(county where Complaint filed)
____________________________, Case No. CI _____________
(your full name)
(case number assigned
by clerk of c
ourt)
Plaintiff,
vs.
COMPLAINT FOR
DISSOLUTION OF
MARRIAGE (No Children)
___________________________,
(spou
se’s full name)
Defendant.
I ___________________________________, without assistance of an attorney,
(your full name)
ask this court for a dissolution of marriage. In support of my complaint, I state that the
following items are true:
1. I live at _____________________________________, in
(your street address)
_________________________________________________________________.
(city, county, and state where you live)
2.
My spouse’s address is ________________________________________ in
(spouse’s street address)
________________________________________________________________.
(city, county and state where spouse lives)
3. Either my spouse or I have lived in the state of Nebraska for more than one
year prior to the filing of this complaint, with the bona fide intention of making this state
our permanent home.
4. At the time I filed this action, either my
spouse or I was living in
(county where Complaint filed)
County, Nebraska.
5. We were lawfully married on
___________________________________
(date of marriage)
in __________________________________.
(city and state of marriage)
___________________
COMPLAINT FOR DISSOLUTION
OF MARRIAGE (No Children)
DC 6:4.1 Rev. 06/19
Neb. Rev. Stat. § 42-353
Nebraska State Court Form
Page 1 of 3
Complaint for Dissolution of Marriage
(No Children)
DC 6:4.1 Rev. 06/19
Self-Represented Litigant Committee
See Self-help Page
IN THE COURT OF ______________ COUNTY, NEBRASKA
DISTRICT
Choose the county
6. Neither my spouse nor I am a party to any other pending actions for divorce,
separation, or dissolution of marriage in this state or in any other state.
7. My spouse is not a member of the Armed Forces of the United States or its
allies.
8. My marriage is irretrievably broken.
9. No child or children were born to or adopted by my spouse or me and none
are expected, or all of our children are age 19 or older.
10. During the course of the marriage, my spouse and I have accumulated
certain items of property, which should be equitably divided between us.
11. My spouse and I have incurred certain debts and obligations during the
marriage, and the liability for payment of these debts and obligations should be equitably
divided between us.
12. I wish my former name, _______________________________________,
(former or maiden name, including first, middle, and last names)
to be restored to me.
13. I want this dissolution of marriage proceeding heard by a district court judge.
14. Check the box that applies:
There are no existing restraining orders, protection orders, or
criminal no-contact orders regarding either party.
OR
There are one or more existing restraining orders, protection
orders, or criminal no-contact orders involving one or more of the
parties. Details are as follows:
Page 2 of 3
Complaint for Dissolution of Marriage
(No Children)
DC 6:4.1 Rev. 06/19
Self-Represented Litigant Committee
(a) Type of order: __________ restraining;
__________ protection; __________ criminal no-contact.
(b) Name of court, case number, and date of order for each
order:
________________________________________________
(name of court, case number and date of each order)
________________________________________________
________________________________________________
________________________________________________
WHEREFORE, I request the court:
A. Dissolve my marriage.
B. Equitably divide the property and debts between my spouse and
me.
C. Restore to me my former name of:
________________________________________________.
(former name, including first, middle and last names)
D. Grant any further relief that may be just.
Signature (Plaintiff)
Full Name (Plaintiff)
P
age 3 of 3
Complaint for Dissolution of
M
arriage
(No Children)
DC 6:4.1 Rev. 06/19
Self-Represented Litigant Committee
Date
Your Full Street Address/P.O. Box
City/State/ZIP Code
Phone Email Address