Uncontested Divorce Questionnaire Legal Divorce Document Form for Plaintiff and Defendant Information Plaintiff Full Name * Plaintiff Phone Number * Plaintiff Residence Address * Docket Number F.M. * Plaintiff County * Plaintiff City * Plaintiff State * County where complaint is filed * Defendant Full Name * Defendant Phone Number * Defendant Resident Address * Date of Marriage/Civil Union * Place of Marriage/Civil Union * The name that you would like to assume after your divorce/dissolution * Please Upload a copy of your Marriage Certificate and any other pertinent document Drop a file here or click to upload Choose File Maximum file size: 516MB Text Reason for Divorce * Seperation Desertion Extreme Cruelty Irreconcilable Differences Are both parties in agreement for divorce? * Yes No Separation This is to be filled out if your divorce is being submitted because of Separation Date of Separation * Desertion This is to be filled out if your divorce is being submitted because of Desertion Plaintiff’s residence address at the time of Desertion * Defendant’s residence address at the time of Desertion * Date when Defendant deserted Plaintiff * Date when plaintiff and defendant started living apart * Name of the child & Date of birth – 1 Name of the child & Date of birth – 2 Name of the child & Date of birth – 3 Name of the child & Date of birth – 4 Any other court cases as plaintiffs or defendants * Yes No Docket no. of the case – 1 Docket no. of the case – 2 Docket no. of the case – 3 Demands of Plaintiff * If you are requesting other relief from court, describe what you want here Plaintiff’s Signature signature keyboard Clear Date on which plaintiff signs this document Defendant’s signature * signature keyboard Clear Date on which defendant sign this document * Name of the person who performed the ceremony * Extreme Cruelty This is to be filled out if your divorce is being submitted because of Cruelty Date when your spouse/partner began his/her acts of cruelty towards you * Present date or date on which acts of cruelty stopped * The specific acts of cruelty committed by the defendant * Date the act of cruelty was committed * Beneficiary * Describe the act of cruelty * Life Insurance Life Insurance Company Name * Policy Number * Policy Owner’s Name * Name of Insured * Name of Insured * Policy Owner’s Address * Face Amount $ * Beneficiary * Policy Term * Health Insurance Health Insurance Company Name * Name of Insured * ID Number * Insured’s Address * Group Number * Coverage Type: * Single Hospital Diagnostic Parent Child Family Optical Dental Major Medical Prescription Drivers of the Vehicle * Lien Holder Lessor Automobile Insurance Company Name * Policy Number * Company Address Policy Expiration Date * Vehicle Make * Vehicle Model * Vehicle Year * Coverage Limits * Lawsuit Threshold * Umbrella Coverage * Yes No Drivers of the Vehicle Lien Holder Lessor Address of Lien Holder/Lessor * Use of the Vehicle: * Personal Business Personal and Business HOMEOWNERS INSURANCE Company Name * Company Address * Policy Number * Policy Expiration Date * Insured’s Address * Coverage Limits Umbrella Coverage * Yes No Mortgage (if applicable) * Umbrella Coverage $ * Address of Mortgagee * Rider(s) to Policy: * Jewelry Furs Artwork Other Submit If you are human, leave this field blank.
