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Free Minnesota Joint Petition for Marriage Dissolution without Children Form

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Use this template/form as a Joint Petition for Marriage Dissolution without Children Form in the State of Minnesota

Minnesota Joint Petition for Marriage Dissolution Without Children

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Text version of this Form

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State of Minnesota District Court
County of: Judicial District:
Court File Number:
Case Type: Dissolution

In Re the Marriage of:

,
Name of Husband (First, Middle, Last)

Joint Petition, Agreement, and
and Judgment and Decree For
Marriage Dissolution
Without Children
,
Name of Wife (First, Middle, Last)

1. Information about Husband:

Full Name:
First Middle Last

Address:
Street Address Apt. No.

City County State Zip Code

Date of Birth: __________________________

Month Day Year

Husband’s former or other names:
(Or write “none”) First Middle Last

Husband’s social security number is listed on Confidential Form 11.1 and submitted
along with the Joint Petition.

2. Information about Wife:

Full Name:
First Middle Last
Address:
Street Address Apt. No.

City County State Zip Code

Date of Birth: __________________________
Month Day Year

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Wife’s former or other names:
(Or write “none”) First Middle Last

First Middle Last

Wife’s social security number is listed on Confidential Form 11.1 and submitted along
with the Joint Petition.

3. Children: “Minor” children are under age 18, or under age 20 but still in high school.

a. Do Husband and Wife have minor children together? YES NO

(If YES, you are using the wrong forms.)

b. Do Husband and Wife have any adult dependent children who are not able to support

themselves because of a physical or mental condition? YES NO

(If you answered YES, you may ask the court to make an order regarding support for the adult

dependent, but you should use the Marriage Dissolution with Children forms to do this.)

c. Has wife given birth, since marrying Husband, to a child who is not Husband’s child?

YES NO

If you answered NO to c, skip to d. If YES, continue below:

i. Fill in the information for all children born to Wife since marrying Husband, who are

not husband’s biological children.

Full Name of Child Date of Birth Age

ii. Is there a court order naming someone other than the Husband as the father of the

child(ren) listed in (i)? YES NO If YES, fill in:

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Full Name of Child Date of Court County/State of Order Court Case No.
Order

iii. Have the Wife and biological Father signed a Minnesota Recognition of Parentage

(ROP) for any of the children listed in (i) above? YES NO

If YES, state the full name of the child:

and attach to the Petition a certified copy of the Recognition of Parentage.

Has the Husband signed the “Husband’s Non-Paternity Statement” for any of the

children listed at (i) above? YES NO

If YES, state the name of the child:

and attach a certified copy of the “Husband’s Non-Paternity Statement.”

Stop: For each minor child listed at c.(i.) you must have a court order OR the Recognition of

Parentage and Non-Paternity Statement to use the Dissolution Without Children forms.

Otherwise, use the Marriage Dissolution with Children forms.

d. Is Wife pregnant? YES NO UNKNOWN (If the Wife is pregnant

you are using the wrong form. Use Marriage Dissolution with Children.)

4. Our Marriage

Husband and Wife were married on: (month, day, year)

in the City of , County of , State

of , Country of

5. 180 Day Requirement

Husband has been living in Minnesota for the past six (6) months: YES NO

Wife has been living in Minnesota for the past six (6) months: YES NO

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6. Armed Forces

Husband is an active member of the armed forces: YES NO

If YES, has the member of the armed forces been stationed in Minnesota for the past six

(6) months? YES NO

Wife is an active member of the armed forces: YES NO

If YES, has the member of the armed forces been stationed in Minnesota for the past six

(6) months? YES NO

7. Marriage Cannot be Saved

There has been an irretrievable breakdown of our marriage relationship.

8. Physical Living Situation

Do Husband and Wife live together at this time? YES NO

If NO, the date of separation was: .
Month Day Year

If YES, Husband and Wife are living together at this time because:

9. Other Proceedings

A separate court case for dissolution, legal separation or annulment has already been

started by Husband or Wife in Minnesota or another state: YES NO

If YES, the type of court case is: and it was started in

County in the State of and the Court file

number is , and the outcome of the case is Open

Closed Unknown or .

10. Protection or Harassment Order

An Order for Protection or a Harassment/Restraining Order is in effect regarding

Husband and Wife: YES NO If YES, the Order protects: Husband

Wife. The Order was filed in County on the

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date: , and the Court file number is

Month Day Year

A copy of the Order is submitted along with this Joint Petition.

11. Public Assistance: (Note: If either person is receiving public assistance from the State of Minnesota or

applies for it after this proceeding is started, notice of this marriage dissolution action must be given to the

county’s collections and support office. See Minnesota Statutes Section 518A.44)

a. Husband receives public assistance from the State of Minnesota: Yes No

If YES, the assistance is from_______________________County. (check all that apply)

MFIP in the amount of $ per month.

Tribal TANF in the amount of $ per month.

General Assistance in the amount of $ per month.

Medical Assistance

Child Care Assistance

MinnesotaCare

b. Wife receives public assistance from the State of Minnesota: Yes No

If YES, the assistance is from ______________________County. (check all that apply)

MFIP in the amount of $ per month.

Tribal TANF in the amount of $ per month.

General Assistance in the amount of $ per month.

Medical Assistance

Child Care Assistance

MinnesotaCare

12. Husband’s Employment

a. Husband is employed: Yes No Husband is self-employed: Yes No

b. Husband works at least 40 hours per week: Yes No

If Husband is unemployed or working less than 40 hours / week, answer these

questions:

i. Why is Husband unemployed or working less than 40 hours / week?

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ii. What is Husband’s past work experience (type of jobs, hours, pay, length of time at

the job) and what are Husband’s professional qualifications or licenses?

c. Current Employment: (if Husband currently has more than two jobs, use an attachment for the

additional jobs.)

Name of Husband’s Employer (If self-employed, list name and business address)

Employer’s Street Address

City State Zip Code

Name of Husband’s Employer if self-employed, list name and business address)

Employer’s Street Address

City State Zip Code

st nd
Questions about Current Jobs 1 Job 2 Job

Is Husband paid by the hour or hourly salary hourly salary
salaried?

What is the average number of
hours Husband works per week?
________________hours ________________hours

How much overtime pay does
Husband receive per week on
$_____________________ $____________________
average?
Does Husband receive bonuses? If Yes, how much was received If Yes, how much was received
st in bonuses last year? in bonuses last year?
Yes No 1 Job
$_____________ $_____________
Yes No 2nd Job How much does Husband expect How much does Husband expect

to receive this year? to receive this year?
$___________ $___________

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13. Husband’s Income

Source of Income Amount Per Month (or zero) before deductions/taxes

Self Employment Income $______________ per month

Self Employment income means gross receipts minus costs of goods sold

minus ordinary and necessary business expenses.

Job with __________________________ $______________ per month

Monthly income from a job = Hourly wage x Hours worked per week x 4.33 (weeks per month)

Second Job with _____________________ $______________ per month

Third Job with ______________________ $______________ per month

Commissions from all jobs $______________ per month

Divide the total amount you expect this year by 12 to get a monthly average

Unemployment benefits $______________ per month

Social Security Retirement, Survivors or Disability

Income (RSDI) (do not include SSI) $______________ per month

Investment and Rental Income $______________ per month

Annuity payments $______________ per month

Pension or Disability from work or military $______________ per month

Worker’s Compensation $______________ per month

Court-ordered spousal maintenance received $______________ per month

Other income____________________________ $______________ per month
List Source

Add all of the above. Total monthly income $ _____________ per month

Enter the amount of child support Husband is court-ordered
to pay for any nonjoint child(ren) $______________ per month

Enter the amount of spousal maintenance Husband is court-ordered
to pay to a current or former spouse $______________ per month

14. Wife’s Employment

a. Is Wife employed? YES NO Is Wife self-employed? YES NO

b. Is Wife working at least 40 hours per week? YES NO

If Wife is unemployed or works less than 40 hours/week, answer these questions:

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i. Explain why Wife is not working or why Wife works less than 40 hours/week

ii. What is Wife’s past work experience (type of jobs, hours, pay, length of time at the

job) and professional qualifications or licenses?

c. Current Employment: (If Wife has more than two jobs at this time, use an attachment for the

additional jobs.)

Name of Wife’s Employer (If Self-Employed list name and business address)

Employer’s Street Address

City State Zip Code

Name of Wife’s Employer (If Self-Employed list name and business address)

Employer’s Street Address

City State Zip Code

st nd
Questions about Jobs 1 Job 2 Job

Is Wife paid by the hour or salaried? hourly salary hourly salary

What is the average number of ________________hours ________________hours
hours Wife works per week?

How much overtime pay does Wife
receive per week on average?
$_____________________ $____________________

Does Wife receive bonuses? If Yes, how much did Wife If Yes, how much did Wife
receive in bonuses last year? receive in bonuses last year?

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st
Yes No 1 Job $____________________ $___________________
nd How much does Wife expect How much does Wife expect to
Yes No 2 Job
to receive this year? receive this year?
$____________________ $___________________

15. Wife’s Income

Source of Income Amount Per Month (or zero) before deductions/taxes

Self Employment Income $______________ per month

Self Employment income means gross receipts minus costs of goods sold minus ordinary and necessary

business expenses.

Job with __________________________ $______________ per month

Monthly income from a job = Hourly wage x Hours worked per week x 4.33 (weeks per month)

Second Job with _____________________ $______________ per month

Third Job with ______________________ $______________ per month

Commissions from all jobs $______________ per month

Divide the total amount you expect this year by 12 to get a monthly average

Unemployment benefits $______________ per month

Social Security Retirement, Survivors or Disability

Income (RSDI) (do not include SSI) $______________ per month

Investment and Rental Income $______________ per month

Annuity payments $______________ per month

Pension or Disability from work or military $______________ per month

Worker’s Compensation $______________ per month

Court-ordered spousal maintenance received $______________ per month

Other income____________________________ $______________ per month
Identify Source

Add all of the above. Total monthly income $ _____________ per month

Enter the amount of child support Wife is court-ordered
to pay for any nonjoint child(ren) $______________ per month

Enter the amount of spousal maintenance Wife is court-ordered
to pay to a current or former spouse $______________ per month

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16. Health Care Coverage (Health Care Coverage does not include Minnesota Care or

Medical Assistance.)

a. Wife has medical dental insurance or no insurance.

b. Husband has medical dental insurance or no insurance.

17. Spousal Maintenance

Spousal Maintenance is money paid by one spouse to the other for living expenses.

Check only one box:

Husband and Wife do not need spousal maintenance at this time, or in the future.

Both parties agree that each party is fully capable of self-support and is not dependent

upon the other for additional support in the form of spousal maintenance. Each party has

made a full and fair disclosure of all income and assets and liabilities that each is

responsible for, and agrees that this waiver is reasonable. The waiver is fair and

equitable and is supported by the above consideration and was signed by both parties

after full financial disclosure to each other.

Husband or Wife may need spousal maintenance in the future. The court should

reserve maintenance to allow either party to ask for spousal maintenance in the future

because: (explain why you want to do this)

Husband needs spousal maintenance from Wife now. Husband is _________ years of

age, Husband and Wife have been married for _________ years. Husband has the

following education:________________________ . Husband ’s gross

monthly income totals $__________________. Husband’s monthly expenses total

$______________ and Husband is not able to maintain the standard of living established

during the marriage because:

Wife has the ability to pay Husband $_____________per month for spousal maintenance.

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Wife needs spousal maintenance from Husband now. Wife is _______years of age,

Husband and Wife have been married for _______years. Wife has the following

education:______________________________________. Wife ’s gross monthly income

totals $______________. Wife ’s monthly expenses total $________________, and Wife

is not able to maintain the standard of living established during the marriage because:

Husband has the ability to pay Wife $_____________per month for spousal maintenance.

18. Name Change

a. Neither person wants to change his/her name.

b. Wife Husband wants to change his/her name to: (full name, not initials )

first middle last

This name change request is made with no intent to defraud or mislead anyone:

True False

The person requesting the name change has been convicted of a felony

YES NO

If YES:

i. Notice of this request for name change has been given to the proper authority as

required by Minn.Stat.§259.13. (IMPORTANT NOTICE: If you are a convicted

felon and you request a name change without following the requirements of Minn.

Stat §259.13, using the new last name after your divorce is a gross misdemeanor.)

ii. An Affidavit of Service of the Notice marked Exhibit “A” has been attached to

this Joint Petition.

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AGREEMENT OF HUSBAND AND WIFE

1. We have made this agreement to settle once and for all what we owe to each other and

what we can expect to receive from each other. Each of us states that nothing has been

held back, and that we have honestly included everything we could think of in listing our

assets (everything we own and that is owed to us) and our debts (everything we owe) and

that we believe the other has been open and honest in writing this agreement. We will

sign and exchange any papers that might be needed to complete this agreement before or

after the divorce.

2. Real Estate

Real estate includes a homestead, condominium, apartment building, vacant land,
contract for deed interest, remainder interest, and more.
Husband owns no real estate by himself or with anyone else.

Wife owns no real estate by herself or with anyone else.

Husband and/or Wife own real estate as described on the Real Estate Attachment(s).

(Use a separate Real Estate Attachment sheet for each parcel of real estate. The Real

Estate Attachment sheet(s) must be attached to this Joint Petition, even if Husband and

Wife have no real estate.)

All Real Estate Attachments are incorporated into this Joint Petition, Agreement,

Judgment and Decree and Husband and Wife agree that the real estate shall be awarded

as stated on the Real Estate Attachment(s) in Attachment “C”.

Check one:

There is one Real Estate Attachment; OR

There are ______ Real Estate Attachments.

3. Non-Marital Property

Non-marital Property means: (1) anything that you or your spouse owned before the marriage; (2)

a gift, bequest, devise, or inheritance made by a third party to one but not to the other spouse; (3)

anything that you or your spouse got in trade or in exchange for your non-marital property; (4)

anything that is an increase in the value of non-marital property (STOP: Property can be part non-

marital and part marital. Defining and valuing non-marital property can be complicated. If you

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have any concerns or questions, you should stop here and talk to an attorney.) (5) anything you or

your spouse received after the valuation date set by the Court; or (6) anything defined as non-

marital property by a valid antenuptial contract.

a. Husband owns non-marital property:

YES NO

If YES, Husband and Wife agree that that the following property is Husband’s non-

marital property and shall be awarded to Husband:

The total value of Husband’s non-marital property is $

b. Wife owns non-marital property:

YES NO.

If YES, Husband and Wife agree that the following property is Wife’s non-marital

property and shall be awarded to Wife:

The total value of Wife’s non-marital property is $

4. Division of Marital Property

Marital Property means almost anything that you or your spouse own that you or your spouse

received during the marriage, even during the times that you and your spouse were separated.

This includes real estate, boats, cabins, household goods, furniture, jewelry, and other things.

(See attached Asset Sheet listing all assets. The Asset Sheet must be attached to the Joint

Petition, even if husband and wife have no assets.)

The Asset Sheet is incorporated into this Joint Petition, Agreement, Judgment and Decree

and Husband and Wife agree to divide their marital property as listed by them in Attachment

“A”.

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5. Division of Marital Debts

Marital Debts means debts incurred by you or your spouse during the marriage, even during the

times that you and your spouse were separated. Do not include monthly expenses you pay in full

each month, such as telephone and utilities.

(See attached Debt Sheet listing all debts. The Debt Sheet must be attached to the Joint

Petition, even if wife and husband have no debts.)

The Debt Sheet is incorporated into this Joint Petition, Agreement, Judgment and Decree

and Husband and Wife agree to divide their marital debts as listed by them in Attachment “B”.

6. Spousal Maintenance

a. Neither party is awarded spousal maintenance. Husband and Wife have waived

any claims to spousal maintenance for the past, present, or future, and expressly

waive all rights to modify their waivers of maintenance. This court is divested of

jurisdiction to award or modify maintenance in the future pursuant to Karon v.

Karon, 435 N.W. 2d 501 (Minn. 1989).

Consideration for this agreement is: (check all that apply)

the parties’ mutual waivers of maintenance

the property settlement

the parties’ respective incomes and ability to earn income

other:

The Court has reviewed this agreement and finds it to be fair and equitable under all of

the circumstances, and supported by sufficient consideration including the parties’ mutual

waivers, incomes per year and the property division. Full disclosure of each party’s

financial circumstances has occurred.

b. Maintenance is reserved because :

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Either party can ask the court to order the payment of spousal maintenance in the

future by filing a Motion stating a change in circumstances.

c. Husband Wife shall pay permanent spousal maintenance to the other

party in the amount of $ per month starting on (date):

d. Husband Wife shall pay temporary spousal maintenance to the other

party in the amount of $ per month starting on (date):

and ending on (date): .

The monthly amount of permanent or temporary spousal maintenance shall be:

subject to income withholding from the payor’s income, regardless of source, by his

or her employer, trustee, or other payor of funds and mailed to: Minnesota Child Support

Payment Center, P.O. Box 64326, St. Paul, MN 55164-0326. If the person paying

spousal support is self-employed, send payments to Minnesota Child Support Payment

Center, P.O. Box 64306, St. Paul, MN 55164-0306. To start income withholding,

Husband or Wife must apply for income withholding only services at the Child

Support office in their County and must send a copy of this Order to the Child

Support office. Until income withholding starts, the person owing maintenance shall

pay the amount directly to the spouse receiving it.

OR

maintenance shall be paid directly by the spouse owing the maintenance to the

spouse receiving it, payable on the _____________day of each month.

7. Insurance Coverage

Husband and wife shall each provide for his or her own health and dental insurance.

Either party may be eligible to extend for a limited time, at his/her own expense, the

dependent coverage available under the other party’s insurance plan, pursuant to federal

and state statutes.

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8. Other:

We also agree to the following:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

BASED UPON THE ABOVE INFORMATION, Husband and Wife request that the

Court issue a final judgment and decree terminating our marriage and ordering the terms of this

Agreement.

READ and SIGN the Verification and Acknowledgments.

STATE OF MINNESOTA )
) SS
COUNTY OF )
(County where documents signed)

Verification and Acknowledgments

a. I have read this document. To the best of my knowledge, information and belief the
information contained in this document is well grounded in fact and is warranted by
existing law.

b. I have not been determined by any Court in Minnesota or in any other State to be a
frivolous litigant and I am not the subject of an Order precluding me from serving or
filing this document.

c. I am not serving or filing this document for any improper purpose, such as to harass the
other party or to cause delay or needless increase in the cost of litigation or to commit a
fraud on the Court.

d. I understand that if I am not telling the truth or if I am misleading the Court or if I am
serving or filing this document for an improper purpose, the Court can order me to pay
money to the other party, including the reasonable expenses incurred by the other party
because of the cost of serving or filing this document, Court costs, and reasonable
attorney’s fees.

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e. WAIVER (Rule 306.01(c)): I know I have the right to be represented by a lawyer of my
choice. I hereby expressly waive that right and I freely and voluntarily sign the foregoing
stipulation.

DATE: DATE:

Signature of Husband Signature of Wife
(Sign only in presence of notary public) (Sign only in presence of notary public)

( ) ( )
Daytime Telephone Number of Husband Daytime Telephone Number of Wife

Sworn / affirmed to before me this Sworn / affirmed to before me this

Day of , _______ Day of ________________

______________________________
Notary Public Notary Public

HUSBAND’S ATTORNEY WIFE’S ATTORNEY

Husband is Wife is

acting as his own attorney acting as her own attorney

OR OR

is represented by the following attorney: is represented by the following attorney:

Name Name

Address Address

City / State / Zip City / State / Zip

Telephone Telephone

Attorney Registration Number Attorney Registration Number

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(If public assistance is being provided to a party or nonjoint children, the public authority may

need to sign off on this Joint Petition and Agreement.)

The public authority responsible for the collection and enforcement of child support reviewed

and agreed to the Joint Petition and Agreement of the above-named parties.

DATE:

Name and Title

Attorney Registration No.

Address

City / State / Zip

Telephone

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COURT ORDER

This case came before the Court without a hearing on the parties’ Joint Petition for

Dissolution of Marriage. The Court, having reviewed the file, makes the following Order:

1. The parties’ Joint Petition and Attachments contains the necessary facts and includes an

agreement on all issues before the Court. The real estate, if any, and the personal property

of the parties is hereby awarded according to the division set out in their foregoing Joint

Petition, which is made part of this final judgment. Debts and liabilities of the parties

must be paid as provided in their foregoing Joint Petition. The parties are ordered to obey

all of its provisions.

2. The marriage between the parties is dissolved and the parties are single.

3. Husband’s Wife’s name is changed to:

___________________________________________________________

first middle last

4. Each party shall execute any documents necessary to transfer real estate and personal

property as awarded herein without further order of the Court. Should either party fail to

execute the necessary documents, a certified copy of the Judgment and Decree shall

operate to transfer title as awarded herein.

5. NOTICE: IF THE AGREEMENT OF THE PARTIES INCLUDES AN AWARD OF

SPOUSAL MAINTENANCE, Appendix A is incorporated and made a part of this final

judgment. Appendix A contains, among other things, provisions regarding payments to

the Public Agency pursuant to Minnesota Statutes § 518A.50; Rules of Maintenance;

Wage and Income Deduction of Maintenance pursuant to Minnesota Statutes § 518A.53;

Change of Address or Residence; Cost of Living Increase of Maintenance pursuant to

Minnesota Statutes § 518A.58; and Judgments for Unpaid Maintenance pursuant to

Minnesota Statutes § 548.091.

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General Rule of Practice 125 notwithstanding, let Judgment be entered immediately.

The foregoing facts were found BY THE COURT
by me after due hearing and the
Order thereon is recommended.

District Court Referee Judge of District Court

Dated: Dated:

Judgment

I certify the above constitutes the Judgment of the Court and Judgment is hereby entered.

Court Administrator

Deputy

Dated:

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Attachment “A”
DIVISION OF ASSETS AND VALUE

Husband’s Name:

Wife’s Name:

1. We agree on how to divide our assets (everything we own and that is owed to us).
2. Each person shall receive as their own all assets in their column.

Definitions: Current Fair Market Value is an estimate of the amount of money you could get
if you sold the item to a stranger, such as through a newspaper advertisement. It does not mean
what you paid for it originally, and it does not mean what it would cost you to replace it if you
lost it. If you are still paying for an item, list it in husband’s or wife’s column at the present
value.
Present value means the current fair market value minus the amount you still owe.

Who Gets the Item and What is the Value
*Enter the current fair market
value or present value of the item in
DESCRIPTION OF ASSETS the column of the person getting the
item.
 If you do not have the type of property described, enter a zero

in the columns for Husband and Wife.

 To avoid confusion at a later date, describe each item as clearly
as possible. For example, include the last 4 digits of account *HUSBAND *WIFE
numbers (xxx2873), names of banks, & whose name is on the
title or account, if applicable.

 List all property owned separately or together, no matter when
it was acquired, except do not list the non-marital property
described at #3 of the Joint Petition.
Cash on hand: $ $

Cash in banks/credit unions: (Name of bank, last 4 digits of
account number, whose name is on the account)
$ $
$ $
$ $
$ $
$ $
Stocks/Bonds:
$ $
$ $
$ $
$ $
$ $

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Notes (money owed to you in writing):
$ $
$ $

Husband Wife
Money owed to you (not evidenced by a note):
$ $
$ $
$ $
Business interests: (Name of business, who owns it)
$ $
$ $
Automobiles: (Year, Make, Model) (Reminder: Use present
value if you are still paying for the items.)
$ $
$ $
$ $
$ $
Boats:
$ $
$ $
Other vehicles: (Snowmobiles, 4-Wheelers, etc.)
$ $
$ $
$ $
Retirement plans
Profit Sharing or Pension: (Enter “present value”. Contact plan
administrator for the present value. Include name of employer/group providing
the plan, and type of plan.)
$ $
$ $
401(k), IRAs or other: (Enter current account balance, name of bank
where funds are held, whose name is on the account.)
$ $
$ $
$ $
Furniture & furnishings:
We have already divided the furniture and furnishings in a fair $ $
manner. (Enter in each spouses’ column the total value of their share of
the furniture and furnishings already divided);
We agree to divide the furniture and furnishings as follows: (List
items not included above.)
$ $
$ $
$ $
$ $

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$ $
$ $
$ $
$ $

Husband Wife
Collectibles & Jewelry:
$ $
$ $
$ $
$ $
Life insurance: (cash surrender value) (Name of insurance company and
last 4 digits of policy number.)
$ $
$ $
Sporting & entertainment & electronic equipment: (TV,
stereo, guns, etc.)
$ $
$ $
$ $
$ $
$ $
$ $
Real Estate:
Do Not List Here. Use Real Estate Attachment.

Other assets:
$ $
$ $
$ $
$ $
Total Value of Property To Each Person: Husband Wife
(Excluding Real Estate, and any Non-Marital Property listed at
Paragraph #4 of the Joint Petition.) $ $

DIV302 State ENG Rev 10/10 www.mncourts.gov/forms Page 23 of 27

———————– Page 24———————–

Attachment “B”
DIVISION OF LIABILITIES/DEBTS

Husband’s Name:

Wife’s Name:

Date we filled out this form:
1. We agree on how to divide our marital debts (debts we have incurred since our marriage date,
either separately or together).
2. Each person shall pay as their own the debts listed in their column, and shall not ask the other
person to pay these debts/bills.
3. We have listed all marital debts we know of on this Attachment. Any debts incurred by one of
us alone and not listed on this Attachment shall be paid by the person whose name is on the
debt/bill.
*Write the current amount
DESCRIPTION OF DEBT(S) owed in the column of the
 If you do not have the type of debt described, enter a zero in the person who will pay it.
columns for Husband and Wife.

 To avoid confusion at a later date, describe each debt as clearly *HUSBAND *WIFE
as possible. For example, state who the debt is owed to, whether
husband’s or wife’s name is on the debt, and the last 4 digits of
account numbers (xxx3094), if applicable.

 List all debts in husband’s name alone and in wife’s name alone
and in both names together. Include debts incurred during the
marriage and after separation. Do not include bills you pay in
full each month.

Mortgages and loans on Real Estate:
Do not list here. Use the Real Estate Attachment.
Charge/credit card accounts:
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
Auto loans:
$ $
$ $
$ $

DIV302 State ENG Rev 10/10 www.mncourts.gov/forms Page 24 of 27

———————– Page 25———————–

Bank/credit union loans:
$ $
$ $
$ $
$ $
Husband Wife
$ $
$ $
Student loans:
$ $
$ $
$ $
$ $
Money you owe: (not evidenced by a note )
$ $
$ $
$ $
$ $
Judgments:
$ $
$ $
$ $
Other debts:
$ $
$ $
$ $
$ $
$ $
Husband Wife
Total Debts to be Paid by Each Person:
(Excluding Real Estate mortgages and loans.) $ $

DIV302 State ENG Rev 10/10 www.mncourts.gov/forms Page 25 of 27

———————– Page 26———————–

Attachment “C”
REAL ESTATE ATTACHMENT

Fill out a separate Attachment for each parcel of real estate.

1. Real Estate belongs to: (List all owners)

2. Street Address of the real estate is:

City State Zip Code

The property is in County.

3. Legal Description is: (Use the full legal description from the deed. If the legal

description is long, you may use an attachment. Type or print neatly.)

4. Purchase date (month, day, year) and purchase

price: $ .

5. Mortgages or loans: (Write “NONE” if there is no mortgage).

st
1 Mortgage: Amount currently owed $ and name of lender

2nd Mortgage: Amount currently owed $ and name of lender

DIV302 State ENG Rev 10/10 www.mncourts.gov/forms Page 26 of 27

———————– Page 27———————–

6. Current Market Value of this property: $

7. This property is the homestead: Yes No

AGREEMENT OF HUSBAND AND WIFE

1. All right, title, and interest of Husband and Wife in the real estate described above shall

be awarded to:

Husband Wife

2. Husband and Wife also agree that : (Describe any liens in favor of husband or wife, or

other agreements about the use, sale of, or award of the property. Attach additional pages

if needed. If there are no other agreements, write “None”.)

3. The Mortgage(s) or Loan(s) described above shall be paid by Husband Wife

starting on the following date:

(write “NONE” if there is no mortgage or loan.)

DIV302 State ENG Rev 10/10 www.mncourts.gov/forms Page 27 of 27


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