Form R-209c Rev 03/05 - Report Of Absolute Divorce Or Annulment

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Form R-408 rev4 12/2014 draft
THE COMMONWEALTH OF MASSACHUSETTS
Registry of Vital Records and Statistics
NOT A PUBLIC RECORD
Name of Court/County:
Docket Number:
TYPE OF JUDGMENT:
 Absolute Divorce
 Annulment
Date of this Marriage:
State/Country of Marriage:
Date of Judgment:
Date of Absolute Divorce:
Cause for which divorce or annulment was granted:
Name of Register or other official submitting this form:
PARTY A
Middle
Last
1a. Full Name:
First
 Plaintiff
1b.
1c.
2. Date of Birth
Surname upon Divorce/Annulment
Surname at birth or adoption
 Defendant
3. Sex:
4.
5.
6.
SSN
Number of this
Number of Minor
 M  F
Marriage
st
nd
:
Children in Custody of
(1
, 2
)
Party A:
7a. Current Residence:
# and Street (not a mailing address):
7b.
7c.
7d.
City/Town
State/Country
Zip Code
PARTY B
Middle
Last
8a. Full Name:
First
 Plaintiff
8b.
8c.
9. Date of Birth
Surname upon Divorce/Annulment
Surname at birth or adoption
 Defendant
10. Sex:
11.
12.
13.
SSN
Number of
Number of Minor
 M  F
st
this Marriage
Children in Custody of
(1
,
nd
:
Party B:
2
)
14a. Current Residence:
# and Street (not a mailing address):
14b.
14c.
14d.
City/Town
State/Country
Zip Code
CHILDREN OF THIS MARRIAGE
15. Total #
16. Names:
17. Date(s) of Birth
First
Middle
Last
a.
a.
b.
b.
List full names
and dates of
c.
c.
birth.
Continue on
d.
d.
reverse if
necessary.
e.
e.
RVRS USE ONLY

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