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Petition for Dissolution of Marriage (with Children)

The Alaska Petition For Dissolution of Marriage form has to be submitted at the beginning of the divorce process in the State of Alaska. A meeting between spouses is required for filling this form.

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AS 25.24.200-.260 Signature 
of Party  A
Page  1 of  17 
DR-105  (8/15)(cs)
PETITIO N FOR  DISSOLUTION OF MARR IAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) IN THE SUPERIOR COURT FOR THE STATE OF ALASKA 
AT 
In the Matter of the Dissolution   )  
of the Marriage of   )  
)  
  and   )  
)  
,   )  
)  
Party A 
and Party B ) CASE NO. 
PETITION FOR  DISSOLUTION
OF MARRIAGE   (WITH CHILDREN)  
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I.   INFORMATION ABOUT PETITIONERS  Has either spouse filed an action for legal separation before filing this action?
    Yes   No 
If yes, please list the case number, date, and place of filing: 
A. PARTY A
1.
Date of birth:  Place of birth:  (city) 
(state)  2.
Length of Alaska residence: 3.
Home phone:  Cell phone: 4. Residence address:
(street address) 
(city)  (state)  (ZIP) 5. Mailing address:
(box or street number)  (city)  (state) 
(ZIP) 6. Occupation:
 Work phone: 7. Most recent employer:
 Phone: 8. Employer’s address:
9. Driver’s license number:
B. PARTY B
1.
Date of birth:  Place of birth:  (city) 
(state)  2.
Length of Alaska residence: 3.
Home phone:  Cell phone: 4. Residence address:
(street address) 
(city)  (state)  (ZIP) 5. Mailing address:
(box or street number)  (city)  (state) 
(ZIP) 6. Occupation:
 Work phone: 7. Most recent employer:
 Phone: 8. Employer’s address:
9. Driver’s license number:
Signature of Party B

AS 25.24.200-.260 Signature 
of Party  A
Page  2 of  17 
DR-105  (8/15)(cs)
PETITION  FOR DISSOLUTION OF MARRIAGE  (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) C.
  Date and Place of Marriage.   Date of marriage:   /  /  (month)  (day) (year)
Place of marriage: 
(city) 
(state) 
D.   Health Care and Health Insurance  Does either spouse 
need medical care or treatment?     Yes     
No   If yes, state which spouse and describe the care or treatment 
needed:  Is either spouse 
covered by health insurance  (by an  employer or  otherwise)?   Yes    No
If yes, state which  spouse and the amount  paid for the  insurance by  the spouse  or spouses:  E.
 Domestic Violence 
Has either spouse been involved in any of the following during the marriage: 
1. a criminal charge of a crime involving domestic violence,
2. a domestic violence protective order under AS 18.66.100-18.66.180 ,
3. injunctive relief against domestic violence under former AS 25.35.010 or 25.35.020,  or
4. a  domestic  violence  protective  order  issued  in  another  jurisdiction  and  filed  with  the
court in this state under AS 18.66.140? Yes     
No        If yes, describe below: Has  there  been  any domestic  violence  during the  marriage  (whether  or  not  the police  were 
involved or anything was filed in court
)?   Yes   
No   F. Has
 either spouse received  advice from an attorney  about dissolution or  divorce?  
Yes     
No    If yes, state which spouse(s):  Is either spouse represented by an attorney?   Yes   
No   If yes, state which spouse(s):  
Signature of Party B

AS 25.24.200-.260  For 
more information, see  Prior Child Deduction Chart  and Civil Rule 90.3.  Page 
3 of  17 
DR-105  (8/15)(cs)
PETITIO N FOR  DISSOLUTIO N OF MARR IAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) II.
FINANCIAL INFORMATION A.
 Gross Income  (Do not list ATAP or SSI below.) Party A Party B
  Gross wages  $  $ 
Value of employer-provided housing/food/etc. 
(also includes COLA, military BAH and BAS)  $  $ 
Unemployment compensation  $  $ 
Permanent fund dividend  $  $ 
Other:  $ 
$ 
$  $ 
$ 
$ 
TOTAL INCOME  $ 
  $ B.
 Deductions Allowable Under Civil Rule 90.3  Federal, state and local income tax  $  $ 
Social security tax or self-employment tax  $  $ 
Medicare tax  $  $ 
Employment security tax (SUI)  $  $ 
Mandatory retirement contributions  $  $ 
Mandatory union dues
  $  $ 
Voluntary retirement contributions if plan earnings 
are tax-free or tax-deferred, up to 7.5% of gross 
wages and self-employment income when 
combined with mandatory contributions  $  $ 
Other mandatory deductions (specify): 
$  $ 
Spousal  support  (alimony)  ordered  in  other  cases 
and currently paid  $  $ 
Child  support  ordered  for  prior  children  of  a 
different relationship and currently paid 1
  $  $ 
In-kind  support  for  prior  children  of  a  different 
relationship calculated under 90.3(a)(1)(D) 2
  $  $ 
Work-related child care for children in this case  $  $ 
TOTAL DEDUCTIONS  $ 
  $ C.
 Net Income  TOTAL INCOME from section A  $  $ 
TOTAL DEDUCTIONS from section B  $  $ 
Subtract deductions from income to get 
NET INCOME  $ 
  $ Signature of Party A
  Signature of Party B
1
    
Not to exceed support amount calculated under 90.3(a)(2). “Prior children” includes children from a different 
relationship who were born or adopted before the children in this case.  2 Each party must attach a copy of his or her most recent federal tax return
, W2, and at least two
copies  of  his  or  her  most  recent  paystubs.  If  income  or  deductions  will  change  after  the
dissolution, file documents showing expected income and deductions. The following income and deductions are   monthly   yearly. 
If work is seasonal, show yearly income.

AS 25.24.200-.260 Signature 
of Party A
Page  4 of  17 
DR-105  (8/15)(cs)
PETITIO N FOR  DISSOLUTION OF MARR IAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) D.
 Adjusted Annual Income Party A  Party B
  1. If  the  above  figures  are  based  on  monthly
information, multiply NET INCOME from section C
by 12 to get
2. If  the  above  figures  are  based  on  yearly
information,  repeat  the  NET  INCOME  amount
from section C to show
This figure will be used to calculate child support on page 9. 
E.
  Monthly Expenses Party A  Party B
Housing  and u tilities   $   $  
Food   $   $  
Transportation   $   $  
Medical   $   $  
Other     $   $  
$   $  
$   $  
$   $  
I
II. PROPERTY AND DEBT INFORMATION, AND AGREEMENT OF PETITIONERS
Below is a list of our assets and debts, and our agreement about dividing our assets and debts.
We believe the division below is fair and just. A.  Assets 
[Describe  all your  property  and  its  value.  Then  check  the  boxes  showing  whether  it 
was acquired during the  marriage, who possesses it now, and to  whom you want  it awarded.]  1.
Do  you  have  a  written  community  property  agreement  or  a  community  property  trust
und er Alaska law (AS 34.77)?    Yes  
No     Be sure to include community property
in the lists below. Signature 
of Party B ADJUSTED ANNUAL INCOME   $     $  
ADJUSTED ANNUAL INCOME   $     $  
TOTAL   EXPENSES   $   $  
F.
  Bankruptcy.     Party A    Party B filed for bankruptcy and that case is pending. 
Acquired During 
Marriage  Currently 
Possessed  By  To Be 
Awarded  To 
2. Real Property (land  and buildings)
provide street address or legal
description Value  yes 
no  A  B  JT  A  B  JT *  $ 
$ 
$ 
$ 
$

Page 5 of 
17 
DR -105 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) 
*
For jointly awarded real property at address : a. We will sell the property and split any profit with % to Party A and 
% to Party B.  Until the property is sold,    Party A   Party B will 
make all payments and decisions about the property, and   will   will not be 
reimbursed from sale proceeds before any profit  is paid.  
b. One of us will buy the other out
.  Party A   Party B will buy the other 
party’s interest in the property in an amount equal to 
 % of the fair market value.  We also agree that   the amount of this payment will be $ 
or   we will have a licensed appraiser or real estate broker determine the 
property’s fair market value.  We will select the appraiser or broker together.  
c. Other:
Use separate sheets for other real property to be awarded jointly. 
[Note: An award of real property to the parties jointly does not convey a right of survivorship.  
Consult an attorney with concerns about your right of survivorship. AS 13.12.804(a)(2).]  3. Motor   Vehicles (include make,   model,
a nd   license   or registration  number,
and/ or  vehicle identification  number
for   each vehicle, mobile home, ATV,
boat ,   snow machine , etc . ) Acquired  
During  
Marriage   Currently 
Possessed  
By   To Be  
Awarded  
To  
Value   yes   no   A   B   JT   A   B   JT  
$  
$  
$  
$  
$  
$  
$  
$  
$  
$  
$  
$  
$  
$  
$  
Signature of Party A 
Signature of Party B

Page 6 of 
17 
DR -105 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) 4. Other  Property ( furni ture , appliances,
jewelry, computers, guns, tools , bank
accounts, etc. For ban k   or other financial
institution accounts, you may list the last 3 	
digits
  of the account number  and   the n ame
of the issuing institution.) Acquired  
During  
Marriage   Currently  
Possessed 
By   To Be  
Awarded  
To  
Value   yes   no   A     B   JT   A   B   JT  
$  
$  
$  
$  
$  
$  
$  
$  
$  
$  
$  
$  
$  
$  
$  
5.
Retirement Benefits. We understand that this agreement is only between us and that
pension plan provider(s) may require other documents to accept our agreement.  We
also understand that the court will not draft a waiver document or an order including a
qualified domestic relations order (QDRO) that divides the retirement asset(s).   Neither of us earned retirement or military pension benefits during the marriage. 
  One or both of us earned retirement or pension benefits during the marriage: 
  Party A earned retirement or military pension benefits during the marriage: 
Last 3 num bers of account   Value of account   Being paid now?   (Y/N)  
  Party B earned retirement or military pension benefits during the marriage: 
Last 3 numbers of account   Value of account   Being paid now?   (Y/N)  
 We agree that we will each keep our own retirement and pension benefits.  
This is fair and equitable because:  Signature of Party A 
Signature of Party B

Page 7 of 
17 
DR -105 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1)   Our agreement about the distribution of retirement or military pension benefits is 
attached. If the agreement is not accepted by the retirement plan administrator as a 
qualified domestic relations order (QDRO), we agree that the court, upon motion by 
a party, may make any necessary changes. If changes are necessary, we agree that 
the effective date of the order will remain the date of our original dissolution decree. 
A copy of the present value statement from the plan administrator for each 
retirement account is attached.   [Note: This is required.   An account statement  is  not the same as a present value statement.  You should consult an attorney if you 
have concerns about the valuation of pension benefits.] 
6.   Transfer Deadline.  
All payments from one party to the other party will be made  by   .   All documents necessary to carry out this agreement (including but not limited to signing 
quit claim deeds, refinancing, transferring title) will be done by  
.   Any property stored 
by one party for the other will be transferred by   .  
B.  Debts 
[List every debt owed whether or not it is a joint debt.  List to whom each debt is owed and 
the amount owed. Then check the boxes showing whether the debt was incurred during the 
marriage, who now owes the debt, and who you agree will pay it. Include ALL debts that  are currently owed (mortgages, car loans, credit cards, etc.)  For credit card, bank card, or 
debit card accounts, you may list the last 4 digits of the account number and the name of 
the issuing institution. Note: Even though you agree 
who is responsible to pay a debt that i s 
in both of your names, the bank or other creditor may still hold the other spouse 
responsible for the debt if payments are not made.] 
      Incurred  
During  
Marriage      
Currently  
Owed By      
To Be  
Paid By  
Owed To   Amount   yes   no     A   B   JT     A   B   JT  
    $                        
    $                        
    $                        
    $                        
    $                        
    $                        
    $                        
    $                        
    $                        
    $                        
    $                        
    $                        
 
IV.  SPOUSAL MAINTENANCE (ALIMONY) AGREEMENT 
$   per month to be paid by   Party A
    Party B, beginning  
 until  
 or until the recipient dies or remarries.   If child support payments will be  made through 
CSSD, you may also have spousal maintenance payments made through CSSD. 
Do you want spousal maintenance payments to be made through CSSD?   Yes    
No  
        
Signature of Party A  Signature of Party B

Page 8 of 
17 
DR -105 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) 
V.  CHILD CUSTODY JURISDICTION INFORMATION 
A.  The following are children under age 19 born of the marriage or adopted by the petitioners: 
  (1)  Child’s Name   Place of Birth   Birthdate  
 
Sex  
  Marital Status   School Grade  
Present Address (since    L   L   F   Who Has Custody   Relationship  
 
Prior Residences for  
past 5 years (dates)   City & State   Person child lived with  
(Name & Current Addre ssF   Relationship  
 
to  
       
to  
       
to  
       
 
 
(2)  Child’s Name   Place of Birth   Birthdate  
 
Sex  
  Marital Status   School Grade  
Present Address (since    L   L   F   Who Has Custody   Relationship  
 
Prior Residences for  
past 5 years (dates)   City & State   Person child liv ed with  
(Name & Current Address)   Relationship  
 
to  
       
to  
       
to  
       
 
 
(3)  Child’s Name   Place of Birth   Birthdate  
 
Sex  
  Marital Status   School Grade  
Present Address (since    L   L   F   Who Has Custody   Relationship  
 
Prior Residences for  
past 5 years (dates)   City & State   Person child lived with  
(Name & Current Address)   Relationship  
 
to  
       
to  
       
to  
       
 
 
 
      
Signature of Party A  Signature of Party B

Page 9 of 
17 
DR -105 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) (4)  Child’s Name   Place of Birth   Birthdate  
Sex   Marital Status   School Grade  
Present Address (since  /   /   )   Who Has Custody   Relationship  
Prior Residences for  
past 5 years (dates)   City & State   Person child lived with  
(Name & Current Address)   Relationship  
to  
to  
to  
B.
  Has either Party A or Party B participated as a party, a witness, or in another capacity in 
another proceeding concerning the custody of any of the above children or visitation with 
them?   Yes
     
No   If yes, describe the previous child custody determination: 
Name of Court    Case Number  Date  C
ourt’s Decision    C.
 Does either Party A or Party B know of a proceeding that could affect this dissolution case 
(such as a proceeding relating to domestic violence, protective orders, termination of 
parental rights, adoption or enforcement of a court order)?    Yes 
    
No  
If  yes, describe:  Name of Court  Case Number Nature of Proceeding 
D.
  Does either Party A or Party B know of any person not a party to this dissolution case who 
has physical custody of any of the above children or claims to have the right to physical 
custody, legal custody, or visitation?      Yes     
No  
If  yes , list each person’s name and address , and what the person claims: E.
  Is Party A or Party B pregnant?     Yes
    No 
If yes, include arrangements for this child in the following sections. 
F.   Is paternity disputed regarding any child?    Yes     
No  
Has paternity been disestablished for any child born during the marriage?    Yes     
No  
If you answer yes to either of these questions, there may be additional requirements. 
   Signature of Party A 
Signature of Party B NOTE:  You  bot h  have  a  continuing  duty  to  inform  the  court  of  any  other  court 
proceeding  in  this  state  or  any  other  state  concerning  any  of  the  children  listed 
above.

Page 
10 of  17 
DR -105 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) 
VI. CHILD CUSTODY AGREEMENT Name of Child   Physical Custody  
Awarded To   Legal Custody  
Awarded To  
If you agreed to a shared physical custody 
arrangement, you must  specify the  custody 
schedule. You  may use the model parenting form (DR-4 75) or describe the schedule below:  VII. VISITATION AGREEMENT
A. Visitation Rights of Parents   We agree 
 will have the following specific visitation rights:   summer vacation: 
  holidays: 
  weekends: 
  other: 
[If you want child support reduced, you must specify dates as explained in section V, 
page 11, of the Instructions.] 
 Our agreement about parenting and visitation 
is set forth in the attached parenting 
agreement (DR-475  or other).  We understand  that the court  must approve  a 
parenting agreement  as being in our child(ren)’s best interest.   We  also understand 
that  this dissolution will not  be approved  until we have an  approved parenting plan.  B.
 Visitation with Other Persons 
Names of Other Persons:  Describe visitation agreement: 
Signature of Party A 
Signature of Party B

Page 
11 of  17 
DR -105 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) 
V
II I. CHILD SUPPORT ( Civil Rule 90.3) [Note: You cannot waive child support or agree to a different amount than what is calculated
under 
Civil Rule 90.3 , unless one of the exceptions in Civil Rule 90.3(c) applies .  For example, the 
obligor’s adjusted annu al income is more than $120,000; or the  obligor’s annual income is
so low that the amount of support would be less than $600; or you can prove to the court that
manifest injustice will result unless the support amount  is varied.]
A.   Child Support Calculati on Party A  Party B 1.
 a.   Adjusted Annual Income (from II.D. on page 4)  $  $ b.
If line 1.a. is more than $120,000, write
$120,000 here.  Otherwise, repeat amount 
on line 1.a.:  2.
Multiply line 1.b. by:
.20 for one child;
.27 for two children; x x  .33 for three children; and
.03 for each additional child
TOTAL
3.
Monthly Child Support Payment (before calculating health insurance adjustment).
Child support will be paid as stated below.  The first payment will be made no later than
.  Payments after that will be made no later than the   1 st
  day of each month thereafter.
  [See definitions of types of custody in Civil Rule 90.3(f).] a.
Primary  Custody.  One  parent  has  primary  physical  custody.    Divide  Annual  Child
Support amount from line 2 above for the non-custodial parent by 12 = $ to be paid each month by   Party A        Party B.
b.
Shared Custody. The child(ren) will reside with each parent for a period specified
in writing of at least 30% of the year.  [Attach form DR-306 to show
calculations.]  Monthly child support payment (from line 10 of DR-306) to be paid
each month except     =   $ to be paid by the    Party A        Party B.
c.
Divided Custody. Each parent will have primary physical custody of one or more
of the children and the parents will not share physical custody of any of the
children.  [Attach form DR-307 to show your calculations.]
Monthly child support payment (from line 7 of DR-307)  =  $ to be paid by the    Party A        Party B.
d.
Hybrid Custody.  One parent has primary physical custody of one or more of the
children and the parents will share physical custody of at least one child of the
relationship. [Attach form DR-308 to show your calculations.]
Monthly child support payment (from line 8 of DR-308)  =  $ to be paid by the    Party A        Party B.
Signature of Party A 
Signature of Party B ANNUAL CHILD SUPPORT   $    $ 
(amount from “TOTAL” line above or   $600, whichever is larger.)

Page 
12 of  17 
DR -105 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) 
4.
Health Care Coverage.
a. Health Insurance. I f the children are covered by an insurance company other than
the Indian Health Service or Tricare, you should also fill out court form  DR-330,	
Notice to Employer Re: Children’s Medical Insurance.	 
(1) Does Party A have health insurance available for the child(ren) at reasonable cost through  Party A’s employer, union, or otherwise?   Yes   
No  
(2) Does Party B have health insurance available for the child(ren) at reasonable  cost through  Party B’s em ployer, union, or otherwise?    Yes   
No  
(3) Are the children eligible for services th rough the Indian Health Service?    Yes   
No  
(4) Do the children have other health insurance or care available?   Yes
     
No  
Describe:  If the answer to (3) and (4) is no, one of the parents must agree to provide 
insurance for the child(ren) if such insurance is available at 
a reasonable cost.  
The cost of the children’s insurance must be divided equally by the parents unless 
the court orders a different division for good cause. 
AGREEMENT: Health insurance for the child(ren) will be purchased by:    Party A at a monthly cost to Party A of $ 
*   Party B at a monthly cost to Party B of $ 
* through the above person’s
    employer    union 
whose name and address are 
The cost of health insurance for the child(ren) will be divided between the parties 
 equally    
  Explain reason for unequal division:  [*List only the cost to insure the children involved in this case.  If there is no extra 
cost	

 to the parent to include the children in the parent’s insurance coverage,  you 
cannot deduct any cost for the children’s health insurance .  The parent must submit 
documentation from  the health insurance provider (employer, union, etc.) showing 
separately the cost of health insurance for the parent and  the p	
arent’s dependents.  See Civil Rule 90.3(d) for further explanation.  For more information, see 
Ca	
lculating Cost of Child(ren)’s Health Insurance
 chart on the court’s website.]  b.
Health Care Expenses Not Covered  by Insurance (including medical, dental, vision
and mental health counseling expenses).
We agree that the children’s reasonable health care expenses not covered by
insurance will be paid as follows (unless they are over $5,000 in a calendar year):   Party A will pay half and Party B will pay half. 
  Party A will pay  
 and Party B will pay   . Explain reason for not sharing these uncovered expenses equally: 
If the uncovered expenses are over $5,000 in a calendar year, the parties will pay 
based on their relative financial circumstances when the expense occurs. 
Signature of Party A 
Signature of Party B

Page 
13 of  17 
DR -1
05 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) 
We agree that each of us will reimburse the other for our share of uncovered health 
care expenses within 30 days after we are given the bill, proof of payment and, if 
applicable, a health insurance statement (EOB) showing what part of the cost is 
uncovered. We understand that the bills and other materials must be sent to the 
other parent for reimbursement within a reasonable time. 
5. Monthly Child Support Payment (after adding or deducting health insurance costs).
a. Monthly Child Support Payment from paragraph 3 above 
(on  page 1 1) $ 
b.
If obligor is buying health insurance for the child(ren), subtract 50% (or   %) of the monthly insurance payment.
–$	
(The “obligor” is the parent paying child support.)	
c. If obligee is buying health insurance for the child(ren), add 50% (or   %) of the monthly insurance payment.
+ $ 	
(The “obligee” is the parent receiving child support.)	
6.We calculated t he Net Mon	

thly Child Support Payment in paragraph 5.d. according to:
a. The formula in Civil Rule 90.3(a) or (b).
b. Civil Rule 90.3(c)(2). Obligor’s adjusted annual income is more than $120,000.
c. Civil  Rule  90.3(c)(3).  Obligor’s  amount  of  support  is  less  than  $600 
per  year.
Obligor’s income is low because obligor is:   incarcerated 
  unable to work because 
  other 
d. Civil Rule 90.3(c)(1).  Manifest injustice will result if support 
is no t varied
because: 7.
Seasonal Income.  
Obligor’s income is seasonal and obligee agrees that, as long as 
the total annual amount remains the same, obligor can make higher payments during
high income months and lower payments during low income months as follows:
Higher Monthly Amount $  should be paid in (list months) Lower Monthly Amount $ 
 should be paid in (list months) 8. Travel Expenses. Travel expenses necessary for visitation will be paid as follows:
Signature of Party A 
Signature of Party B d. Net M onthly Child Support Payment $

Page 
14 of  17 
DR -105 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) 
9. Native Corporation Dividends.
a. The custodian of any Native Corporation dividends paid on behalf of the child(ren)will be b.
Except as provided below, the funds will be saved in an account for the child(ren) .
Both parents will have access to all statements from the account annually.
c. Any taxes owing on any Native Corporation dividends paid on behalf of the child(ren) will be timely paid by (name) d. Any Native Corporation dividends paid on behalf of the children:
 
May be spent for the child(ren)’s health, education , and welfare.   May be spent only if both parents provide prior written approval. 
  Other:  
10.
Extended Visitation Credit.   This credit does not apply to us. 
  This credit applies to us because one of us will have primary physical custody and 
the other (the obligor parent) will have extended visits with the children for periods 
longer than 27 consecutive days.  If and when the obligor parent actually exercises 
the extended visitation, child support will be reduced for these periods as follows:  [Note:  This credit may not be more than 75% of the amount owed for the period
.] 
B.    We agree that child support will continue while each child is 18 years old as long as the 
child is (1) unmarried, (2) actively pursuing a high school diploma or equivalent level of 
technical or vocational training, and (3) living as a dependent with the obligee parent or 
guardian or a designee of the parent or guardian.   We object to continuing child 
support to the date of graduation because:   C.  Do you want the assistance of the Child Support Services Division (CSSD) to 
enforce the support order and keep records of the payments?        
Yes       No
 
If yes, fill out the attached application for CSSD services. [Note: If the parent with custody 
of the children is receiving assistance from the Alaska Temporary Assistance Program 
(ATAP), child support payments must be made to CSSD.] 
D.   Immediate Income Withholding 
Child support will be withheld from the income of the person paying support and paid through the Child Support Services Division (CSSD) unless one of the following exceptions is 
approved by the court:    We made the following alternative arrangement [Note that if you receive ATAP, CSS
D 
must agree to the arrangement]:  Also, the person paying support agrees to keep the other party (or CSSD if CSSD is 
enforcing the order) informed of his/her current employer and the availability of 
employment-related health insurance coverage for the child(ren) until the support order 
is satisfied. 
Signature of Party A 
Signature of Party B

Page 
15 of  17 
DR -105 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1)   We believe there is good cause not to require immediate income withholding because it 
is not in the best interests of the child(ren) for the following reason: 
    Also,  the  person  paying  support  agrees  to  keep  the  other  party  (or  CSSD  if  CSSD  is 
enforcing  the  order)  informed  of  his/her  current  employer  and  the  availability  of 
employment-related health insurance coverage for the child(ren) until the support order 
is satisfied. 
    The  person  paying  support  currently  receives  social  security  or  other  disability 
compensation that includes regular payments to the child(ren) at least equal to the child 
support owed each month. Monthly payment to child(ren): $  . Source of the payment:  
. [Note:  To  the  extent  that  these  payments  to  the  children  do  not  satisfy  the  monthly  amount  owed,  the  court  will  order 
that the remaining amount due be withheld from income.] 
 
E.   Federal Taxes  
1.   Federal Tax Exemptions and Child Tax Credits.   We agree as follows:    
 will claim the child(ren) every year.    Every year, Party A will claim the following child(ren) 
 and Party B will claim the following child(ren) 
   The parents will claim the  child(ren) in alternating years with   Party A   Party B 
claiming the child(ren) for  odd-numbered tax years such as 2015 and 2017, and the 
other parent claiming them for even-numbered tax years such as 2014 and 2016.    Other:  
 The parties also agree to provide each other with a signed IRS Form 8332, 
if needed,  by 
February 1 so that it may be timely filed with the IRS. 
Th is agreement regarding the child(ren)’s exemption(s)  may be modified without a court 
order  if  both  parties  agree  in  writing.   As  required  by  AS  25.24.232,  we  also  agree  that 
the  parent  who  has  physical  custody  of  the  child(ren)  for  a  period  less  than  the  other 
parent may not claim the exemption in any tax year if on December 31 of that year the 
parent  was  behind  in  child  support  payments  in  an  amount  more  than  four  times  the 
monthly child support obligation. 
2.   Other  Federal  Tax  Considerations.  We  understand  that  the  parent  who  has  physical 
custody of a child for the greater part of the year, whether or not that parent claims the 
exemption  for  the  child,  may  be  able  to  claim  other  tax  benefits  such  as  the  Earned 
Income  Credit,  Head  of  Household  filing  status,  and  Credit  for  Dependent  (Child)  Care 
Expenses. 
 
F.   Permanent Fund Dividend (PFD) 
1.  We agree that    will  timely  apply  for  the  Alaska  PFD  on behalf of the child(ren) while they are minors.
    The parent who claims the federal tax 
exemption for any child(ren) agrees to timely  pay the taxes on the children’s PFD. 
2.  Except as provided below, the child(ren)’s PFD funds will be saved in an  account for the 
child(ren).  Both parents will have access to all statements from the account annually. 
 
        
Signature of Party A  Signature of Party B

Page 
16 of  17 
DR -105 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) 
3. The child(ren)
’s PFD funds:  
May be spent for the child(ren)’s health, education,  and welfare.   May be spent only if both parents provide prior written approval. 
  Other:  
IX
. RESTORE OR CHANGE NAME   Restore Name.  Petitioner wants a prior name restored as follows 
(print full names clearly):  From:  
  To: (
Party A’s  current full name)  (Party A’s  prior full name) 
From:  To: (
Party B’s  current full name)  (Party B’ s prior full name)    Change to New Name.  [Before checking this box, it is important to read pages 
16-17 of the 
instructions.  Failure  to  publish  notice  of  your  hearing  on  the  court’s  website  may  delay  the 
decree of dissolution or result in denial of the requested name change.] 
Petitioner   wants to take and be legally (current legal name) 
known by a new name, which is   The reasons for this request for a change of name are: 
Petitioner seeks this name change for personal  reasons and not to avoid judgments, debts, 
obligations,  or  to  defraud  any  person.  The  reasons  stated  are  consistent  with  the  public 
interest. 
X.   OTHER AGREEMENTS (IF ANY)  Signature of Party A 
Signature of Party B

Page 
17 of  17 
DR -105 (8/15)(cs)  AS 25.24.200-.260 
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)  Civil Rule 90.1(a), f(2)(A)(B), (i)(1) 
XI.  SIGNATURES AND VERIFICATIONS 
After you have both completely filled out this petition, each of you must sign below in front of a 
notary.  Each  signature  on  this  page  must  be  separately  notarized.   You  will  need  to  show 
identification to the notary. 
  Verification   
I  say  on  oath  or  affirm  under  penalty  of  perjury  that  I  have  read  this  petition  and  believe  that  all 
statements  made  in  th is petition  are  true.   I also certify  that  I  am  signing  voluntarily  and  not  because 
of  fear,  threat,  coercion,  or  restraint.    I also  state  that  this  petition  contains  the  entire  agreement 
between my spouse and me. 
 
        
Signature of Party A  Signature of Party B 
 
        
Date  Date 
 
  Subscribed and sworn to or affirmed before me 
at    , Alaska,   
  .  
 
 
   
Clerk of Court, Notary Public or other person 
authorized to administer oaths.  
My commission expires:     
 
 
(SEAL)   Subscribed and sworn to or affirmed before me 
at    , Alaska,  on   
  .  
 
 
   
Clerk of Court, Notary Public or other person 
authorized to administer oaths.  
My commission expires:     
 
 
  (SEAL)
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