Form provided as a courtesy the Louisiana Access to Justice Commission. No enrollment of counsel is expressed or implied. Every factual
situation is different, and all litigants are encouraged to explore options for representation at www.LSBA.org/goto/FindLegalHelp.
SELF-REPRESENTED LITIGANT PETITION FOR DIVORCE
(103) (NO MINOR CHILDREN) AND FOR REQUESTING USE
OF MAIDEN NAME
THESE FORMS ARE ONLY FOR MARRIED COUPLES WHO HAVE ALREADY BEEN
LIVING SEPEATE AND APART FOR AT LEAST SIX (6) MONTHS BEFORE FILING FOR
A DIVORCE. If you have not been living apart from your spouse for over (6) months, you cannot
use these forms.
You will be filing your divorce as a “self-represented litigant,which means you are responsible for your
case and no attorney will be representing you. As the person suing for divorce, you will be known as the
Petitioner and your spouse will be known as the Defendant. All the forms you need to file for a divorce
are attached.
HOW TO COMPLETE THE FORMS:
Note: The forms are numbered at the bottom of each page.
1. Make sure that all of the blanks are filled in on those pages marked with a “1” at the bottom. These
forms are titled “PETITION FOR DIVORCEand VERIFICATION.” Make at least one (1)
copy of the form marked “PETITION FOR DIVORCE” after you have filled it out.
2. Take all of the pages marked with the number “1” at the bottom to the Clerk of Court’s Office
located in the parish where you live. You should also bring one (1) copy of the form marked
Petition For Divorce with you. Go to the Civil Department and tell the clerk that you do not have
a lawyer, and that you want to file your divorce.
3. Ask the clerk to file all of the forms marked with the number “1” at the bottom. Also ask the clerk
to stamp a date AND write the docket number of your case on the copy you brought of the Petition
for Divorce. This is important because you will need your docket number and the date you filed
your petition for divorce later. Keep your copy of the Petition for Divorce in a safe place.
4. You will need to check with your local Clerk of Court to determine the case “filing fee.” If you
cannot afford to pay the fee when you file your case, you can include an “IN FORMA PAUPERIS
AFFIDAVIT,” which asks the court to delay (but not eliminate) the cost of filing. Fill out all
sections of the IN FORMA PAUPERIS AFFIDAVIT. Reference your check stubs to fill out
section (7) and be sure to sign this document in the presence of a notary. This document can be
found on the list of available forms, and is labeled with the number “2” at the bottom. If you are
able to pay the court fees, you can skip this step.
5. Call the Clerk’s office to check to see when your spouse is served(recommended to wait about
1-2 weeks before calling to check on service). Once the Clerk’s office tells you that your spouse
has been served, you must wait at least fifteen (15) days from the date your spouse was served.
Then call the Clerk’s office again to make sure your spouse has not filed an answer or other
pleading.
6. If your spouse has filed an answer to the lawsuit, you should check with the court to see if any
hearings have been scheduled.
7. If nothing has been filed by your spouse, take the form titled MOTION FOR PRELIMINARY
DEFAULT (which is marked “3-default” at the bottom of the page) to the Clerk’s office. Be sure
to fill in the section at the bottom for your address AND bring two (2) copies of the Motion for
Preliminary Default, already filled out, along with the original. Ask the clerk to: 1-file the original
copy of the Motion, 2-stamp a date on your copy of the Motion for you to keep, 3- send you the
other copy of the Motion for Preliminary Default marked with the date that the Judge signed it
(your address should be listed on the bottom of the page
Form provided as a courtesy the Louisiana Access to Justice Commission. No enrollment of counsel is expressed or implied. Every factual
situation is different, and all litigants are encouraged to explore options for representation at www.LSBA.org/goto/FindLegalHelp.
8. You will receive a copy of the Preliminary Default in the mail. It should show the date the
Preliminary Default was signed. Now, you must also fill in the form titled AFFIDAVIT OF
CORRECTNESS (marked with “4” at the bottom of the page). You must sign it in the
presence of a notary! You must also fill in the section of the JUDGMENT OF DIVORCE titled
Petitioner’s Certification” at the bottom of the pageyou will need to know the date of service,
whether it was domiciliary or personal service, and the date that the Judge signed the Motion for
Preliminary Default. Lastly, fill in the document titledCERTIFICATE OF DIVORCE with you
and your spouse’s personal information.”). You should also ask the Clerk of Court whether you are
required to file the form titled “APPENDIX 28.1B: LA. C.C.P. ART. 1702(E) DIVORCE
CHECKLIST.”
9. Bring the AFFIDAVIT OF CORRECTNESS (marked with a number “4”), the JUDGMENT
OF DIVORCE (marked with a number “4”), the CERTIFICATE OF DIVORCE and the
DIVORCE CHECKLIST (if necessary) to the Clerk’s office. Ask the Clerk to have a Judge sign
them.
10. Once a Judge has signed your JUDGMENT OF DIVORCE, the Clerk’s office will send you a
certified copy of it. You are divorced as of the date of the Judge’s signature at the bottom of the
Judgment of Divorce. Keep this certified copy for your records.
All litigants are better off when represented by a licensed attorney. For help
finding representation, visit www.LSBA.org/goto/FindLegalHelp
. If you do not
understand a legal term, need to have a hearing in open court, or need to clarify
the correct response or application to your situation, you may want to seek
more information or advice from the following resources:
Louisiana LawHelp: www.louisianalawhelp.org
Free Legal Answers: LA.freelegalanswers.org
Law Library of Louisiana: lasc.libguides.com/resources-for-self-represented-
litigants
Form provided as a courtesy the Louisiana Access to Justice Commission. No enrollment of counsel is expressed or implied. Every factual
situation is different, and all litigants are encouraged to explore options for representation at www.LSBA.org/goto/FindLegalHelp.
_______________________ * ______ JUDICIAL DISTRICT COURT
VERSUS: * DOCKET NO: _________ DIV. _____
_______________________ * ____________ PARISH, LOUISIANA
PETITION FOR DIVORCE UNDER CIVIL CODE ARTICLE 103
The petition of _______________________________, (print your name), a major
domiciled in the Parish of ____________, (print name of parish where you live) State of Louisiana,
respectfully represents:
1.
Made defendant is ____________________ (print spouse’s name), a major currently
domiciled in the Parish of __________________, (print name of parish where spouse lives) State of
Louisiana.
2.
The parties were married on the ______day of___________________, _______, in
_________________ Parish, Louisiana. (print date of marriage and parish where married).
3.
Petitioner and defendant physically separated on the _______day of ________________,
________, and have continued to live separate and apart since that time. (print date of separation).
4.
Of the marriage, no children were born or adopted.
5.
Petitioner requests and is entitled to a divorce under the provisions of Civil Code Article
103(1), based on the parties having lived separate and apart for more than six (6) months without
reconciliation.
6.
Petitioner (only if you are the wife), wishes to have her name confirmed as
___________________________________. (print your full maiden name).
7.
Petitioner, due to poverty and want of means, is unable to pay the costs of this suit and
desires to file and prosecute this action under the provisions of LA C.C.P., Articles 5181-5188.
WHEREFORE, petitioner prays that after all legal delays and due proceedings, that
there be judgment granting petitioner a divorce, that her maiden name be confirmed, and that
defendant be cast with all court costs.
Respectfully submitted by:
_______________________________
PETITIONER, In Proper Person (signature)
Print your name and address:
________________________________
________________________________
Telephone No.____________________
(1)
Form provided as a courtesy the Louisiana Access to Justice Commission. No enrollment of counsel is expressed or implied. Every factual
situation is different, and all litigants are encouraged to explore options for representation at www.LSBA.org/goto/FindLegalHelp.
_______________________ * ______ JUDICIAL DISTRICT COURT
VERSUS: * DOCKET NO: _________ DIV. _____
_______________________ * ____________ PARISH, LOUISIANA
VERIFICATION
STATE OF LOUISIANA
PARISH OF ________________
BEFORE ME, the undersigned authority, personally came and appeared:
___________________________________
who, after being duly sworn, did depose and say that:
He/She is the petitioner in the above entitled matter, and all of the allegations contained in
the petition are true and correct to the best of his/her knowledge, information and belief.
_____________________________
AFFIANT
SWORN TO AND SUBSCRIBED before me, notary, this ________ day of
____________________ , 20____.
______________________________
NOTARY PUBLIC
CLERK OF COURT: PLEASE SERVE (if work address is given, service must be
personal)
Defendant
(name and physical home or work address)
_______________________
_______________________
_______________________
_______________________
(1)
Form provided as a courtesy the Louisiana Access to Justice Commission. No enrollment of counsel is expressed or implied. Every factual
situation is different, and all litigants are encouraged to explore options for representation at www.LSBA.org/goto/FindLegalHelp.
_______________________ * ______ JUDICIAL DISTRICT COURT
VERSUS: * DOCKET NO: _________ DIV. _____
_______________________ * ____________ PARISH, LOUISIANA
MOTION FOR PRELIMINARY DEFAULT
ON MOTION OF Petitioner, (print your name) _____________________, and on
suggesting to this Honorable Court that:
A verified Petition for Divorce was filed on this matter on the _____ day of
__________________, 20____. (print the date that was stamped on your copy of the petition).
Defendant was served on the ______ day of _____________________, 20____. (print the
date that your spouse was served).
No answer or other responsive pleading having been filed, petitioner now moves for entry
of Preliminary Default under Code of Civil Procedure Article 1701.
Respectfully submitted by,
________________________________
PETITIONER, In Proper Person (signature)
Clerk’s Certification
I hereby certify that a review of the record reveals that no answer or other responsive pleadings have been filed in
this case on the issue of divorce.
___________________________________ _____________________________________
Deputy Clerk Date
ORDER
Considering the above Motion, it is ORDERED that a Preliminary Default be entered in
the above captioned cause, in the minutes of this Court.
THUS, DONE AND SIGNED this ________ day of_________________, 20___ at
_______________________ Louisiana.
_________________________________
DISTRICT JUDGE
*Note to Clerk of Court: Please return a copy of this Motion and Order, with the date of the
Judge’s signature to Petitioner at this address:
(print your address):
_____________________________
_____________________________
_____________________________
_____________________________
(3-DEFAULT)
APPENDIX 28.1B: LA. C.C.P. ART. 1702(E) DIVORCE CHECKLIST
LOUISIANA CIVIL CODE ARTICLE 103(1) OR ARTICLE 103(5) DIVORCE
Certification for Default Confirmation under Louisiana Code of Civil Procedure Article 1702(E)
Note: Must be completed by Petitioner or his/her attorney and submitted/filed with the Judgment of Divorce.
______________________________ DOCKET NUMBER: ________________________
Petitioner
versus
______________________________ PARISH OF _______________________________
Defendant
A. Dates
1. Petition for Divorce: ______________ Date Petition Filed
2. Parties physically separated: ______________ Date of Separation
3. Service of the Petition:
a. If Sheriff’s return is in the record, indicate date and type of service:
Personal/Domiciliary (Circle one) ______________ Date of Service
If Domiciliary, then name of person served __________________ and the relationship?:_______________
OR OR
b. If a Waiver of Service is filed into the record, provide date of
execution and filing : ______________ Date Waiver Executed
______________ Date Waiver Filed
4. Preliminary default entered: ______________ Date PD Entered
By Oral/Written Motion (Circle one)
5. Have two days, exclusive of holidays, elapsed since the entry of preliminary
default, with no answer or other opposition having been filed?
Yes
B. Pleadings
1. Is the Petition for Divorce in the record?
Yes
2. Are proper jurisdiction and venue expressly alleged in the Petition?
Yes
3. Does the petitioner’s Affidavit submitted or filed with the Judgment specifically attest
to the facts sufficient to obtain a divorce or will testimony be offered in lieu thereof?
Yes
4. If the defendant has made an appearance in the case, was notice of the preliminary
default sent to defendant by certified mail pursuant to La. C.C.P. Art. 1702(A)
or is there a filed waiver of the notice by the defendant?
Yes; or
Yes (Waiver)
5. Are the original and at least one copy of the proposed final Judgment attached?
Yes
C. Grounds for Divorce (La. C.C. Art. 103/
C.C.P. Art. 1702(E))
1. The parties have minor children, and have been living separate and apart 365 days or more
without reconciliation.
Yes
OR
2. The parties have no minor children and have been living separate and apart
180 days or more without reconciliation.
Yes
OR
3. On __/__/20__, after a contradictory hearing, or consent decree, a protective order or an
injunction was issued during the marriage in accordance with law, against the defendant
in order to protect the petitioner who seeks the divorce or a child of one of the spouses from abuse.
Yes
PETITIONER’S/ATTORNEY’S CERTIFICATION
I hereby certify that I have examined the record or conformed copies of all pleadings in the above-captioned case, and the
information provided herein is true and correct based upon my personal knowledge, information, and belief.
______________________ _________________________________________ ___________________
Date of Record Examination Signed by Petitioner/Attorney for Petitioner Attorney’s Bar Number
______________________ _________________________________________ ___________________
Date of Certification Address Telephone Number
CLERK’S CERTIFICATION
Two days, exclusive of holidays, have elapsed since the preliminary default was entered and no answer or opposition has been filed.
_________________________ _________________________________
Date Signature of Minute Clerk
HEARING OFFICER RECOMMENDATION
Considering the record in this case, the submission of the petitioner/mover’s counsel, it being the finding of the hearing officer that
all legal requirements for granting a divorce under Louisiana Civil Code Article 103(1) or Article 103(5) have been met, IT IS HEREBY
RECOMMENDED that the attached Judgment of Divorce be made the Order of this Court, no objection having been made by either
party.
_________________, Louisiana, this ____ day of ___________________, 20____.
__________________________________
Hearing Officer
Save Form
Print Form
Form provided as a courtesy the Louisiana Access to Justice Commission. No enrollment of counsel is expressed or implied. Every factual
situation is different, and all litigants are encouraged to explore options for representation at www.LSBA.org/goto/FindLegalHelp.
_______________________ * ______ JUDICIAL DISTRICT COURT
VERSUS: * DOCKET NO: _________ DIV. _____
_______________________ * ____________ PARISH, LOUISIANA
AFFIDAVIT OF CORRECTNESS
STATE OF LOUISIANA
PARISH OF______________
BEFORE ME, the undersigned notary public, personally came and appeared:
______________________________
Petitioner
Who, being duly sworn, did depose and state:
1. That he/she is a person of the full age of majority and who is domiciled in
________________ (print name of parish where you live) Parish, Louisiana;
2. That he/she is the petitioner in the above entitled and numbered action;
3. That the defendant is a major currently domiciled in the Parish of
__________________ (print name of parish where your spouse lives);
4. That he/she and defendant were married on the ____day of _________________,
_______ (print date of marriage);
5. That of the marriage, no children were born or adopted;
6. That he/she and defendant physically separated on the ______ day of
________________, ______, (print date of separation) and have remained living separate and
apart without reconciliation since that time;
7. That petitioner desires to obtain a divorce under Civil Code Article 103(1) on the basis
of the parties having lived separate and apart without reconciliation for six (6) months or
more; and
8. That defendant is not on active duty with the Armed Forces of the United Stated or any
of its allies.
__________________________________
PETITIONER
SWORN TO AND SUBSCRIBED before me, on this day of______________
20____.
__________________________________
NOTARY PUBLIC
__________________________________(print name and No.)
(4)
Form provided as a courtesy the Louisiana Access to Justice Commission. No enrollment of counsel is expressed or implied. Every factual
situation is different, and all litigants are encouraged to explore options for representation at www.LSBA.org/goto/FindLegalHelp.
_______________________ * ______ JUDICIAL DISTRICT COURT
VERSUS: * DOCKET NO: _________ DIV. _____
_______________________ * ____________ PARISH, LOUISIANA
CONFIRMATION OF DEFAULT AND JUDGMENT OF DIVORCE
This matter was considered pursuant to the provisions of Louisiana Civil Code Article
103(1) and Code of Civil Procedure Article 1702(E). The Court having considered the entire
record of this matter and petitioner’s affidavit of correctness (Exhibit A), and the law and
evidence in favor thereof, renders as follows:
IT IS HEREBY ORDERED ADJUDGED AND DECREED that the preliminary
default previously entered herein on the ____ day of ________________, 20____, be now
confirmed.
IT IS FURTHER ORDERED, ADJUDGED, AND DECREED that there be a
judgment in favor of petitioner ________________________, and against defendant
_________________, decreeing a divorce between the parties on the basis of the parties having
lived separate and apart continuously and without reconciliation for a period of six (6) months or
more as per Civil Code Article 103(1).
IT IS FURTHER ORDERED, ADJUDGED, AND DECREED that Petitioner’s name
is confirmed as _____________________________________, which is her maiden name. (print
your full maiden name).
IT IS FURTHER ORDERED, ADJUDGED, AND DECREED that all costs
associated with these proceedings are assessed to the defendant.
JUDGMENT READ, RENDERED AND SIGNED, this ______ day of
_____________, 20___ , at __________________, Louisiana.
__________________________________
DISTRICT JUDGE
Clerk’s Certification
I hereby certify that a review of the record reveals that no answer or other responsive pleadings have been filed in
this case.
___________________________________ _____________________________________
Deputy Clerk Date
Petitioner’s Certification
(sign and date below to indicate that you have reviewed the record)
I hereby certify that defendant was served domiciliary/personal (circle one) on ___________________ (write the
date of service) and a preliminary default judgment was entered on ____________________ (write the date of the
preliminary default judgment).
___________________________________ _____________________________________
Petitioner Date
(4)