(Type or print former name)
(Rev. 11/09/13) CCDR 0019 B
Case No. ______________________
2. THE CO-PETITIONERS FURTHER STATE:
(a) The duration of the marriage/civil union does not exceed 8 years.
(b) Irreconcilable differences have caused the irretrievable breakdown of the marriage/civil union and the parties
have been separated 6 months or more. Efforts at reconciliation have failed or future attempts at reconciliation
would be impracticable and not in the best interests of the family.
(c) No children were born of the relationship of the parties or adopted by the parties during the marriage/civil
union. Neither party is pregnant by the other party.
(d) Neither party is dependent on the other party for support or each party is willing to waive the right to
support. Each party understands that prior consultation with an attorney may have helped to determine
eligibility for spousal support.
(e) Each party waives any right to spousal support.
(f) Neither party has any interest in real estate.
(g) The total fair market value of all marital/civil union property, after deducting all debts owed, is less than
(h) One Co-Petitioner's gross annual income from all sources is $_______________. The other Co-Petitioner's gross
annual income from all sources is $ _______________. The total annual income of both parties is less than
$35,000. Neither party has a gross annual income from all sources in excess of $20,000.
(i) Both parties have disclosed to each other all assets and their tax returns for all years of the marriage/civil union.
(j) The parties have executed a written Agreement dividing all assets in excess of $100 in value and
allocating responsibility for debts and liabilities between themselves. A copy of the Agreement, signed by
both parties, is filed with this petition.
WHEREFORE, THE PARTIES SEEK A DISSOLUTION, AND ASK THAT
A. Each party's right to spousal support be forever barred and terminated.
B. The written Agreement of the parties dividing marital/civil union assets, debts and liabilities, a copy of which is
filed with this petition, be incorporated into the final order and judgment of this Court granting the petition for
C. (Optional) That the Co-Petitioner's be restored to his/her former name:
VERIFICATION BY CERTIFICATION
Under penalties of perjury as provided by law pursuant to 735 ILCS 5/1-109, the undersigned certifies that the
statements set forth in this document are true and correct except as to matters herein stated to be on information and
Co-Petitioner Signature Co-Petitioner Signature