. The attached agreement was signed freely and voluntarily by each of us, and we intend to be bound by it.

7. [If required: We have each filled out and signed financial statements that are attached to this petition.]

8. [If applicable: Wife wants to have her former name restored to ________].

9. We each certify that we have not been threatened or pressured into signing this request. We each understand that the result of signing this request may be a final dissolution of our marriage with no further relief.

10. We each understand that we are both required to appear before the judge to testify to the matters contained in this request.

11. We understand that we each may have legal rights against each other arising out of the marriage and that by signing this request we may be giving up those rights.

12. Neither of us is a member of the military.

13. We ask the court to dissolve our marriage and enforce the marital settlement agreement.

[Signature, Verification, see Captions, Prayers, Etc.]