Petition For Dissolution Of Marriage Page 4
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4d. Other Grounds per 750 ILCS 5/401 (Please specify)
Part F. Parties' Agreements
1.
The parties have reached agreement(s) on the following issues:
custody,
visitation,
child support or
maintenance (support for a spouse)
State the specific arrangements:
.
(Attach additional pages as needed)
Part G. Relief Requested
1. FOR THESE REASONS, I request that judgment be entered that provides as follows:
(Check all that apply)
a. That the marriage be dissolved.
b. That sole custody of the minor child(ren) be awarded to
Petitioner
Respondent.
c. That joint legal custody of the minor child(ren) be awarded with
Petitioner
Respondent
to be the residential custodian.
d. That visitation with the minor child(ren) be
granted
restricted
barred
reserved.
e. That child support be awarded.
f. That a fair division of the property or its value acquired during the marriage be divided in just
proportions.
g. That maintenance to the Petitioner be
granted
waived
reserved
h. That maintenance to the Respondent be
granted
barred
reserved
i. That a change back to my former name:
be granted.
Full Former Name
j. That any other appropriate relief be awarded.
Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure,* the
undersigned certifies that the statements set forth in this instrument are true and correct.
Date
Signature
Printed Name
* - Any person who makes a false statement, material to the issue or point in question, which he does
not believe to be true, in any document certified by such person in accordance with 735 ILCS 5/1-109 shall
be guilty of a Class 3 felony punishable by two (2) to five (5) years imprisonment and/or a $10,000.00 fine.
Distribution: (3 Copies)
Original to Circuit Clerk
Petitioner
Respondent
Page 4 of 4
174-CSR200 (Rev 09/04)
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