If yes, state their names and dates of birth.
Name(s) Date of Birth
_________________________________________ _______________________
_________________________________________ _______________________
_________________________________________ _______________________
Is the Wife pregnant? ( ) No ( ) Yes___________________
9. Have both you and your spouse signed and filed a marital settlement agreement (and parenting
plan if there are children) settling all of the issues in this case? ( ) Yes ( ) No
Answer all the questions below:
A. Do you recognize both you and your spouse’s signature on the agreements(s)?
( ) Yes ( ) No ( ) Not applicable
B. Do you believe the agreement is fair?
( ) Yes ( ) No ( ) Not applicable
C. Have both of you fully disclosed all assets, liabilities and incomes to each other?
( ) Yes ( ) No ( ) Not applicable
D. Did both you and your spouse sign the written agreement(s) freely and voluntarily?
( ) Yes ( ) No ( ) Not applicable
E. Do you want the Court to approve your agreement(s) and make it part of the Final Judgment of
Dissolution of Marriage?
( ) Yes ( ) Not applicable
10. If there IS NO
agreement filed in your case, do you want the Court to enter a Final Judgment
Dissolution of Marriage that:
[check one] ( ) Only grants the dissolution of your marriage
( ) Grants the dissolution of your marriage and the other relief requested in
the Petition for Dissolution of Marriage.
( ) Not applicable
11. Is the wife asking the court to restore her former name? ( ) Yes ( )No
If yes, state the full restored name desired:
______________________________________________________________________
First Middle Last
NOTE: The court can only restore a legal name the wife once had, either by birth or marriage. It
cannot grant a new name the wife has never had before.
12. Is there anything else you believe the Court should know that has not been covered above?
( ) No ( ) Yes – (State briefly below)
__________________________________________________________________________________