Form Dr-100 - Petition For Dissolution Of Marriage (No Minor Children) Page 2
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8C. Party B
1. Length of residence in Alaska:
2. Residence address:
(street address)
(city)
(state)
(zip)
3. Home phone:
Cell phone:
4. Mailing address:
(box or street number)
(city)
(state)
(zip)
5. Occupation:
Work phone:
6. Most recent employer:
D. Date and Place of Marriage. Date of marriage:
/
/ 20
(month)
(day)
Place of marriage:
(city)
(state)
E. Health Care and Health Insurance
Does either spouse need medical care or treatment?
Yes
No
If yes, state which spouse and describe the care or treatment needed:
Is either spouse covered by health insurance (through an employer or otherwise)?
Yes
No
If yes, state which spouse and the amount paid for the insurance by the spouse or spouses:
F. Domestic Violence
Has either spouse been involved in any of the following during the marriage:
1. a criminal charge of a crime involving domestic violence,
2. a domestic violence protective order under AS 18.66.100 - 18.66.180,
3. injunctive relief against domestic violence under former AS 25.35.010 or 25.35.020, or
4. a domestic violence protective order issued in another jurisdiction and filed with the court
in this state under AS 18.66.140?
Yes
No
If yes, describe below:
Has there been any domestic violence during the marriage (whether or not the police were
involved or anything was filed in court)?
Yes
No
G. Has either spouse received advice from an attorney about divorce or dissolution?
Yes
No
If yes, state which spouse(s):
Is either spouse represented by an attorney?
Yes
No
If yes, state which spouse(s):
Signature of Party A
Signature of Party B
Page 2 of 8
DR-100 (8/15)(cs)
AS 25.24.200-.260
PETITION FOR DISSOLUTION OF MARRIAGE (NO MINOR CHILDREN)
Civil Rule 90.1(a), f(2)(A)(B), (i)(1)
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