Court Rules


Rule 68 - Dissolution of Marriage

Rule 68 - Form 1499 - Affidavit of Petitioner/Respondent Requesting Dissolution of Marriage Pursuant to Rule 68.3.1
IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI
FAMILY COURT DIVISION
AT KANSAS CITY INDEPENDENCE

IN RE THE MARRIAGE OF: ) _______________________________, )
Petitioner ) and ) _____________________________ _, )
Respondent. )
AFFIDAVIT OF PETITIONER RESPONDENT REQUESTING
DISSOLUTION OF MARRIAGE PURSUANT TO RULE 68.3.1
Petitioner Respondent upon his her oath submits the following affidavit pursuant to Circuit Court Rule 68.3.1, to form a basis for the court’s entering judgment in this case upon affidavit and without the necessity of a formal hearing.

1. The petition in this case was filed on ______________________________. (insert date)

2. Respondent was served with summons in this case on ______________. (insert date)
filed a verified entry of appearance on_________________ .(insert date)
3. Petitioner Respondent is and has been a resident of the State of Missouri for more than ninety days immediately preceding the filing of the petition in this case.

4. Both parties are over eighteen years of age.

5. At the time of filing, Petitioner resided at ______________________________________ (street address, city, state, zip code), in ______________________County, Missouri.

6. At the time of filing, Respondent resided at ____________________________________ (street address, city, state, zip code), in _______________ County, ________________.

7. Petitioner’s social security number is _______________________________.

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8. Respondent’s social security number is _____________________________.

9. Petitioner is represented by ______________________________________(name) 10. Respondent is represented by______________________________________(name)
11. Petitioner is employed at ___________________________________ (full name of
employer) located at _____________________________________________________.
(street address, city, state, zip code) 12. Respondent is employed at ___________________________________ (full name of
employer) located at _____________________________________________________. (street address, city, state, zip code)
13. Petitioner’s Respondent’s Statement of Income and Expenses (Form 1402B) and
14. Petitioner and Respondent were married on _____________________________(date) at ___________________________________(city, state). The marriage was recorded in the County of _____________________, State of ___________________________.

15. Petitioner and Respondent separated on or about _____________________________.

16. Petitioner Respondent believes that there is no reasonable likelihood that the marriage of Petitioner and Respondent can be preserved and, therefore, believes that the marriage is irretrievably broken.

17. Petitioner is not on active duty with the Armed Forces of the United States of America or its allies.

18. Respondent is not on active duty with the Armed Forces of the United States of America or its allies.

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19. Petitioner Respondent is not pregnant.

20. There is no nonmarital property.
There is no marital property to be divided. 21. Petitioner and Respondent both waive any claim for spousal maintenance from the other. Petitioner and Respondent acknowledge that this waiver precludes the court from subsequently ordering spousal maintenance.
Petitioner and Respondent have agreed that spousal maintenance in the amount of
22. Petitioner Respondent is unaware of any genuine issue as to any material fact in this proceeding.

23. Petitioner Respondent requests that her former name of ______________________ be restored to her and states that there is no fraud in connection with this request.

24. There were no child[ren] born or adopted during the marriage. (Complete the remaining sections if there are child[ren] of the parties to this action.)
The child[ren] born or adopted during the marriage are: The following child[ren] are emancipated by reason of age, marriage, entry in the military or
nonattendance at a school of higher education and are not physically or mentally incapacitated. 25. The child[ren] lived with Petitioner Respondent at ____________________________

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______________________________________________ (street address, city, state), for six months immediately preceding the filing of this petition.

26. The Petitioner Respondent has not participated in any capacity in any other litigation concerning the custody of the child[ren] in this or any other state. Petitioner Respondent has no information of any custody proceeding concerning the child[ren] pending in this court or a court of any other state, and knows of no person not a party to these proceedings who has physical custody of the child[ren] or who claims to have custody or visitation rights with the child[ren].

27. Petitioner and Respondent have entered into a custody agreement which is attached and incorporated herein by reference. Petitioner and Respondent request that the court incorporate the terms of the custody agreement in the judgment of dissolution.

28. Attached hereto is a child support worksheet (Form 14) which has been agreed to by both parties. Petitioner Respondent attests to the truth of the contents of the child support worksheet.

29. The parties agree that the amount of support calculated by the Child Support Guidelines is unjust and inappropriate and agree that Petitioner Respondent shall pay $ _________ per month per child for a total of $ _____________per month child support. Reasons for deviation from Form 14 child support calculation are: ___________
30. The child support rights have have not been assigned to the State of Missouri

31. Costs paid by Respondent Petitioner.

Printed Name:_______________________________




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STATE OF MISSOURI )
COUNTY OF JACKSON )
Personally appeared before me on __________________________, who upon being sworn stated that the foregoing statements were true and accurate to the best of his her knowledge and belief.

CERTIFICATE OF MAILING

I hereby certify that a copy of the foregoing was mailed on the ________ day of ____________ by U.S. Mail, postage prepaid to: Respondent Petitioner.





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Form 1499 Adopted by Court en Banc 9/27/96
Effective 10/27/96