Fill - Free fillable Petitioner, v. (Indiana Legal Help) PDF form

Page 1 of 2 Approved by the Coalition for Court Access

CCA-GF-0719-3003

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 DC case type as defined in Administrative Rule 8(B)(3).

4. There are related cases: (If yes, please indicate below)

☐ Yes

☐ No

_____

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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

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CCA-DC-0320-1069

www.indianalegalhelp.org

NOT FOR PUBLIC ACCESS

IN ACCORDANCE WITH INDIANA RULES ON

ACCESS TO COURT RECORDS

ATTENTION CLERK: FOR SELF REPRESENTED LITIGANTS TREAT THIS FORM AS IF IT

IS PRINTED ON LIGHT GREEN PAPER. IF E-FILED, FILE AS A CONFIDENTIAL

DOCUMENT.

STATE OF INDIANA IN THE ____________________ ___________ COURT

COUNTY OF __________________ CAUSE NO: _____________________________

IN THE ________________OF

_______________________

Minor Child (paternity only)

_______________________

Petitioner

vs.

_______________________

Respondent

CIVIL APPEARANCE FORM

Social security numbers of all family members in cases involving child support

Name: ______________________________________SS#________________________________

NOT FOR PUBLIC ACCESS

_____

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Approved by the Coalition for Court Access

CCA-DC-0719-1023

STATE OF INDIANA IN THE ________________ _________________ COURT

COUNTY OF _____________ CAUSE NO. _________________________________

IN RE THE MARRIAGE OF:

________________________

Petitioner,

and

________________________

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 ________________________________.

_____

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8. There are _____ children of the parties currently living who are either less than

twenty-one (21) years of age or incapacitated, namely:

Name and Date of Birth

Age

Address

9. Petitioner _________ pregnant.

Respondent

_________ pregnant.

10. The parties’ marriage has suffered an irretrievable breakdown.

11.

☐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.

12. is the fit and proper person to have custody

of the minor child(ren).

13. An order for child support and parenting time should be issued.

14.

☐ There are no other open cases related to this/these child(ren).

-OR-

☐ There are other open cases related to this/these child(ren). They are:

____

_____

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Location (County and State) Cause/Case Number

15. Petitioner ________ a lifetime sex or violent offender.

Respondent ________ a lifetime sex or violent offender.

16. Debts.

☐ There are no debts to divide.

-OR-

☐ Petitioner wishes the court to divide the following debts.

a. ____________________________________________________________

____________________________________________________________

b. _________________________________________________________

c.

d.

17. Assets and property.

☐ There are no assets to divide.

-OR-

☐ Petitioner wishes the court to divide the following assets, including personal

property.

a. ____________________________________________________________

____________________________________________________________

b. _________________________________________________________

_____

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☐ Restraining the parties from removing the child(ren) from the state without

the permission of the court or all parties;

☐ 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

STATE OF INDIANA IN THE COURT

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

_____

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

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

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:

_____

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CCA-DC-0719-1027

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

is awarded custody of the minor child(ren).

☐

Petitioner

☐ Respondent

shall pay temporary child support for the minor child(ren) in

the amount of $__________ per week beginning on

_______________________. All support payments shall be

made through the County Clerk’s Office (case payments only)

or the State Central Collection Unit PO Box 7130,

Indianapolis, Indiana 46220-7130 (any payments other than

cash). The court shall issue and immediately activate Income

Withholding Order pursuant to IC 31-16-15 to any employer

or income provider to the child support Obligor.

☐ Petitioner

☐ Respondent

shall be responsible for the first $_____________ of annual

uninsured medical expenses for the minor child(ren).

Thereafter, Petitioner shall be responsible for _____% and

Respondent for _____ % of annual uninsured medical

expenses for the minor child(ren).

☐

Petitioner

☐ Respondent

shall have temporary parenting time with the minor child(ren)

as the parties agree or according to the Indiana Parenting

Time Guidelines.

☐

Petitioner

☐ Respondent

shall have temporary possession of the marital residence.

_____

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☐

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:

________________________________________________

☐ 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:

________________________________________________

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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 removing the child(ren) from the state without

the permission of the court or all parties;

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

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

☐ Other:

____________________________________________________________

ALL WHICH IS SO ORDERED

Judicial Officer

Distribution:

Page 1 of 1 Approved by the Coalition for Court Access

CCA-DC-0719-1024

STATE OF INDIANA IN THE COURT

COUNTY OF CAUSE NO._______________________________

IN RE THE MARRIAGE OF:

__________________________

Petitioner,

v.

__________________________

Respondent.

VERIFIED WAIVER OF FINAL HEARING

Come now Petitioner and Respondent pursuant to Indiana Code 31-15-2 and submit their

Verified Waiver of Final Hearing. In support of this Waiver, the parties state that:

1. More than sixty (60) days have passed since the filing of Petitioner’s Verified

Petition for Dissolution of Marriage.

2. Both parties request the Court to approve their Settlement Agreement and Decree

of Dissolution of Marriage.

3. Both parties voluntarily waive the opportunity to hold a final hearing on contested

issues and have signed below before filing this document with the court.

I affirm under the penalties of perjury that the foregoing representations are true.

____________________________________ ____________________________________

Petitioner Respondent

Address:

_____________________________________

_____

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CCA-DC-0319-1025

STATE OF INDIANA IN THE COURT

COUNTY OF CAUSE NO._______________________________

IN RE THE MARRIAGE OF:

__________________________

Petitioner,

v.

__________________________

Respondent.

SETTLEMENT AGREEMENT AND DECREE OF DISSOLUTION OF MARRIAGE

The parties having submitted a Settlement Agreement and the Court having seen and

considered the Verified Petition of Dissolution of Marriage by the parties now approves the

following:

. Petitioner and Respondent were married on _____________________________,

and separated on ________________________________.

 ___________________________________ has been a continuous resident of

_______________________ County for the last three months.

 _____________________________ has been a continuous resident of the State of

5. There are _____ children of the marriage, namely:

Name

Date of Birth

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

6. Custody and care of the minor child(ren).

It is in the best interest of the child(ren) that:

2.

3.

Indiana for the six months prior to the filing of the Verified Petition for Dissolution of

Marriage.



4.

____________________ is  pregnant.

_____

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☐ The parties shall have joint legal custody over the minor child(ren) with

Petitioner being the primary custodial parent.

☐ The parties shall have joint legal custody over the minor child(ren) with

Respondent being the primary custodial parent.

☐ Petitioner shall have sole legal custody of the minor child(ren) and shall be

the primary custodial parent.

☐ Respondent shall have sole legal custody of the minor child(ren) and shall

be the primary custodial parent.

☐ Other, as described below:

____________________________________________________________

7. Parenting Time

Parenting time with the minor child(ren) shall be as follows:

☐ Petitioner

☐ Respondent

☐ Other

shall have parenting time with the minor child(ren), at a

minimum, as set out by the Parenting Time Guidelines

The parties agree that it is in the best interests of the

minor child(ren) to follow a parenting time schedule that

does NOT follow the Indiana Parenting Time Guidelines.

Parenting time with the minor child(ren), shall be as

follows:

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8. Child Support

☐

Petitioner

☐ Respondent

☐ Petitioner

☐ Respondent

☐

Petitioner

☐ Respondent

☐ Petitioner

☐ Respondent

will pay child support in the amount of $______________

per week as shown by the attached child support

worksheet, beginning on the first Friday following the

date of the Decree. All support payments shall be made

through the County Clerk’s Office (cash payments only)

or the State Central Collection Unity PO Box 7130,

Indianapolis, Indiana 46207-7130 (any payments other

than cash). The court shall issue an immediately activated

Income Withholding Order pursuant to IC 31-16-15 to

any employer or income provider of the child support

Obligor.

shall be responsible for all controlled expenses related to

the upbringing of the minor child(ren). (For use only in

cases when parenting time is equally shared).

will be responsible for the first ________________ of

annual uninsured health and medical, dental, optical,

hospital and prescription expenses for the minor

child(ren). Thereafter, Petitioner shall be responsible for

________% of annual uninsured medical expenses for the

minor child(ren), and Respondent shall be responsible for

__________ % of annual uninsured medical expenses for

the minor child(ren).

will be responsible to pay a child support arrearage in the

amount of $_______________ which has accrued during

the pendency of this proceeding. Such arrearage shall be

paid in the periodic amount of $________________ per

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week in addition to the current support rendered above,

until such arrearage has been satisfied.

9. Health insurance

The provisions for health insurance maintenance shall be as follows:

☐ Petitioner

☐ Respondent

shall maintain medical, dental and optical insurance as

available through employment, or Health Insurance

Marketplace, or by government provided insurance for the

minor child(ren).

☐

Other

Health insurance is not available to either parent at a

reasonable cost, therefore, neither party is ordered to

provide health insurance at this time.

In the event that health insurance for the children becomes

available at a reasonable cost to one or both of the parties,

the party to whom such coverage is available shall obtain

coverage for the children within a reasonable time after

such coverage becomes available.

10. Taxes

The arrangement for claiming the tax credits, exemptions and deductions for the

minor children shall be as follows:

☐ Petitioner

☐ Respondent

shall be entitled to claim the minor child(ren) for federal,

state, and local income tax purposes on an annual basis.

The parties shall cooperate to sign all necessary

documents that will allow the party claiming the

exemptions to do so.

☐ Other

Petitioner and Respondent shall each be entitled to claim

the minor child(ren) for federal, state, and local income

tax purposes in alternating years.

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Petitioner shall be entitled to claim the minor child(ren) in

the year _________, and every ___________ year

thereafter.

Respondent shall be entitled to claim the minor child(ren)

in the year _________, and every ___________ year

thereafter. The parties shall cooperate to sign all

necessary documents that will allow the party claiming

the exemption to do so.

11. Joint debt.

The division of jointly held debts shall be as follows:

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

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

Respondent harmless from liability, expenses, 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

_______________________________ _____________________

_____

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12. 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:

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:

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13. 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)

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

paragraph number 11 or 12 of this Decree.

14. 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:

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

property:

15. Marital Residence.

The parties are owners of real estate located at:

_______________________________________________________________________.

☐ Petitioner

☐ Respondent

shall retain or take possession and shall become the sole

owner of said real estate.

☐ Petitioner

☐ Respondent

Shall vacate the marital residence by:

______________________________________________.

☐ Petitioner

☐ Respondent

Shall be responsible for all payments related to property

taxes and homeowners insurance and shall receive the

deductions for mortgage interest and taxes.

☐ Petitioner

☐ Respondent

Shall transfer, by Quitclaim Deed, his/her interest in said

real estate to the party retaining possession of the marital

residence by:

_____________________________________________ .

☐ Petitioner

☐ Respondent

Agrees to refinance the mortgage debt related to the

marital residence and make a 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 liability, expense, attorney

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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 the parties

agree that:

☐ Petitioner

☐ Respondent

shall retain or take possession of the leased premises, be

responsible for the remaining rental payment and fees

due under said lease, and agrees to hold the other party

harmless from all liability, expense, attorney fees, loss or

damage which may be a result of the failure to make

required payments under said lease.

☐

Petitioner

☐ Respondent

Shall vacate the leased residence by ________________.

☐

Other

_____________________________________________

16. 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.

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

18. The parties mutually represent and acknowledge that the division of property and

payment of debts is fair and equitable and each is satisfied with such division.

I affirm under penalties of perjury that the foregoing representations are true.

____________________________________

Petitioner’s signature

STATE OF INDIANA

COUNTY OF _______________________

Before me _________________________________, a notary public ______________________

County, State of Indiana, personally appeared ________________________________________

and being duly sworn upon his/her oath, says that the facts alleged in the foregoing instrument

are true.

Date _______________________________________

Notary Public ________________________________

My Commission Expires _______________________

I affirm under penalties of perjury that the foregoing representations are true.

____________________________________

Respondent’s signature

STATE OF INDIANA

COUNTY OF _______________________

Before me _________________________________, a notary public ______________________

County, State of Indiana, personally appeared ________________________________________

and being duly sworn upon his/her oath, says that the facts alleged in the foregoing instrument

are true.

Date _______________________________________

Notary Public ________________________________

My Commission Expires _______________________

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15. Findings of the Court

This document represents an agreement submitted by the parties for approval by the Court.

The parties have submitted a waiver of final hearing and have agreed that the property distribution

provisions of this agreement represent a just and reasonable division of the marital estate and debts.

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:

_________________________________ __________________________________

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