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CCA-GF-0520-3011
STATE OF INDIANA IN THE COURT
COUNTY OF CAUSE NO.________________________________
IN RE THE MARRIAGE OF:
__________________________
Petitioner,
v.
__________________________
Respondent.
APPEARANCE BY UNREPRESENTED PERSON IN CIVIL CASE
1. My name is _________________________________ and I am:
Initiating
and in this case I am not represented by a lawyer.
2. Contact information for receiving legal service of document and case information as required
by Court Rules. (NOTE: If you are the Initiating Party and this case, or a related case,
involves a protection from abuse order, a workplace violence restraining order, or a no-
contact order, you must provide an address for the purpose of legal service of documents.
But, that address should not be one that exposes your location.)
Address:
Email address:
I will accept service at the above email address.
Phone:
Fax:
OR, if in a related case, you have used the Attorney General confidential address, you may
check the box below:
Attorney General confidential address
3. This is a DN case type as defined
in Administrative Rule 8(B)(3).
4. There are related cases: (If yes, please indicate below)
Yes
No
CLEAR FORMS
PRINT FORMS
_________
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Caption and case number of related cases:
Caption: Case No.:
Caption: Case No.:
Caption: Case No.:
Caption: Case No.:
Caption: Case No.:
Caption: Case No.:
Additional information as required by local rule:
Signature
CERTIFICATE OF SERVICE
I hereby certify that I sent a copy of this document on ________________________ by first-
class U.S. mail, postage prepaid to ____________________________________________ at the
following address:
______________________________
______________________________
______________________________
______________________________
Signature
Page 1 of 3 Approved by the Coalition for Court
Access CCA-DC-0919-1037
STATE OF INDIANA IN THE ________________ _________________ COURT
COUNTY OF ________________ CAUSE NO. _________________________________
IN RE THE MARRIAGE OF:
________________________
Petitioner,
v.
________________________
Respondent.
VERIFIED PETITION FOR DISSOLUTION OF MARRIAGE
With Request for Provisional Orders
The Petitioner, _________________________________, now states:
1. Petitioner’s residential address is:
_____________________________________________________________________________.
2. Respondent’s residential address is:
_____________________________________________________________________________.
3. Petitioner has been a resident of the state of _________________ for ___ years
and ____ months and a resident of ________________ County for ____ years and ____ months.
4. Respondent has been a resident of the state of ________________ for ___ years
and ____ months and a resident of ________________ County for ____ years and ____ months.
5. ___________________________________ has been a continuous resident of
______________________________________ County or stationed at a United States military
installation within the county for the last three (3) months.
6. ________________________________ has been a continuous resident of the
State of Indiana or stationed at a United States military installation within Indiana for the last six
(6) months.
7. Petitioner and Respondent were married on _____________________________,
and separated on ________________________________.
8. There are no children born of the marriage.
9. There _________ debts or assets to divide.
_________
___________
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10. __________________________ is pregnant.
11. This marriage has suffered an irretrievable breakdown and should be dissolved.
12. I am filing this petition on my own behalf.
-OR-
I am the guardian of ______________________________ and am filing this
petition because ________________________________ is incapacitated. My name is
__________________________________ and my address is:
_____________________________________________________________________________
and I have attached a copy of the court order granting me authority to petition for dissolution of
marriage described in IC 29-3-9-12.2.
15. Petitioner ________ a lifetime sex or violent offender.
16. Respondent ________ a lifetime sex or violent offender.
17. Change of name:
Wife would like the following former name restored
_______________________________________________.
Wife does not request a name change.
18. Petitioner ________ a member of the military.
19. Respondent ________ a member of the military.
I request that this Court issue its order dissolving the marriage of the parties, and for all
other just and proper relief and until this matter is finalized:
20.
I do not request any provisional orders.
-OR-
I request the following provisional orders:
Temporary possession of the marital residence;
Temporary division of debts;
Temporary division of property;
Temporary division of motor vehicles;
_____
_____
_____
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Spousal maintenance;
Restraining the parties from transferring, encumbering, concealing, or in
any way disposing any of the property of the parties;
Other:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
The undersigned affirms under penalties for perjury that the foregoing
representations and statements are true.
______________________________
Signature
CERTIFICATE OF SERVICE
I
hereby certify that I sent a copy of this document on ________________________ by
first-class U.S. mail, postage prepaid to ____________________________________________
at the following address:
______________________________
______________________________
______________________________
______________________________
Signature
STATE OF INDIANA IN THE COURT
COUNTY OF CAUSE NO._______________________________
IN RE THE MARRIAGE OF:
__________________________
Petitioner,
v.
__________________________
Respondent.
SUMMONS
[For Dissolution of Marriage Cases Only]
The State of Indiana to Respondent:
You have been sued by your spouse for dissolution of marriage. The case is pending in
the Court named above.
If this Summons is accompanied by an Order Setting Hearing, you must appear in Court
on the date and time stated on the Order Setting Hearing. IF YOU DO NOT APPEAR,
EVIDENCE MAY BE HEARD AND A DECISION MAY BE MADE BY THE COURT. If a
Temporary Restraining Order is issued, it is effective immediately upon your receipt or
knowledge of the Order.
If you wish to retain an attorney to represent you in the matter, it is advisable to do so
before the date stated on the Notice of Provisional Hearing.
If you take no action in this case after receipt of this Summons, the Court can grant a
Dissolution of Marriage and/or make determinations that may include but not limited to any of
the following: paternity, child custody, child support, maintenance, parenting time, property (real
or personal), and other distribution of assets and debts, attorney fees and costs.
Dated: , Clerk
, County
_________
The following manner of service of Summons is hereby designated:
Registered/Certified mail to be sent by the Clerk
Service by Sheriff on Individual at address shown above
Service by Sheriff at place of employment, (name and address of spouse’s employer)
____________________________________________________________________
____________________________________________________________________
_____________________________________________________________________________________
SHERIFF’S RETURN OF SERVICE OF SUMMONS
I hereby certify that I have served this summons on the ____ day of _______________, 20____.
By delivering a copy of the Summons and a copy of the complaint to the Respondent
identified on the first page of the Summons.
By leaving a copy of the Summons and a copy of the complaint/petition at:
________________________________________________________________________
which is the dwelling place or usual place of abode of the Respondent and by mailing a
copy of the Summons to the Respondent at the above address.
Other Service or Remarks: _________________________________________________.
Sheriff’s costs Sheriff
By:
Deputy
CLERK’S CERTIFICATE OF MAILING
I hereby certify that on the ______ day of _______________________, 20____, I mailed
a copy of this Summons and a copy of the Petition to the Respondent identified on the first page
of the Summons by (registered or certified mail), ______________________________________
requesting a return receipt, at the address provided by the Petitioner.
Dated:
Clerk, County
RETURN ON SERVICE OF SUMMONS BY MAIL
I hereby certify that the attached receipt was received by me showing that the Summons
and a copy of the Petition mailed to the Respondent identified on the first page of this
Summons was accepted by the Respondent on the _____ day of
_______________________, 20____.
I hereby certify that the attached return receipt was received by me showing that the
Summons and a copy of the petition was returned not accepted on the _____ day of
_______________________, 20____.
I hereby certify that the attached return receipt was received by me showing that the
Summons and a copy of the Petition mailed to the Respondent identified on the first page
of this Summons was accepted by _________________________ on behalf of the
Respondent on the _____ day of _______________________, 20____.
Dated:
Clerk, County
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STATE OF INDIANA IN THE COURT
COUNTY OF CAUSE NO._______________________________
IN RE THE MARRIAGE OF:
__________________________
Petitioner,
v.
__________________________
Respondent.
ORDER SETTING PROVISIONAL HEARING
A Verified Petition for Dissolution of Marriage and Request for Provisional Orders has
been filed in this Court. The Court now sets this matter for a Provisional Hearing. The parties
must be prepared to present evidence in support of their petition. Failure to appear may result in
matters being decided in your absence.
IT IS SO ORDERED that this matter shall be heard on:
_____________________________________________________________________________.
Dated: ____________________________________
Judicial Officer
The Clerk shall serve this pleading upon _________________________________
by certified mail at the following address (this requires an additional fee payable to the Clerk):
____________________________________________
____________________________________________
____________________________________________
The Clerk shall have this pleading served upon ___________________________
by sheriff at the following address:
____________________________________________
____________________________________________
____________________________________________
Distribution:
_________
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CCA-DC-0719-1038
STATE OF INDIANA IN THE COURT
COUNTY OF CAUSE NO._______________________________
IN RE THE MARRIAGE OF:
__________________________
Petitioner,
v.
__________________________
Respondent.
PROVISIONAL ORDER
Petitioner appears/does not appear and Respondent appears/does not appear for
provisional hearing on ______________________. The Court having been duly advised in this
matter now finds the following:
Petitioner
Respondent
shall have temporary possession of the marital residence.
Petitioner
Respondent
shall maintain medical, dental and optical insurance as
available through employment, or Health Insurance
Marketplace, or by government provided insurance for the
foll
owing persons:
________________________________________________
________________________________________________
________________________________________________
_____________________
___________________________
Petitioner
Respondent
shall pay temporary spousal maintenance to the other party as
follows:
________________________________________________
________________________________________________
________________________________________________
There shall be a temporary division of debts as follows:
Petitioner
Respondent
shall be responsible for the following debts:
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
_________
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Petitioner
Respondent
shall be responsible for the following debts:
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
There shall be a temporary division of property, as follows:
Petitioner
Respondent
shall have sole possession of the following items of
property:
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
Petitioner
Respondent
shall have sole possession of the following items of
property:
________________________________________________
________________________________________________
________________________________________________
There shall be a temporary division of motor vehicles, as follows:
Petitioner
Respondent
shall have temporary possession of the following vehicles:
_______________________________________________
(
Vehicle #1, Make, Model, and Year)
_______________________________________________
(Vehicle #2, Make, Model, and Year)
Petitioner
Respondent
shall have temporary possession of the following vehicles:
_______________________________________________
(
Vehicle #1, Make, Model, and Year)
_______________________________________________
(Vehicle #2, Make, Model, and Year)
There shall be a temporary restraining order in effect during these proceedings:
Restraining the parties from transferring, encumbering, or concealing, or
in any way disposing of any of the property of the parties;
Other:
____________________________________________________________
____________________________________________________________
____________________________________________________________
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ALL WHICH IS SO ORDERED
Judicial Officer
Distribution:
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STATE OF INDIANA IN THE COURT
COUNTY OF CAUSE NO._______________________________
IN RE THE MARRIAGE OF:
__________________________
Petitioner,
v.
__________________________
Respondent.
MOTION FOR FINAL HEARING
The Petitioner now states that sixty (60) days have passed since the last filing of the
Verified Petition for Dissolution of Marriage and requests that this matter be set for Final
Hearing on the next available hearing date.
Signature
CERTIFICATE OF SERVICE
I hereby certify that I sent a copy of this document on ________________________ by
first-class U.S. mail, postage prepaid to ____________________________________________
at the following address:
______________________________
______________________________
______________________________
______________________________
Signature
_________
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CCA-DC-0719-1029
STATE OF INDIANA IN THE COURT
COUNTY OF CAUSE NO._______________________________
IN RE THE MARRIAGE OF:
__________________________
Petitioner,
v.
__________________________
Respondent.
ORDER SETTING FINAL HEARING
The Petitioner has filed a Motion for Final Hearing which the Court has considered and
now grants.
IT IS SO ORDERED that the final hearing for this matter shall be heard on:
_____________________________________________________________________________.
[The court allows ____________ for the hearing.]
Dated: ____________________________________
Judicial Officer
The Clerk shall serve this pleading upon _________________________________
by certified mail at the following address (this requires an additional fee payable to the Clerk):
____________________________________________
____________________________________________
____________________________________________
The Clerk shall have this pleading served upon ___________________________
by sheriff at the following address:
____________________________________________
____________________________________________
____________________________________________
Distribution:
_________
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CCA-DC-0319-1039
IN THE COURT
CAUSE NO._______________________________
STATE OF INDIANA
COUNTY OF
IN RE THE MARRIAGE OF:
__________________________
Petitioner,
v.
__________________________
Respondent.
DECREE OF DISSOLUTION OF MARRIAGE
The Court having reviewed the Verified Petition for Dissolution of Marriage and having
held a final hearing in this matter, now finds the following:
1. Petitioner and Respondent were married on _____________________________,
and separated on ________________________________.
2. ___________________________________ has been a continuous resident of
______________________________________ County for the last three months.
3. ________________________________ has been a continuous resident of the
State of Indiana for the last six months prior to the filing of the Verified Petition for
Dissolution of Marriage
4. ___________________ is pregnant.
5. Petitioner ____________ a member of the military.
6. Respondent ___________ a member of the military.
7. There are no children of the marriage.
8. Joint debt.
The division of jointly held debts shall be as follows:
The parties have no outstanding debts for which they are responsible
_________
_____
_____
______
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Petitioner will be solely responsible for the following debts and shall hold
Respondent harmless from liability, expense, attorney’s fees, and loss which may be
incurred by Respondent arising out of Petitioner’s failure to pay such debts.
Name of Creditor Amount of Debt
_______________________________ _____________________
_______________________________ _____________________
_______________________________ _____________________
_______________________________ _____________________
Respondent will be solely responsible for the following debts and shall hold
Petitioner harmless from liability, expense, attorney’s fees, and loss which may be
incurred by Petitioner arising out of Respondent’s failure to pay such debts.
Name of Creditor Amount of Debt
_______________________________ _____________________
_______________________________ _____________________
_______________________________ _____________________
_______________________________ _____________________
9. Individual debt.
The individual debt division shall be as follows:
Debts held in Petitioner’s name only:
Petitioner shall be solely responsible for all debts held in his/her individual name,
and all debts incurred by him/her in his/her name since the date of final separation.
Petitioner agrees to hold Respondent harmless from liability, expense, attorney’s fees,
and loss which may be incurred by Respondent, arising out of Petitioner’s failure to pay
such debts.
Other:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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Debts held in Respondent’s name only:
Respondent shall be solely responsible for all debts held in his/her individual
name, and all debts incurred by him/her in his/her name since the date of final
separation. Respondent agrees to hold Petitioner harmless from liability, expense,
attorneys fees, and loss which may be incurred by Petitioner, arising out of Respondent’s
failure to pay such debts.
Other:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
10. Vehicles
The vehicle division shall be as follows:
There are no vehicles to divide.
Petitioner shall have possession of the following vehicle(s), and Respondent shall
execute all documents necessary to transfer title of said vehicles within a reasonable time
following the date of this Order:
________________________________________________________________________
(Vehicle #1, Make, Model and Year)
________________________________________________________________________
(Vehicle #2, Make, Model and Year)
Respondent shall have possession of the following vehicle(s), and Petitioner shall
execute all documents necessary to transfer title of said vehicles within a reasonable time
following the date of this Order:
________________________________________________________________________
(Vehicle #1, Make, Model and Year)
________________________________________________________________________
(Vehicle #2, Make, Model and Year)
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All outstanding debts related to the above listed vehicles has been allocated
above.
11. Personal property.
The parties’ personal property division shall be as follows:
The parties have divided all items of personal property.
Petitioner shall have sole possession of the following items of personal property:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Respondent shall have sole possession of the following items of personal
property:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
12. Marital Residence.
The parties are owners of real estate located at
_______________________________________________________________________,
and:
Petitioner shall retain/take possession and shall become the sole owner of
Respondent said real estate
Petitioner shall vacate the marital residence by ___________________ ____
Respondent
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Petitioner shall be responsible for all payments related to property, taxes and
Respondent homeowners insurance and shall receive the deductions for
mortgage interest and taxes.
Petitioner shall transfer, by Quitclaim Deed, ______ interest in said real
Respondent estate to the party retaining possession of the marital residence by
______________________________.
Petitioner will refinance the mortgage debt related to the marital
Respondent residence and make good faith effort to obtain a release of the
other party on said debt on the earliest possible date. Upon release
of the other party from mortgage debt, the other party shall
transfer, by Quitclaim Deed, his/her interest in said real estate.
The party assuming responsibility for mortgage agrees to hold the
other party harmless from all liability, expense, attorney fees, loss
or damages which may be a result of a failure to make payments
on said mortgage debt.
Other ______________________________________________________
______________________________________________________
______________________________________________________
The parties are jointly responsible on a lease for a residence located at
________________________________________________________________________
and
Petitioner shall retain possession of the leased premises, be responsible for
Respondent the remaining rental payment and fees due under said lease, and
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agrees to hold the other party harmless for all liability, expense,
attorney fees, loss or damage which may be a result of the failure
to make required payments under said lease.
Petitioner shall vacate the leased residence by ________________________.
Respondent
Other ______________________________________________________
______________________________________________________
______________________________________________________
13. Change of names.
Petitioner would like the following former name restored and is not a lifetime sex
or violent offender or Petitioner has complied with I.C. 31-15-2-19; Petitioner shall
hereinafter be known as:
_________________________________________________________
Respondent would like the following former name restored and is not a lifetime
sex or violent offender or Respondent has complied with I.C. 31-15-2-19; Respondent
shall hereinafter be known as:
_________________________________________________________
Neither Petitioner nor Respondent requests a name change.
14. The marriage has suffered an irretrievable breakdown and should be dissolved.
15. Findings of the Court
The Court, having held a hearing during which both parties appeared and presented
evidence, now finds that the property distribution provisions of this order:
constitute a presumptive equal division of marital property and is therefore just
reasonable.
do not constitute the presumptive equal division of marital property, however are,
for the reasons set forth below, just and reasonable:
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______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
IT IS THEREFORE ORDERED by the Court that the parties’ marriage is hereby
dissolved.
Date: _____________________________ __________________________________________
Judicial Officer
Distribution:
Petitioner’s Name and Mailing Address: Respondent’s Name and Mailing Address:
_________________________________ __________________________________
_________________________________ __________________________________
_________________________________ __________________________________
_________________________________ __________________________________