Petition For Dissolution Marriage Without Children Form - Kansas District Court
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4IN THE TRIBAL DISTRICT COURT
OF THE PRAIRIE BAND POTAWATOMI NATION
11444 158
ROAD, MAYETTA, KS, 66509
TH
___________________________________________
Case Number: ________________________
Name of Petitioner
PETITION FOR DISSOLUTION OF
___________________________________________
MARRIAGE WITHOUT CHILDREN
Name of Respondent
STATEMENTS MADE TO THE COURT, UNDER OATH:
1.
INFORMATION ABOUT ME, THE PETITIONER:
Name: _________________________________________________________________________________________
Address: _______________________________________________________________________________________
Date of Birth: _________________________________ Social Security Number: _____________________________
Home Phone Number:__________________________Cell Phone Number:__________________________________
Where Employed / Job Title: ______________________________________________________________________
[ ] I am Native American and an enrolled member of the ___________________________________________tribe.
[ ] I am not a Native American.
2.
:
INFORMATION ABOUT, MY SPOUSE, THE RESPONDENT
Name: _________________________________________________________________________________________
Address: _______________________________________________________________________________________
Date of Birth: _______________________________ Social Security Number: _______________________________
Home Phone Number:__________________________Cell Phone Number:__________________________________
Where Employed / Job Title: ______________________________________________________________________
[ ] Spouse is a Native American and an enrolled member of the ______________________________________tribe.
[ ] Spouse is not a Native American.
3.
:
INFORMATION ABOUT MY MARRIAGE
Date of Marriage: ________________ City & State or Country where married:______________________________
4.a.
COMMUNITY PROPERTY: (check one box)
[ ] My spouse and I did not acquire any community property during the marriage, OR
[ ] My spouse and I acquired community property during our marriage, and we should divide it as
follows:
Petitioner
Respondent
Value
Real Estate Located at:
_____________________________________
[ ]
[ ]
$________________
Legal Description: ___________________________________________________________________
___________________________________________________________________________________
Household furniture and appliances:
Petitioner
Respondent
Value
___________________________________
[ ]
[ ]
$_________________
___________________________________
[ ]
[ ]
$_________________
Household furnishings:
Petitioner
Respondent
Value
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