Missouri Answer Form

If you want to initiate a divorce process in the State of Missouri, you are required to complete and submit the Missouri Answer Form to the country clerk’s office at your registered place of residence.

Extracted Text for Proper Search

Petition	for Dissolution of Marriage	 Page	1of 12	
IN THE CIRCUIT	COURT OF _________________________, MISSOURI	
(County where court is located)	
In re the Marriage of
_________________	_____________	____________________	_________	(First)	(Middle)	(Last)	(Jr./Sr./III)	
Petitioner,	(Your full name should be entered here)	Ca	se No. ____________	(Will be assigned when case is filed)	
-and	-	
Division No. ____________	_________________	_____________	____________________	_________	(Will be assigned when case is filed)	(First)	(Middle)	(Last)	(Jr./Sr./I	II)	
Respondent.	(Enter your spouse s full name here)	
Count	I  P	etition for Dissolution of Marriage	

1.  How many petitions have you filed	
in this case	
?	

This is the first petition I have filed in this case. (Original Petition)

This is the second petition I have filed in this case	.	

This is the third petition I have filed in this case	
.	

2.  Are you the Husband or the Wife?	

I am the Wife.

I am the Husband.	

3
.  What is your mailing address?

_________________________________________________________(Street)
_________________________	__________________	___________	(City)	(State)	(Zip)	
_________________________	_____________________________	
(Telephone Number)	
(E
-
M
ail Address	
)	

4
.  What	
are the last four numbers of	
your social security number?	

XXX	-XX	-_____________	

5
.
What is your spouse s mailing address?

_________________________________________________________(Street)
_________________________	__________________	___________	(City)	(State)	(Zip)	
_________________________	_____________________________	
(Telephone Number)	
(E
-
Mail Address)	

6
.
What	
are the last four numbers of	
your	
spouse s	
social s	
ecurity	

number?
XXX	-XX	-_____________	

C

Form CAFC001-08/29/2009

Petition for Dissolution of Marriage   Page 2 of 12	
7. DIRECTIONS FOR SERVICE ON RESPONDENT	
How will your spouse receive legal notice of this proceeding?	

Respondent has signed a verified  Answer to Petition for	
Dissolution of Marriage  which is being filed with the  Petition for
Dissolution of Marriage.   Therefore, do not issue a summons.	

Respondent has signed a verified  Waiver of Service and Entry of	
Appearance  which is being filed with the  Petition for Dissolution of
Marriage.   Therefore, do not issue a summons.	

Respondent will voluntarily enter his/her appearance in this case	

and therefore summons should be issued but held in the Sheriff s
office for this County.  If a verified  Waiver of Service and Entry of
Appearance  is not filed within thirty (30) days, this case may be
dismissed without further notice to Petitioner.	

Summo	
ns should be served upon Respondent at his/her	

residence:
________________________________________________________(Street)
_________________________ __________________ ___________(City) (State) (Zip)	

Summons should be served upon Respondent at his/her place of	

employment:_________________________________________ __________________(Employer s Name - if applicable) (Hours of Employment)
________________________________________________________(Street)
_________________________ __________________ ___________	(City) (State) (Zip)

Respondent cannot be served in Missouri.  Therefore, service by	

registered mail is requested.  A copy of the  Affidavit for Service by
Mail  is attached to this form.  See Missouri Supreme Court Rule
54.12(b)	

The whereabouts of Respondent are unknown and there is no	

way of contacting him or her. I have attempted to locate the
Respondent and have been unable to do so.  Therefore, service by
publication will be required.  A copy of the  Affidavit for Service by
Publication  is attached to this form.  Child support, maintenance or
other money judgments will not be allowed against Respondent if
service is by publication.  Publication must be made in the County
where this matter is filed in a newspaper of general circulation.  See
Missouri Supreme Court Rule 54.12(c).	

Other:	
______________________________________________	

Form CAFC001-08/29/2009

Petition	for Dissolution of Marriage	 Page	3of 12	

8.  What is your age	?	______________	_	(Number of Years)	

9.In what country do you currently reside?	_____________________	_	(Country	)	

10	
.  In what state do you currently reside and for what length of	

time have your resided in your state of residence?	
_________________________	______	______	______	(State of Residence)	Years	Months	Days	(Length of Residence in this State)	

11	
.  In what county do you currently reside	
and for what length of	

time have you resided in your county of residence?	
_________________________	______	______	______	(Name of County)	Years	Months	Days	(Length of Residence in this County)	

12	
.  What is your current employment status?	

Employed

Unemployed

Self	
-
employed	

13	
.  If you are employed or self	
-
employed, where do you currently	

work?	
_________________________________________(Employer s Name or type of self	-employment)	
________________________________________________________(Street)
_________________________	__________________	___________	
(City)	
(State)	
(Zip)	

14	.  What is your	total	monthly gross income from all sources?	
________________________(Total Monthly Gross Income)	

15	
.
Can you support yourself through the combined income from	

your employment and income from property that you will receive
in the dissolution?	

Yes

No	

16	.  Wha	t is your spouse s	age	?______________	_	(Number of Years	)	

Form CAFC001-08/29/2009

Petition	for Dissolution of Marriage	 Page	4of 12	

17	.In what country does your spouse currently reside?
________________________	_	
(Country	)	

1
8
.  In what state does your s	
pouse currently reside and for what	

length of time has your spouse resided in his or her state of
residence?	
_________________________	______	______	______	(State of Residence)	Years	Months	Days	
(Length of Residence in this State)	

1
9
.  In what county does your s	
pouse currently reside and for what	

length of time has your spouse resided in his or her county of
residence?	
_________________________	______	______	______	(Name of County)	Years	Months	Days	
(Length of Residence in this County)	

20	
.  If your spouse does not live in	
Missouri,	
did you and your	

spouse live	together	in Missouri during your marriage	?	

Yes.

No.

Not Applicable. (My spouse currently resides in Missouri)	

21	
.
What is your spouse s current employment status?

Employed

Unemployed

Self	-employed	

Unknown	

22	
.  If your spouse is employed or self	
-
employed, where does he	

or she currently work	?	
_________________________________________(Employer s Name or type of self	-employment)	
________________________________________________________(Street)
_________________________	__________________	___________	(City)	(State)	(Zip)	

2
3
.  What is your spouse s	
total	
monthly gross income from all	

sources?	
_______________________	_	(Total Gross	Monthly Income)	

Form CAFC001-08/29/2009

Petition	for Dissolution of Marriage	 Page	5of 12	

24	
.
Can your spouse support him or herself through the c	
ombined	

income from his or her employment and income from property that
he or she will receive in the dissolution?	

Yes

No

Unknown	

25	
.
Is your spouse on active duty in the military?

Yes

No	

(MM/DD/YYYY)	

2
7
.  I	
n what	
country, state and county	
did you get your marriage	

license?	
________________________	_	__________________________	(Country	)	(State)	
_______________	__________	
(Name of County)	

2
8
.  On what date did you and your spouse separa	
te?	

_____________(MM/DD/YYYY)	

2
9
.
Is there any reasonable likelihood that your marriage can be	

preserved?	

Yes

No	

30	
.
Is	
your marriage irretrievably broken?

Yes

No	

31	
.  Stat	
e any arrangements	
which you and your spouse hav	
e	

made for the maintenance of the other party or the custody and
support of any	children.	
____________________________________________________________________
____________________________________________________________________	

32	
.
Is Wife pregnant?

Yes

No	

33	
.  How many living children do	
you and your spous	
e
have	

together that were born	after	
the date of you	r marriage?	
_________________(Number of Children)	

Form CAFC001-08/29/2009
26.  On what date were you married?	_____________

Petition	for Dissolution of Marriage	 Page	6of 12	

34	
.  How many living children did	
you and your spouse	
adopt?	

_________________(Number of Children)	

35	
.  How many living children do	
you and your spouse	
have	

together that were born	before	
the date of	your	marriage?	
_________________(Number of Children)	

36	
.  H	
ow many living children did Wife have with someone other	

than Husband that were born	after	
the date of their marriage? (This	
number includes children born since the parties separated)	
_________________(Number of Children)	

37	
.  Enter the total number of childr	
en from lines 33, 34, 35, and 36	
.	

(Numb	er of Children)	

NOTE:  If line 37	is zero, then you may skip Questions 38 th	rough 49	and	go directly to	Question	

50	.	

INSTRUCTIONS FOR QUESTIONS 38 THROUGH 41	PERTAINING TO CHILDREN	
Questions 38 through 41	each have 1	0subparts lettered  a  through  j .  These subparts are arranged vertically in two columns on	
each page.  Each of these two columns represents the information for one child.  Question 38	pertains to the first child, Qu	estion 39	
pertains to the second child, and so on.

If you answered Question 37	with  0 	,you sho	uld skip Questions 38	thro	ugh 49	and go directly to	Que	stion 50	.	

If you answered Question 37	with  1 	,you should answer Question 38	for the one child you list	ed in your answer to	
Question 37	and if the child is not emancipated, you	should also answer questions 4	2 through 49	inclusive.	

If you answered Questio	n 37	with  2 	,you should answer Questions 38 and 39	for the two children you listed in your	
answer to Question 37.  If either of the children is not emancipated, you	should also answer questions 42 through 49	inclusive.	

If you	answered Question 37	with  3	 ,you sh	ould answer Questions 38 through 40	for the three children you list	ed in	
your answer to Question 37.  If any of the children are not emancipated, you should also answer questions	42 through 49	inclusive.	

If you answered Question 37	with  4 	,you s	hould answer Questions 38 through 41	for the four children you list	ed in your	
answer to Question 37.  If any of the children are not emancipated, you should also answer questions	42	throug	h 49	inclusive.	

If you answered Questio	n 37	with a number greater th	an  4 	,you should answer Questions 38 through 41	for the	
four children you list	ed in your answer to Question 37	.  Additionally, you should attach additional pages answering all the quest	ions	
asked in Question 38	for each child you have in addition to the children you have described in Questions 38 through 41	.  If any of	
the children are not emancipated, you should also answer questions 42 through 49	inclusive.	

You must list the children even if they are adults or if they are in someone else s custody.  Yo	u	

must also list each child that was born after the date of the marriage even if Husband is not the

father of the child.

Form CAFC001-08/29/2009	
_________________

Petition	for Dissolution of Marriage	 Page	7of 12	

QUESTION 38	
(To be answered if the answer to question 37	is one or more)	
CHILD ONE	

38	a.	W hat is the full name of this child?	a.	

38	b.What are the last four numbers of this child s Social Security Number?	
b.  XXX-XX-	

38	c.  W hat is the c	urre	nt a	ddress	of this child?	c.	

38	d.	W hat	is this child	 s age	?	
d.	

38	e.  Check all of the following boxes that apply:	(To be answered for each child	)	

This child is married	or is on active duty in the military.	

This child is self	-supporting, and the custodial parent has relinquished parental control over this child by express	
or implied consent.	

This child is over the age of 21, is not insolvent,	and is not physically or mentally incapacitated from supporting	
himself or herself.
This child is over the age of 18	,has not yet reached the age of 21	,is not insolvent,	is not physically	or mentally	
incapacitated from supporting himself or herself and one	or more	of the following is true:	

This child is not currently enrolled in or attending high school or college.

This child	graduated from high school,	but has not been continuously enrolled in college since October 1	
immediately following his or her graduation from high school.	

This child graduated from high school and has	been continuously enrolled in college	since October 1	
immediat	ely following his or her graduation from high school, but has not completed at least 12 hours each	
semester or completed at least 9 hours and worked 15 hours per week during the same period.
(This provision does not apply to a child who has been diagnosed with a learning disability, or whose
physical disability or diagnosed health problem limits the child s ability to carry sufficient credit hours.)	
If the circumstances of the child manifestly dictate, the court may waive the October first deadline for e	nrollment	.   College  means any junior college,	community college, college or university at which the child attends classes regularly.  As used in this form,  college  also	includes an	ypostsecondary	training or schooling for which the student is assessed a fee	and attends classes regularly.	

If you did not check any of the boxes in Question  	38	e , y	ou must answer the rest of the	
informati	on for this child on this page	(parts  38f  through  38	j ) and y	ou must als	o a	nswer	
questions 42 through 49	for	this child.	This child	IS NOT	
emancipated	and the court must make	
orders with respect to custody and support of this child	.	
If you check	ed	any of the boxes in Question  	38e 	, y	ou do not need to answer the rest of the	
information	for this child and questions 42 through 49	do not apply to this child.	This child	IS	

emancipated.

38	f.With whom has this child primarily resided during the previous sixty days?	f.	

38	g.  W ho should have legal custody of this child?	NOTE: Legal custody refers to	who will	make the decisions concerning health, education and welfare for this child.  RSMo	�452.375.1(2)	
g.	
Wife

Husband

Joint Husband/Wife

Third Person	

38	h.  W ho should have physical custody of this child?	NOTE:  Physical custody	refers to where this child will reside and what time this child spends with each parent.  RSMo�452.375.1(3)	
h.	
Wife

Husband

Joint Husband/Wife

Third Person	

38	i.  W ho is the father of this child?	If Husband is not the father of this child, you must	state the name of each person who could be the father.  This person(s) and this child must be joined asparties in this proceeding if Husband is not the father of this child.	
i.	
Husband

Other	(State Name(s))	
____________________	

38	j.  If this child was born prior to the marriage, is Husband listed as the	
father on the birth certificate?	Attach a copy of the birth certificate to this petition.	

j.	
Yes

No

Not Applicable	

Form CAFC001-08/29/2009

Petition	for Dissolution of Marriage	 Page	8of 12	

QUESTION 39	
(To be answered if the answer to question 37	is two or more)	
CHILD TWO	

39a.  W hat is the full name of this child?	a.	

39b.	What are the last four numbers of this child s Social Security Number?	
b.  XXX-XX-	

39c.  W hat is the current address of this child?	c.	

39d.  W hat is this child s age?	
d.	

39	e.  Check all of the following boxes that apply	:	(To be answered for each child	)	

This child is married or is on active duty in the military.

This child is self	-supporting, and the custodial parent has relinquished parental control over this child by express	
or imp	lied consent.

This child is over the age of 21, is not insolvent, and is not physically or mentally incapacitated from supporting	
himself or herself.
This child is over the age of 18, has not yet reached the age of 21	, is not insolvent,	is not physically or mentally	
incapacitated from supporting himself or herself and one or more of the following is true:	

This child is not currently enrolled in or attending high school or college.

This child graduated from high school, but has not been continuously enrolled in college since October 1	
immediately following his or her graduation from high school.	

This child graduated from high school and has been continuously enrolled in college since	October 1	
immediately following his or her graduation from high school, but has not completed at least 12 hours each
semester or completed at least 9 hours and worked 15 hours per week during the same period.
(This provision does not apply to a child who has been diagnosed with a learning disability, or whose
physical disability or diagnosed health problem limits the child s ability to carry sufficient credit hours.)	
If the circumstances of the child manifestly dictate, the court may waive the October f	irst dead	line for enrollment	.   College  means any junior college,	community college, college or university at which the child attends classes regularly.  As used in this form,  college  also	includes an	ypostsecondary	training or schooling for which the student is assessed a fee	and attends classes regularly.	

If you did not check any of the boxes in Question  	39	e , y	ou must answer the rest of the	
informati	on for this child on this page (parts  39f  through  39	j ) and y	ou must als	o answer	
question	s 42 through 49	for this child.	This child	IS NOT	
emancipated and the court must make	
orders with respect to custody and support of this child.
If you checked any of the boxes in Question  	39e 	, y	ou do not need to answer the rest of the	
information	for t	his c	hild and questions 42 through 49	do not apply to this child.	This child	IS	

emancipated.

39	f.	With whom has this child primarily resided during the previous sixty days?	f.	

39	g.  W ho should have legal custody of this child?	NOTE: Legal custody	refers to	who will make the decisions concerning health, education and welfare for this child.  RSMo	�452.375.1(2)	
g.	
Wife

Husband

Joint Husband/Wife

Third Person	

39	h.  W ho	should have physical custody of this child?	NOTE:  Physical custody	refers to where this child will reside and what time this child spends with each parent.  RSMo�452.375.1(3)	
h.	
Wife

Husband

Joint Husband/Wife

Third Person	

39	i.  W ho is the father of this child?	If Husband is not the father of this child, you must	state the name of each person who could be the father.  This person(s) and this child must be joined aspartie	s in this proceeding if Husband is not the father of this child.	
i.	
Husband

Other	(State Name(s))	
____________________	

39	j.  If this child was born prior to the marriage, is Husband listed as the	
father on the birth certificate?	Attach a copy of the birth certificate to this petition.	

j.	
Yes

No

Not Applicable	

Form CAFC001-08/29/2009

Petition	for Dissolution of Marriage	 Page	9of 12	

QUESTION 40	
(To be answered if the answer to question 37	is three or more)	
CHILD THREE	

40a.	W hat is the full name of this child?	a.	

40b.	What are the last four numbers of this child s Social Security Number?	
b.  XXX-XX-	

40c.  W hat is the current address of this child?	c.	

40d.  W hat is this child s age?	
d.	

40	e.  Check all of the following boxes that apply:	(To be answered for each child	)	

This child is married or is on active duty in the military.

This child is self	-supporting, and the custodial parent has relinquished parental control over this child by express	
or implied consent.	

This child is over the age of 21, is not insolvent, and is not physically or mentally incapacitated from supporting	
himself or herself.
This child is over the age of 18, has not yet reached the age o	f 21	, is not insolvent, is not physically or mentally	
incapacitated from supporting himself or herself and one or more of the following is true:	

This child is not currently enrolled in or attending high school or college.

This child graduated from high school, but has not been continuously enrolled in college since October 1	
immediately following his or her graduation from high school.	

This child graduated from high school and has been continuously en	rolled in college since October 1	
immediately following his or her graduation from high school, but has not completed at least 12 hours each
semester or completed at least 9 hours and worked 15 hours per week during the same period.
(This provision does	not apply to a child who has been diagnosed with a learning disability, or whose	
physical disability or diagnosed health problem limits the child s ability to carry sufficient credit hours.)	
If the circumstances of the child manifestly dictate, the court	may waive the October first dead	line for enrollment	.   College  means any junior college,	community college, college or university at which the child attends classes regularly.  As used in this form,  college  also	includes an	ypostsecondary	training or sc	hooling for whic	h the student is assessed a fee	and attends classes regularly.	

If you did not check any of the boxes in Question  	40	e , y	ou must answer the rest of the	
informati	on for this child on this page (parts  40f  through  40	j ) and you mu	st als	o answer	
questions 42 through 49	for this child.	This child	IS NOT	
emancipated and the court must make	
orders with respect to custody and support of this child.
If you checked any of the boxes in Question  	40e 	, y	ou do not need to answer the rest of the	
information	for this child and questions 42 through 49	do not apply to this child.	This child	IS	

emancipated.

40	f.	With whom has this child primarily resided during the previous sixty days?	f.	

40	g.  W ho should have legal custody of this child?	NOTE: Legal custody refers to	who will make the decisions concerning health, education and welfare for this child.  RSMo	�452.375.1(2)	
g.	
Wife

Husband

Joint Husband/Wife

Th	ird Person	

40	h.  W ho should have physical custody of this child?	NOTE:  Physical custody	refers to where this child will reside and what time this child spends with each parent.  RSMo�452.375.1(3)	
h.	
Wife

Husband

Joint Husband/Wife

Third Person	

40	i.  W ho is the father of this child?	If Husband is not the father of this child, you must	state the name of each person who could be the father.  This person(s) and this child m	ust be joined as	parties in this proceeding if Husband is not the father of this child.	
i.	
Husband

Other	(State Name(s))	
____________________	

40	j.  If this child was born prior to the marriage, is Husband listed as the	
father on the birth certificate?	Attach a copy of the birth certificate to this petition.	

j.	
Yes

No

Not Applicable	

Form CAFC001-08/29/2009

Petition	for Dissolution of Marriage	 Page	10	of 12	

QUESTION 41	
(To be answered if the answer to question 37	is four or more	)	
CHILD FOUR	

41a.  W hat is the full name of this child?	a.	

41b.	What are the last four numbers of this child s Social Security Number?	
b.  XXX-XX-	

41c.  W hat is the current address of this child?	c.	

41d.  W hat is this child s age?	
d.	

41e.	Check all of the following boxes that apply:	(To be answered for each child	)	

This child is married or is on active duty in the military.

This child is self	-supporting, and the custodial parent has relinquished parental control over this child by express	
or implied consent.	

This child is over the age of 21, is not insolvent, and is not physically or mentally incapacitated from supporting	
himself or herself.
This child is over the age of 18, has n	ot	yet reached the age of 21	, is not insolvent, is not physically or mentally	
incapacitated from supporting himself or herself and one or more of the following is true:	

This child is not currently enrolled in or attending high school or col	lege.	

This child graduated from high school, but has not been continuously enrolled in college since October 1	
immediately following his or her graduation from high school.	

This child graduated from high school and has	been continuously enrolled in college since October 1	
immediately following his or her graduation from high school, but has not completed at least 12 hours each
semester or completed at least 9 hours and worked 15 hours per week during the same period.
(This provision does not apply to a child who has been diagnosed with a learning disability, or whose
physical disability or diagnosed health problem limits the child s ability to carry sufficient credit hours.)	
If the circumstances of the child manifestly dictate, the court may waive the October first deadline for enrollment	.   College  means any junior college,	community college, college or university at which the child attends classes regularly.  As used in this form,  college  also	includes an	ypostsecondary	training or schooling for which the student is assessed a fee	and attends classes regularly.	

If you did not check any of the boxes in Question  	41	e , y	ou must answer the rest of the	
informati	on for this child on this page (parts  	41	f  through  	41	j ) and y	ou must als	o answer	
questions 42 through 49	for this child.	This child	IS NOT	
emancipated and the court must make	
orders with respect to custody and support of this child.
If you checked any of the boxes in Question  	41e 	, y	ou do not need	to answer the rest of the	
information	for this child and questions 42 through 49	do not apply to this child.	This child	IS	

emancipated.

41	f.	With whom has this child primarily resided during the previous sixty days?	f.	

41	g.  W ho should have legal	custody of this child?	NOTE: Legal custody refers to	who will make the decisions concerning health, education and welfare for this child.  RSMo	�452.375.1(2)	
g.	
Wife

Husband

Joint Husband/Wife

Third Person	

41	h.  W ho should have physical custody of this child?	NOTE:  Physical custody	refers to where this child will reside and what time this child spends with each parent.  RSMo�452.375.1(3)	
h.	
Wife

Husband

Joint Husband/Wife

Third Person	

41	i.  W ho is the father of this child?	If Husband is not the father of this child, you must	state the name of each person who could be the father.  This perso	n(s) and this child must be joined as	parties in this proceeding if Husband is not the father of this child.	
i.	
Husband

Other	(State Name(s))	
____________________	

41	j.  If this child was born prior to the marriage, is Husband listed as the	
father on the birth certificate?	Attach a copy of the birth certificate to this petition.	

j.	
Yes

No

Not Applicable	

Form CAFC001-08/29/2009

Petition	for Dissolution of Marriage	 Page	11	of 12	
Additio	nal Information about Unemancipated Childre	n	
Questions 42 through 49	below pertain to all unemancipated children listed	in your answers to questions 38 through	
41	.  If there are no unemancipated children, you may skip questions 42 through 49	and go directly to	question 50	on	page 12 of this Petiti	on	.The information on this page is required under the Uniform Child	C	
E	et. seq.	and under RSMo.	�454.501.	

42	
.
State all addresses at which the unemancipated children have	

resided during the past	five	years	and the name of the person	or	
persons	with whom said children resided.	
____________________________________________________________________
____________________________________________________________________	

43	
.
Do you	
know of any	
one o	
ther than you or your spouse	
that	

has physical custody of any of the unemancipated children or
claims to have custody or visitation rights with respect to any of
the unemancipated children?	

Yes

No	

44	
.
Do you hav	
e any information of any	
other	
custody proceeding	

concerning any of the unemancipated children pending in a court
of this or any other state?	

Yes

No	

45	
.
Have you participated in any other litigation concerning	
the	

custody of any of the unemancipated children in this or any other
state?	

Yes

No	

46	
.
Have any of the unemancipated children been a victim of	

abuse or neglect?	

Yes

No	

47	
.
If yo	
u answered  Yes  to questions 43, 44	
,
45	
,
or 46	
please	

explain	.	
____________________________________________________________________
____________________________________________________________________	

48	
.
Have any	
orders perta	
ining to any of the unemancipated	

children been entered by the Family Support Division	?	

Yes	, I have att	ached a copy of the order to this petition	.	

No	

49	
.
Are you or your spouse currently receiving benefits purs	
uant	

to TANF	?

Yes

No

Unknown	

Form CAFC001-08/29/2009

Petition	for Dissolution of Marriage	 Page	12	of 12	

50	
.  Are there any other al	
legations	
?	

____________________________________________________________________
____________________________________________________________________

____________________________________________________________________	

REQUEST FOR RELIEF
If you are the W ife, do you want to change your name back to the name you had prior to your marriage or
back to your original maiden name?	

Yes,	I would like to change my name back to my previous married name of _________________.	

Yes, I would like to change my name back to my maiden name of ____________________.

No, I will keep the name I have.	
I WOULD LIKE THE	COURT TO GRANT THE FOLLOWING:	
A dissolution of my marriage;
Custody of the child(ren) born of the marriage as stated herein (if applicable);
Appropriate orders with respect to the support of the minor child(ren) (if applicable);
A division of the marital	property and debts (REQUIRED);	
And such further and other orders as the court would deem appropriate.	

Maintenance to be paid to me by my spouse; (Optional)

Maintenance to be paid to my spouse by me; (Optional)	
Petitioner,	of lawful age, being	duly sworn	on his or her oath, states that	he or she is the petitioner named	
above and that	the	facts stated in the Petition for Dissolution of Marriage are	true according to his or her	
best	knowledge and belief.

__________________________________	__________________________________	
Petitioner	 SIGN HERE	Petitioner	 PRINT YOUR NAME HERE	
Subscribed and sworn to this _____ day of __________________, 20____.
________________________
Notary Public
My Commission Expires:
_____________________

ATTORNEY	INFORMATION	(May	be completed by your	attorney	)	
________________________________________	___________________	Attorney	  SIGN HERE	Missouri Bar Number	
_________________________________________________________Attorney	for	Petitioner	  PRINT YOUR NAME HERE	
_________________________________________________________(Street)
_________________________	__________________	___________	(City)	(State)	(Zip)	
_________________	_________________	______________________	(Telephone Number)	(Fax Number	)	(Email Address)	

Do not enter any	
information here if you are
filing this case witho	ut the	
assistance of a lawyer	.	
This	information may	be	
completed by	your attorney	.	

I have assisted Petitioner in	
the preparation of these
pleadings, but I am not
entering my appearance on
behalf of Petitioner.	

Form CAFC001-08/29/2009