Person Completing this Form must Also Submit Form CCFC133 To

IN THE FAMILY COURT OF ST. LOUIS COUNTY, MISSOURI
,
For File Stamp Only
Petitioner
Date
XXX-XXLast Four Digits of SSN#
,
Case Number
and
,
Respondent
Division
XXX-XXLast Four Digits of SSN#
,
AFFIDAVIT FOR JUDGMENT
(Pursuant to Local Rule 68.8)
1.
My name is
and I am the (Petitioner) (Respondent)* in the above
dissolution of marriage case.
2.
I currently reside at
in
County, State of
.
3.
Check one of the following two boxes:
 I have been a resident of the State of Missouri for at least 90 days immediately prior to the filing of the petition herein. OR
 My spouse has been a resident of Missouri for at least 90 days immediately prior to the filing of the petition herein.
4.
Check one of the following two boxes:
 My spouse (currently resides) (and I have resided during the marriage)* in the State of Missouri. OR
 My spouse has subjected (herself) (himself)* to the jurisdiction of this court by the following acts.
.
5.
Both my spouse and I are over the age of 18 years.
and
6.
I was married to
, the (Petitioner) (Respondent)* herein, on
the marriage is registered in
, State of
.
7.
My spouse and I separated on or about
.
8.
Neither my spouse nor I are on active duty in the armed services at the present time or any time since the filing of the petition.
9.
There is no reasonable likelihood that the marriage can be preserved and the marriage is irretrievably broken.
10. (I am) (My Wife is)* not pregnant.
11. Check one of the following two boxes:
 There are no living minor children born or adopted of the marriage. OR
 There (are) (is)*
minor, unemancipated child(ren) of the marriage, to wit:
Age
Age
,
,
Age
,
Age
,
Form 14 is attached hereto as Exhibit
.
11a. Check if there (is an) (are) unemancipated child(ren).
 There is no other litigation pending in this or any other state concerning the custody of the minor, unemancipated
child(ren) and there are no persons other than my spouse and myself who have physical custody of the minor
child(ren) or claims any rights with respect to the minor child(ren), (except)
.
12. If there are any minor, unemancipated child(ren),* check one of the following three boxes:
 It is in the best interest of the minor child(ren) that (I) (my spouse)* be awarded custody of the minor child(ren). OR
 It is in the best interest of the minor child(ren) that my spouse and I be awarded joint legal custody of the minor
child(ren) and that (I) (my spouse)* be awarded physical custody of the minor child(ren) pursuant to a written
. OR
agreement attached hereto as Exhibit
CCFC109-WS (Pg. 1) Rev. 08/09
Strike words not applicable
13.
14.
15.
16.
17.
18.
 It is in the best interest of the minor child(ren) that my spouse and I have joint legal and physical custody of the minor
.
child(ren) pursuant to a written agreement attached hereto as Exhibit
If there are any minor, unemancipated child(ren),* check one of the following two boxes:
 Child support has been calculated pursuant to Form 14. OR
 The child support calculated pursuant to Form 14 is unjust or inappropriate because
.
Check one of the following two boxes:
 I am able to support myself through appropriate employment or have sufficient assets from which I can support
myself so I am not asking for any maintenance. I understand that by not requesting maintenance at this time, I
cannot come into this or any other court in the future and receive maintenance. I know of no medical, health or other
condition which would prevent me from supporting myself in the future. OR
 I am unable to support myself through appropriate employment and have insufficient assets from which I can
per month.
support myself. Therefore I am in need of maintenance in the amount of $
Check one of the following two boxes:
 My spouse is able to support (herself) (himself)* through appropriate employment or has sufficient assets from
which (she) (he)* can support (herself) (himself)* and therefore (she) (he)* is not entitled to receive maintenance. I
know of no medical, health or other condition which would prevent my spouse from supporting (herself) (himself) *
in the future. OR
 My spouse is unable to support (herself) (himself)* through appropriate employment and has insufficient
assets from which (she) (he)* can support (herself) (himself)*. Therefore my spouse is in need of maintenance
per month.
in the amount of $
Check one of the following two boxes:
 My spouse and I have entered into a separation agreement which divides all our marital and non-marital
property and is signed by both my spouse and myself. The agreement, attached hereto and marked as
Exhibit ___________, is fair and reasonable, and is not unconscionable. I request that the court incorporate the
separation agreement into its judgment herein. OR
 There is no marital or non-marital property for the court to divide.
Check one of the following two boxes:
 Each party is capable of paying for his or her own attorney’s fees, and therefore I request that no attorney’s
fees be ordered to be paid by either party. OR
 Based upon my financial situation and the financial situation of my spouse, it is reasonable that (I) (my
spouse)* pay to
the sum of $
as and for attorney’s fees herein.
Check if applicable:
.
 I request that the court restore to (my spouse) (me)* the (maiden) (former)* name of
I know of no third parties, such as creditors, who would be adversely affected by the said change of name.
COUNTY OF
STATE OF
_____________
of lawful age, being duly sworn upon his/her oath, states that he/she is
the (petitioner) (respondent)* named above; and that the facts stated herein are true according to his/her best knowledge
and belief.
Subscribed and sworn to before me on
_______
.
Notary Public
My Commission Expires
_______
.
*Strike words not applicable
CCFC109-WS (Pg 2) Rev. 08/09