Form Fm-004 - Complaint For Divorce (With Children) (Page 2 of 2) in pdf

Plaintiff has not been involved in any way in, and has no information about, another court case in Maine or in any

other state concerning the custody of the child(ren) except as follows:

Protection from Abuse, (provide docket number):

Probate matter, (provide docket number): ___________________________________________________

Other (describe what kind of other case)

10. No one other than the parties has physical custody of the child(ren), or claims to have custody or

visitation rights with respect to the child(ren), except as follows:

11. (Check all boxes that apply)

No public assistance benefits have ever been received for the child(ren).

Public assistance benefits have been, are now, or will be received for the child(ren). AND

Plaintiff has sent a copy of this complaint to the Department of Health and Human Services at the

following address:

Support Enforcement Division, Central Office Supervisor, State House

Station 11, Augusta, ME 04333-0011. (A copy must be sent when the child(ren) have been,

are now or will be receiving public assistance benefits.)

The Department of Health and Human Services has issued a child support order regarding the child(ren).

(If such an order has issued, a copy of the order must be attached to this Complaint).

The Department of Health and Human Services has been contacted to set up, review, change or enforce a child

support order regarding the child(ren).

12. PLAINTIFF REQUESTS that a divorce be granted and that the court; (Check all boxes that apply)

Determine parental rights and responsibilities regarding the minor child(ren),

including child support (file and exchange form FM-050);

Set apart the non-marital property to each party and divide the marital property;

Order that spousal support be paid to Plaintiff by Defendant (file and exchange form FM-043);

Award reasonable attorney's fees to Plaintiff's attorney (file and exchange form FM-043); and

Change Plaintiff's name to:

Date:

(Plaintiff's signature)

Plaintiff Attorney:

Plaintiff:

Address:

Telephone:

STATE OF MAINE

County

Personally appeared the above named Plaintiff,

, and made Oath that the

foregoing statements are true.

Before me,

Date:

Attorney at Law / Notary Public / Deputy Clerk

Defendant has 20 days after being served with this complaint (being given a copy), to file an answer with the Court

and must provide copies of all filings to other party.

FM-004, Rev. 06/16

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Form Fm-004 - Complaint For Divorce (With Children) Page 2