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Petition for Dissolution

The Petition for the Dissolution of Marriage is a form that has to be completed and submitted to the State of Iowa in order to initiate a divorce process.

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Page  1   of  4     
   #171 - 470  (Rev 12 /1 5 )  IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT  
LAKE COUNTY, ILLINOIS  
IN RE 
THE    MARRIAGE   PARENTAGE 
) 
 ALLOCATION OF PARENTAL )   
SUPPORT  
 CIVIL UNION  RESPONSIBILIT IES   )  
)  
  ________________________________ _______________     )  Case No. ________________________  
)  
vs.   )  
)  
)  
  ________________________________ ______________   )  
)  
PETITION FOR DISSOLUTION  
Part A. Jurisdiction  
(One  party  must  be  a  resident  of  the  State  of  Illinois  for  at  least  90  days  prior  either  to  the  filing  of  this  Petition  or  to   the 
en try of Judgment  of   Dissolution ).  
Petitioner:  
1. I am    __________ years of age.  
2. I presently reside at    ________________________________ ________________________________ _________
City/County and State  
3. My occupation is that of:   ________________________________ ________________________________ ______
Respondent :  
4. The Respondent is    _________     years of age.
5. The Respondent presently resides at    ________________________________ ____________________________
City/County and State  
6. The Respondent’s occupation is that of:    ________________________________ _________________________
Marriage /Civil Union :  
7. The Respondent and I were married /entered into a civil union   on    ________________________________ ______
(mm / dd / yyyy)  
8. The  marriage/civil union   took place in   ________________________________ ___     and is registered in  that state ,
C ity/County ,  State , Country  
c ounty   and country .  
Residency:  (Check all that apply):  
9.   
I have lived in Illinois  since   _______________________________________ .   mm/ dd/ yyyy  
10.   
The  Respondent  has lived  in Illinois  since  ___________________________ .   mm/ dd/ yyyy  
Other Proceedings  (Check one):  
11.   
No petition  for dissolution between the parties  is pending  in any other county or state. 12.   
There is  another petition for dissolution  between the parties  pending  in:   ________________________________ ___   .  
City/County and State

Page  2   of  4     
   #171 - 470  (Rev 12 /1 5 )  Part B. Children/ Related Cases (Check all that apply)  
13.  We have no 
children together.  or(If  any  of  the  following  in  Part  B  apply,  a   completed   Declaration  Under  Uniform  Child  Custody  Jurisdiction 
And  Enforcement  Act  (UCCJEA)  Pursuant  to  750  ILCS  36/209  (#171 - 145)  form  must  be  attached  to  this 
petition. )  
14.   I 
  am /    am not currently pregnant. 15.  The 
Respondent   is /  is not currently pregnant. 16.  The following 
child(ren) were born to or adopted  by the Petitioner and Respondent: (Attach  additional pages as needed)  
It is in the best interest of the child(ren) that  (check one) :  
17.  Temporary and permanent sole allocation of 
parental responsibility  of  ________________________________ Name 
of Child(ren) 
be  awarded to  the   Petitioner   Respondent. 18.  Temporary and permanent joint allocation of 
parental responsibility  of  ________________________________ Name of Child(ren)  
be awarded to the parties.  
It is in the best interest of the child(ren) that the Court provide for  parenting time   as follows  (check one):  
19.  Deny 
 Restrict     Reserve  parenting time because:  _____________________________________________  ________________________________ ________________________________ _______________________    
20.  Grant parenting 
time as follows:  ______________________________________________________________ 21. I  know  of  the  following  related  cases  pending  or  closed  concerning  the  parties  or  child(ren)  (such  as  domestic
violence ,  paternity,  divorce,  allocation  of  parental  responsibility ,  parenting  time ,  juvenile  court  cases,  or
guardianship,  support, etc.):
County/State   Case Number   Kind of Case   Year Filed   Pending or Closed  
(Attach additional pages as needed)  Name   Date of Birth  
(mm/dd/yyyy)   Currently Living With  ( If no child(ren), skip to  paragraph   21 .

Page  3   of  4     
   #171 - 470  (Rev 12 /1 5 )  Part C. Support (Check all that apply)  
22.   
The  Respondent   is /  is not employed. 23.   
The  Respondent   is /  is not able to contribute to the  support of  our child(ren)   and myself. 24. I 
 am  /  am not  (check one) seeking child support for my children because:  ___________________________  
________________________________________________________________________\
__________________   
________________________________________________________________________\
__________________ 25. I 
 am  /  am not  (check one) seeking maintenance (support for a spouse/partner) because:  ______________  
________________________________________________________________________\
__________________   
________________________________________________________________________\
__________________ Part D. Property    
(Include all property you and your spouse/partner own.)  
(Attach additional pages as  needed)  
26. The 
Respondent  and/or I have  the following marital/civil  union property and debts.  (Check all  that apply)
  Real  Estate/House(s): Street Address 
  Pension(s)/Retirement Accounts  Name 
of Company 
   Bank  account(s)  and investment(s):    Name 
of Financial  Institution 
  Motor Vehicle(s):   Year, Make 
and Model 
  Debts  (attach list) 
  Other:   27.  I claim 
the following  property as my  non-marital/civil  union property  because the  property was acquired
 prior to  our marriage/civil union  /  by gift  /  by inheritance /   other	
:  ___________________________  ________________________________ ________________________________ ________________________    
  ________________________________ ________________________________ ________________________    
  ________________________________ ________________________________ ________________________    
28.  
I acknowledge the following property as the Respondent’s non-marital/civil union property because the  property 
was  acquired  prior  to  our  marriage/civil  union  /   by  gift  /  by  inheritance  /  other:   ________   
________________________________________________________________________\
__________________   
________________________________________________________________________\
__________________   
________________________________________________________________________\
__________________ Part  E .  Grounds for Dissolution  
29. From on or  about ______________________, my spouse/partner and I have lived separate and apart from each
(mm/dd/yyyy)  
other  for  a  continuous  period   and  irreconcilable  differences   have  caused  the  irretrievable  breakdown  of  the
marriage/civil  union.    Efforts  at  reconc iliation  have  failed  or  future  attempts  at  reconciliation  would  be
impracticable and not in the best interests of the family.
Part F. Parties’ Agreements  
30.    
The  parties  have  reached  agreement(s)  on  the  following  issues:    allocation  of  parental  responsibility,
parenting time,   child support,    maintenance, (support for a spouse/partner)    property,  debts.  State the 
specific  arrangements:  ________________________________________________________________   
________________________________________________________________________\
__________________   
________________________________________________________________________\
__________________   
________________________________________________________________________\
__________________ (Attach additional pages as needed)

Page  4   of  4     
   #171 - 470  (Rev 12 /1 5 )  Part G. Relief Requested  
FOR THESE REASONS , I request that  judgment be entered that provides as follows:   (Check all that apply)  
    
That the marriage/civil  union be dissolved. 
 That sole allocation of  parental responsibility  of the minor  child(ren) be awarded to   Petitioner  /      
 Respondent. 
 That joint legal allocation of  parental responsibility  of the minor  child(ren) be  awarded to the  parties.
 That parenting  time with the minor  child(ren) be   granted /  restricted /   barred /  reserved.
 That child support be awarded.
 That  a fair  division  of  the  property  or its  value  acquired  during  the  marriage/civil  union  be  divided  in  justproportions. 
  That maintenance to the Petitioner be   granted /  waived  /  reserved.
 That maintenance to the Respondent be   granted /  barred  /  reserved.
 That a  change back  to my  former name:   __________________________________________  be granted. Full Former Name  

  That any other appropriate relief  be awarded.
Under  penalties  as  provided  by  law  pursuant  to Section  1-109  of  the  Code  of  Civil  Procedure,*  the  undersigned  certifies 
that the  statements  set forth in  this instrument are true  and correct. _______________     ________________________________ _______  
  Date   Signature  
________________________________ __________  
Printed Name  
* Any  person  who  makes  a  false  statement,  material  to  the  issue  or  point  in  question,  which  he  does  not  believe  to  be  true,  in  any
document certified by such person in accordance with 735 ILCS 5/1 - 109 shall be guilty of a Class 3 felony punishable by two (2) to five 
(5) years imprisonment and/or a $ 25 ,000.00 fine.  
Prepared by:  
Name:    ________________________________ ____     Pro Se    
Address:    ________________________________ __________    
City: ______________________________ State:    __________    
Phone: ______________________Zip Code:    _____________    
ARDC #:    ________________________________ __________    
Fax:    ________________________________ ______________    
E - mail address:   ________________________________ _____
Next: Petition Cover Sheet for Civil Law, Domestic Relations, and Other Equity Cases Filed in Iowa District Court* Previous: PETITION FOR DIVORCE (with children)
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