FORM DR-3 - Missouri Courts

FORM DR-3
IN THE CIRCUIT COURT OF BARRY, LAWRENCE, STONE COUNTY, MISSOURI
Petitioner,
Social Security #
and
Respondent.
Social Security #
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Date:
Case No.:
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_______________ , _____________ County, State of _____________.
3.
I have been a resident of the State of Missouri for at least 90 days and the County of (County
name) for at least 60 days immediately prior to the filing of the petition herein. [or]
My spouse has been a resident of Missouri for at least 90 days and the County of (County name)
for at least 60 days immediately prior to the filing of the petition herein. [or]
4.
My spouse (currently resides) (and I have resided) during the marriage in the State of
Missouri. [or]
My spouse has subjected (himself) (herself) to the jurisdiction of this court by the following
acts.
5.
Both my spouse and I are over the age of 18 years.
6.
I was married to ______________, the (Petitioner)(Respondent) herein, on ____________ and
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. 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:
____________ born _____________, SSN __________
____________ born _____________, SSN __________
A Parenting Plan to include a Form 14 is attached hereto as Exhibit _____.
11a. 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.
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 Parenting Plan attached hereto. [or]
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 Parenting Plan attached hereto.
13.
Child support has been calculated pursuant to Form 14. [or]
The child support calculated pursuant to Form 14 is unjust or inappropriate because ______.
14.
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 support myself. Therefore I am in need of maintenance in the amount of
$________ per month.
15.
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 in the amount of $__________ per month.
16.
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.
17.
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.
18.
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.
STATE OF MISSOURI
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COUNTY OF
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____________ 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