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Free Minnesota Petition for Dissolution of Marriage without Children Form - PDF Form Download

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


Minnesota Petition for Dissolution of Marriage Without Children

Text version of this Form

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State of Minnesota District Court
County of Judicial District:
Court File Number:
Assigned Judge:
Case Type: Dissolution without Children

In Re the Marriage of:

Name of Petitioner (first, middle, last) Petition For Dissolution Of
Marriage Without Children
and

Name of Respondent (first, middle, last)

STATE OF MINNESOTA )
COUNTY OF )SS
(County where Petition is signed)

1. Information about Petitioner

Full Name: _______________________________________________________________________
First Middle Last
Address where you live:
Street Address Apt. No.

_______
City County State Zip Code

Mailing address: Same as above address OR

Street Address Apt. No.

_______
City County State Zip Code

Date of Birth: ________________________ Petitioner is the husband wife.
Month Day Year

List all of Petitioner’s former or other names or write “None”:

First Middle Last

First Middle Last

2. Information about Respondent

Full Name:
First Middle Last

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Address where Respondent lives :
Street Address Apt. No.

City County State Zip Code

Mailing address: Same as above address OR

Street Address Apt. No.

_______
City County State Zip Code

Respondent’s address is unknown to Petitioner.

Respondent’s Date of Birth: ________________________
Month Day Year

List all of Respondent’s former or other names or write “None”:

First Middle Last

First Middle Last

3. Our Marriage

Petitioner and Respondent were married on: (month, day, year) ,

in the City of _____________________, County of _______________________________, State of

__________________________, Country of .

4. 180 Day Requirement

Has Petitioner been living in Minnesota for the past six (6) months? YES NO

Has Respondent been living in Minnesota for the past six (6) months?

YES NO UNKNOWN

5. Armed Forces

Is Petitioner an active duty member of the armed forces? YES NO

If YES, has Petitioner been stationed in Minnesota for the past six (6) months? YES NO

Is Respondent an active duty member of the armed forces? YES NO UNKNOWN

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If YES, has Respondent been stationed in Minnesota for the past (6) months? YES NO

6. Marriage Cannot be Saved

There has been an irretrievable breakdown of my marriage relationship with Respondent and the

marriage cannot be saved.

7. Physical Living Situation

Do Petitioner and Respondent live together at this time? YES NO

If NO, the date we separated was: .
Month Day Year

If YES, Petitioner and Respondent are living together because:

8. Other Proceedings

a. Has a separate court case for marriage dissolution, legal separation, or annulment already been

started by Petitioner or Respondent in Minnesota or elsewhere? 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 status or outcome of the case is:

Open Closed I do not know

9. Protection or Harassment Order

Is an Order for Protection or a Harassment/Restraining Order in effect regarding Petitioner and

Respondent? YES NO If YES: The Order protects: Petitioner Respondent

and the Order was filed in County in State on

date, and the Court file number is .

A copy of the Order must be attached.

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10. Children

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

a. Do Petitioner and Respondent have minor children together? YES NO

b. Do Petitioner and Respondent 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:

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

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.

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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.)

11. Public Assistance / Medical Assistance

Note: If either party is receiving public assistance from the State of Minnesota or applies for it after this
proceeding is started, the Petitioner must give notice of this marriage dissolution action to the Support and
Collections office for the county paying the assistance.

a. Petitioner receives public assistance from the State of Minnesota: YES NO

If YES, the assistance is from __________________ County. (Check all that apply):

MFIP Tribal TANF General Assistance Child Care Assistance

Minnesota Care Medical Assistance

b. Respondent receives public assistance from the State of Minnesota :

YES NO UNKNOWN

If YES, the assistance is from __________________ County. (Check all that apply):

MFIP Tribal TANF General Assistance Child Care Assistance

Minnesota Care Medical Assistance

12. Supplemental Security Income (SSI)

Supplemental Security Income (SSI) is a Federal income supplement program. It is available to low-income

people if they are over age 65, or blind, or disabled.

a. Petitioner receives Supplemental Security Income (SSI): NO YES in the amount of

$ per month.

b. Respondent receives Supplemental Security Income (SSI): NO YES in the amount of

$ per month, or UNKNOWN

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13. Petitioner’s Employment

a. Is Petitioner employed? YES NO Is Petitioner Self-Employed? YES NO

b. Name and address of Petitioner’s employer. (If Petitioner has more than one job, list the Name

and Address of each employer.)

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

____________________________________________________________________________
Employer’s Street Address

____________________________________________________________________________
City State Zip Code

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

____________________________________________________________________________
Employer’s Street Address

____________________________________________________________________________
City State Zip Code

14. Petitioner’s Gross Income

The Income questions ask for monthly income. If you are paid weekly, multiply your weekly income by 4.33
to get monthly income. If you are paid every two weeks, multiply by 2.17 to get monthly income. If you are
paid twice a month, multiply by 2.

Sources of Income Amount per month (or zero) before taxes and deductions

Self Employment Income $ per month

If you are self employed, calculate your net monthly revenues as follows: (Annual gross revenues
minus annual ordinary and necessary business expenses) divided by 12 = Net Monthly Revenue.
Also, attach Schedule C from last year’s tax return to this Petition.

Income from all jobs $ per month

Commissions from all jobs $ per month

Unemployment benefits $ per month

Social Security Retirement, Survivors or

Disability Income (SSDI or RSDI) $ per month

Investments or Rental Income $ per month

Annuity payments $ per month

Pension or Disability from work or military $ per month

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Workers Compensation $ per month

Court-ordered spousal maintenance you receive $ per month

Other ____________________ $ per month
Identify Source

Total gross income $ per month

Does Petitioner receive child support payments? YES NO If YES, Petitioner

receives child support payments from ____________________________(name(s) of payor(s))

in the total amount of $_________________per month.

15. Respondent’s Employment

Is Respondent employed? YES NO UNKNOWN

Is Respondent Self-Employed? YES NO UNKNOWN

Name and address of Respondent’s employer. (If Respondent has more than one job, list the
Name and Address of each employer.)

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

____________________________________________________________________________
Employer’s Street Address

____________________________________________________________________________
City State Zip Code

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

____________________________________________________________________________
Employer’s Street Address

City State Zip Code

16. Respondent’s Gross Income

Petitioner has no information about Respondent’s income. OR

Petitioner does not have detailed information about Respondent’s income, but has good reason

to believe that Respondent’s pay is $ per week month year, with

bonuses, overtime or commissions in the additional amount of $ per week

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month year. This is Respondent’s Net Income (after taxes and deductions) or Gross

Income (before taxes and deductions.) OR

Petitioner has detailed information about Respondent’s income. (If this is true, fill out the

income information below.)

The Income questions ask for monthly income. If Respondent is paid weekly, multiply weekly income by 4.33
to get monthly income. If Respondent is paid every two weeks, multiply by 2.17 to get monthly income. If
Respondent is paid twice a month, multiply by 2.

Sources of Income Amount per month (or zero) before taxes and deductions

Self Employment Income $ per month

If Respondent is self employed, calculate net monthly revenues as follows: (Annual gross
revenues minus annual ordinary and necessary business expenses) divided by 12 = Net Monthly
Revenue. Also, attach Schedule C from last year’s tax return to this Petition, if available.

Income from all jobs $ per month

Commissions from all jobs $ per month

Unemployment benefits $ per month

Social Security Retirement, Survivors or

Disability Income (SSDI or RSDI) $ per month

Annuity payments $ per month

Investments or Rental Income $ per month

Pension or Disability from work or military $ per month

Workers Compensation $ per month

Court-ordered spousal maintenance you receive $ per month

Other ____________________ $ per month
Identify Source

Total gross income $ per month

17. Medical / Dental Insurance

a. Does Petitioner have insurance coverage through his/her employment?

Medical: YES NO Dental: YES NO

If YES, this medical insurance covers: Petitioner Respondent

and this dental insurance covers: Petitioner Respondent

b. Does Respondent have insurance coverage through his/her employment?

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Medical: YES NO UNKNOWN

Dental: YES NO UNKNOWN

If YES, this medical insurance covers: Petitioner Respondent

and this dental insurance covers: Petitioner Respondent

c. Does Petitioner receive Medical Assistance or Minnesota Care through the State of

Minnesota? YES NO

d. Does Respondent receive Medical Assistance or Minnesota Care through the State of

Minnesota? YES NO UNKNOWN

18. Spousal Maintenance

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

Check only one box:

Petitioner and Respondent can each pay their own living expenses and do not need spousal

maintenance at this time, or in the future.

Petitioner or Respondent 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)

Petitioner needs spousal maintenance from Respondent now. Petitioner is __________years

of age, Petitioner and Respondent have been married for _________years. Petitioner has the

following education:_____________________________________________. Petitioner’s

gross monthly income totals $__________________. Petitioner’s monthly expenses total

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

during the marriage because:

_______________________________________________________

Respondent has the ability to pay Petitioner $_____________per month for spousal

maintenance.

Respondent needs spousal maintenance from Petitioner now. Respondent is __________years

of age, Petitioner and Respondent have been married for _________years. Respondent has the

following education:_____________________________________________. Respondent’s

gross monthly income totals $______________. Respondent’s monthly expenses total

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$________________, and Respondent is not able to maintain the standard of living established

during the marriage because: _______________________________________ .

Petitioner has the ability to pay Respondent $_____________per month for spousal

maintenance.

19. Vehicles

Vehicles are cars, trucks, boats, motorcycles, snowmobiles, personal watercraft, all terrain vehicles etc.

owned by husband or wife together or separately, including vehicles purchased after separation:

Does Petitioner own a vehicle? YES NO

Does Respondent own a vehicle? YES NO UNKNOWN

List all vehicles owned by husband or wife together or separately:

Type of Year/Make/ Name(s) on Value Balance Owed Monthly
Vehicle (car,
Model Title Payment
boat, truck etc.)
$ $ $

$ $ $

$ $ $

$ $ $

20. Marital Property
Marital property means almost anything that you or your spouse now own that was received or
bought during the marriage, even during the times you were separated. Marital Property includes
household goods, furniture, jewelry, boats, real estate and other things. Marital property does not
include a gift or inheritance received by one spouse alone.

Has the marital property been divided between the Petitioner and Respondent to Petitioner’s

satisfaction? YES NO

If NO, Petitioner requests the following marital property:

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________.

21. Non-Marital Property

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Non-marital property means: (1) anything that you or your spouse owned before the marriage; (2)
anything that you or your spouse received as a gift, bequest, devise, or inheritance, to you or your
spouse alone; (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; (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. Does Petitioner have non-marital property? YES NO

If YES, list Petitioner’s non-marital property:

.

b. Does Respondent have non-marital property? YES NO UNKNOWN

If YES, list Respondent’s non-marital property:

___________________________________________________________________________.

22. Cash & Accounts – Not including Pension and Employer-Funded Retirement Accounts

Does Petitioner have money in banks, savings, cash or investments? YES NO

Does Respondent have money in banks, savings, cash or investments? YES NO UNKNOWN

If YES,

a. List all accounts owned by you alone, your spouse alone, or owned by both of you jointly

including those opened after separation. “Type of account” means checking, savings, money market

accounts, certificates of deposit, stocks, bonds, stock options, mutual funds, savings bonds, and

Treasury Bills, etc.

Do not include Pension or Employer-Funded Retirement Accounts, which are listed at #26.

Financial Type of Account Account # Amount Belongs to:

Institution Last 4 digits only (name on account)

XX $

XX $

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XX $

XX $

XX $

XX $

b. List cash not listed at a.:

Petitioner has cash in the amount of $ .

Respondent has cash in the amount of $ OR UNKNOWN.

23. Business Interest

Does Petitioner have an interest in a business? YES NO

Does Respondent have an interest in a business? YES NO UNKNOWN

If YES, the name of the business is ____________________________, the address is

________________________________________________________________________________

and the value is $________________. How did you arrive at this value?

24. Manufactured Home

Does Petitioner own a manufactured home? YES NO

Does Respondent own a manufactured home? YES NO UNKNOWN

If either Petitioner or Respondent own a manufactured home, together or separately, complete

the following information:

a. Address of the manufactured home:

in the city of , state of

b. What type of home is it? (single, double-wide etc.)

c. Whose name(s) is on the title?

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d. When was the home purchased?

e. What was the purchase price? $

f. What is the current values of the home? $

g. How did you arrive at that amount as the current value?

h. How much money is still owed on the home? $

i. If money is owed on the home, who is the money owed to?

j. Do you own the land the home sits on, or do you rent a lot? Rent Own

Note: If you own the lot, you must list the land at Paragraph 25.

25. Real Property – Land, Buildings, Contracts for Deed

All real property now owned by Petitioner or Respondent together or separately must be listed. Include real

property acquired before the marriage, during the marriage, and after separation.

a. Do Petitioner and Respondent jointly own real property? YES NO

b. Does Petitioner own real property solely in his/her own name or with someone other than

Respondent? YES NO

c. Does Respondent own real property solely in his/her own name or with someone other than

Petitioner? YES NO UNKNOWN

d. How many properties are owned by you and your spouse in total? None One Two

Three _______

If you or your spouse own real property, separately or together, complete the following

information about the property. If there is more than one piece of real property, photocopy and

complete a Real Property Information page for each piece of property. Staple the additional sheets

to this Petition, and label each sheet “Attachment to Petition of ____________________” (your

name).

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Real Property Information

1. Real Estate belongs to: (List full names of all owners)_____________________________________

________________________________________________________________________________

2. Legal Description is: (The full legal description must be included. Copy the legal description from

the deed. Do not use the property tax statement legal description. If the legal description is long,

you may use an attachment. Type or print neatly.)

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

3. Street Address of the real property is:

___________________________________________________________________________

City______________________________________State______________Zip Code______________

The property is in_____________________________________County.

4. Purchase date_________________(month , day, year) and purchase price:$

5. Mortgages or loans: (List all mortgages and loans on the property)

There are no mortgages or loans on this property.

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

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

Other mortgages or loans:

6. Current Market Value of this property: $___________________________________

How did you arrive at this value?

7. This property is the homestead: _______Yes _________No

26. Retirement Plans

Does Petitioner have a retirement account? (IRA, 401(k), 403(b) or other)

YES NO If YES:

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a) The account number is: (last 4 digits only)

b) The name of the bank that has the account is:

c) The current account balance is:

Has Petitioner, or Petitioner’s past or present employer, union, or other group, paid money into a

pension, profit sharing, or other retirement plan for Petitioner?

YES NO If YES:

a) The name of the plan is:____________________________________________________

b) The employer, union or group providing the plan is:

c) The date Petitioner began working at the job or joined the union or group plan is:

d) The type of plan is: (e.g. defined benefit, defined contribution)

e) The present value of the pension or plan is:

Does Respondent have a retirement account? (IRA, 401(k), 403(b) or other)

YES NO UNKNOWN

If YES:

a) The account number is: (last 4 digits only)

b) The name of the bank that has the account is:

c) The current account balance is:

Has Respondent, or Respondent’s past or present employer, union, or other group, paid money into

a pension, profit sharing, or other retirement plan for Respondent?

YES NO UNKNOWN

If YES, and it is a Pension, Profit-Sharing, or other Retirement Plan:

a) The name of the plan is:

b) The employer, union or group providing the plan is:

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c) The date Respondent began working at the job or joined the union or group plan is:

d) The type of plan is: (e.g. defined benefit, defined contribution)

e) The present value of the pension or plan is: ___________________________________

27. Debts

Does Petitioner have debt? YES NO

Does Respondent have debt? YES NO UNKNOWN

If YES, list debts in your name, your spouse’s name and in both names jointly. Include unpaid
debts from before the marriage date, during the marriage, and after separation. Fill in all
information completely and attach another sheet of paper if necessary.

Money is owed Money was used Whose Name is on the Account Balance Monthly
to: for: and When was the Debt Owed Payment
Incurred?
Name Date
$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

Total Debt $ $

28. Name Change

Does Petitioner want to change his/her name? YES NO If YES, answer (a) through (c):

a. Petitioner’s name should be changed to:

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First Middle Last

Is this name a former legal name or maiden Name? YES NO If NO, the reason

Petitioner wants to change to this name is:

b. Petitioner has no intent to defraud or mislead anyone by changing his/her name:

TRUE FALSE

c. Has Petitioner been convicted of a felony? YES NO If YES, answer i. and ii:

i. Petitioner has given notice of this request for name change to the proper authority as

required by Minn. Stat. Section 259.13. (See Felon Name Change instructions)

ii. Petitioner has attached to this Petition an Affidavit of Service of the Notice marked

Exhibit “A”.

29. Other Include other facts you think the Court should know.

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

BASED UPON THE ABOVE INFORMATION, Petitioner requests that the Court issue a

final judgment and decree granting the following relief:

1. Dissolving the bonds of matrimony between Petitioner and Respondent to end the marriage.

2. Medical and Dental Insurance for the Parties

a. Ordering each party to provide for his or her own medical dental insurance.

b. Ordering ____________________________(full name) to provide medical dental

insurance for ______________________________________________ (full name).

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c. Allowing____________________________(full name), at his/her own expense, to

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

to federal and state statutes.

d. Reserving the issue of medical and dental insurance for the parties.

3. Spousal Maintenance

a. Maintenance is denied to Petitioner and Respondent.

b. Reserving the issue of maintenance.

c. Ordering Petitioner Respondent to pay spousal maintenance to

Petitioner Respondent.

4. Vehicles

Awarding the vehicles as follows and ordering the party receiving the vehicles to pay for any loans

or insurance for such vehicle:

Year / Make / Model Awarded to:

5. Marital Property

Dividing the parties’ marital property, household goods, furniture and furnishings either:

a. As currently divided OR

b. As follows (attach additional page if necessary):

To Petitioner:

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To Respondent:

6. Non-Marital Property

Dividing the parties non-marital property

a. As currently divided OR

b. As follows (attach additional page if necessary):

To Petitioner:

To Respondent:

7. Cash and Accounts

a. Awarding the savings and investments as follows:

Institution Type of Account Account # Amount Awarded to

(Last 4 digits only)
XX $

XX $

XX $

XX $

XX $

XX $

b. Awarding any cash not included in a. above to the party who currently has the cash OR

Awarding the cash as follows:

8. Business

None OR

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Awarding the parties’ business as follows:__________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

9. Manufactured Home

None OR

Awarding the manufactured home located at :

street address

city state

to Petitioner Respondent. The debt on the manufactured home owed to:

shall be paid by

Petitioner Respondent.

10. Real Property

None OR

Awarding solely to Petitioner Respondent all right, title, and interest of husband

and wife in the real property located at:

Street address___________________________________________________________________

in the City of , County of ___________________________,

State of , which has the following legal description: ______________

_______________________________________________________________________________

_______________________________________________________________________________

with the following mortgages and loans to be paid, after the divorce is final, by Petitioner

Respondent:

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

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

and subject to the following liens or other agreements:

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A lien in favor of Petitioner Respondent in the amount of $ .

Other request regarding the property: (describe the request fully)

11. Additional Real Property

None OR

Awarding solely to Petitioner Respondent all right, title, and interest of husband and

wife in the real property located at:

Street address___________________________________________________________________

in the City of , County of ___________________________,

State of , which has the following legal description: ______________

_______________________________________________________________________________

_______________________________________________________________________________

with the following mortgages and loans to be paid, after the divorce is final, by Petitioner

Respondent:

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

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

and subject to the following liens or other agreements:

A lien in favor of Petitioner Respondent in the amount of $ .

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Other request regarding the property: (describe the request fully)

12. Retirement Funds

a. Awarding Petitioner’s pension, profit sharing, retirement plan, I.R.A., or 401(k) or other

retirement fund as follows:

Petitioner has no retirement funds OR

100% to Petitioner OR

Dividing Petitioner’s retirement benefits fairly and equitably between the parties as follows

.

b. Awarding Respondent’s pension, profit sharing, retirement plan, I.R.A., or 401(k) or other

retirement fund as follows:

Respondent has no retirement funds OR

100% to Respondent OR

Dividing Respondent’s retirement benefits fairly and equitably between the parties as follows

.

13. Debts

a. Dividing the debts as follows and ordering each party to hold the other harmless from any

responsibility for the debts so divided. Include all debts listed at #27 above.

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Debt Owed To: To Be Paid By:

b. Ordering that each party is solely responsible for paying any other debts incurred solely by

him or her and ordering each party to hold the other harmless from any responsibility for

such separately incurred debts.

14. Name Change

Petitioner is not requesting a name change; OR

Changing Petitioner’s name to:
First Middle Last

15. Other:

16. Ordering such other relief as the Court deems just and equitable.

17. Read and sign the Verification and Acknowledgments.

STATE OF MINNESOTA )

) SS
COUNTY OF )
(County where Petition is signed)

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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 serving or
filing this document, Court costs, and reasonable attorney’s fees. I understand that I could also be
prosecuted for perjury if I am not telling the truth in my Petition.

DATE: / /
Month Day Year Petitioner’s Signature
(Sign only in presence of notary public)

Subscribed and sworn to Street Address:

before me this _________day of City, State:

______________, 20________. Zip Code:

_____________________________ Telephone: ( ) ______

Notary Public or Court Clerk

DIV402 State ENG Rev 4/09 www.mncourts.gov/forms Page 24 of 24

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Minnesota Petition for Dissolution of Marriage without Children Form Reviews

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