dissolution of dc 6:5 1 rev. 06/19 marriage (with ...dc 6:5.1 rev. 06/19 pro se committee 6. neither...

of 7

Complaint for Dissolution of Marriage with Child(ren) DC 6:5.1 Rev. 06/19Pro Se Committee

(county where Complaint filed)

____________________________, Case No. CI _____________(your full name) (case number assigned by clerk of court) Plaintiff,

vs. COMPLAINT FOR

DISSOLUTION OF MARRIAGE

(WITH CHILD(REN)) ____________________________,

(spouse’s full name) Defendant.

I ______________________________________, without assistance of an (your full name)

attorney, ask this court for a Dissolution of Marriage. In support of my complaint, I state

that the following items are true:

1. I live at ___________________________________________________, (your street address: if confidential under Nebraska or Federal law, enter county and state only and provide an alternative address for mailing of notice)

in ___________________________________________________________________, (city, county, and state where you live)

2. My spouse’s address is _______________________________________,(spouse’s street address)

in __________________________________________________________________. (city, county and state where spouse lives)

3. Either my spouse or I have lived in the state of Nebraska for more than one year

prior to the filing of this complaint, with the intention of making this state a permanent home.

4. At the time I filed this action, either my spouse or I was living in

______________________ County, Nebraska. (county where Complaint filed)

5. We were married on ___________________________________, (date of marriage)

in _________________________________. (city and state of marriage)

COMPLAINT FOR DISSOLUTION OF

MARRIAGE (With Child(ren))

Nebraska State Court Form

DC 6:5.1 Rev. 06/19 Neb. Rev. Stat. § 42-353

https://supremecourt.nebraska.gov/sites/default/files/DC-6-5-1a.pdfhttps://nebraskalegislature.gov/laws/statutes.php?statute=42-353

of 7


6. Neither my spouse nor I am a party to any other pending actions for

divorce, separation, or dissolution of marriage in this state or in any other state.

7. My spouse is not a member of the Armed Forces of the United States or its

allies.

8. My marriage is irretrievably broken.

9. My spouse and I have ______________ child(ren) whose custody or(number of children)

welfare may be affected by this divorce. Their names and years of birth are:

_____________________________________ _____________ (name of child) (child’s year of birth)



____________________________________ _____________ (name of child) (child’s year of birth)

10. ______________________________ fit to have the care, custody, and(“I am,” “My spouse is,” or “Both my spouse and I are”)

control of our minor child(ren).

11. The following information is provided because of the requirements of the

Uniform Child Custody Jurisdiction and Enforcement Act:

(a) For the last five years, the child(ren)’s addresses and the persons

they have lived with are:

DATES: ADDRESS: NAME and CURRENT ADDRESS OF PERSON(S) WITH WHOM THE CHILD(REN) HAVE LIVED:

______________ ___________________ ________________________________ ______________ ___________________ ________________________________ ______________ ___________________ ________________________________ ______________ ___________________ ________________________________ ______________ ___________________ ________________________________

of 7


(b) Check the box that applies:

I have not been a party or a witness in any other proceeding

concerning the custody of or parenting time with the

child(ren).

OR

I have been a party or a witness in another proceeding

concerning the custody of or parenting time with the

child(ren), as follows:

(name of court)

(case number)

(date of child custody determination, if any)

(c) Check the box that applies:

I know of no other actions or proceedings that could affect

this action. This includes actions or proceedings about

domestic violence, protection orders, termination of parental

rights, and adoptions.

OR

There is currently a proceeding which could affect this action.

(name of court)

(case number)

(date of child custody determination, if any)

of 7


(d) Check the box that applies:

I do not know the names and addresses of any persons other

than my spouse and myself who have physical custody of the

child(ren) or claim to have custody or parenting time rights

with the child(ren).

OR

The following is a list of the names and addresses of persons

other than my spouse and myself who have physical custody

of the child(ren) or claim to have custody or parenting time

rights with the child(ren):

NAME: ADDRESS:

_________________________ _____________________________________

_________________________ _____________________________________

12. _________________________ able to provide support for the child(ren). (“I am” or “My spouse is”)

13. During the course of the marriage, my spouse and I have accumulated

certain items of property, which should be fairly divided between us.

14. My spouse and I owe certain marital debts and obligations and the

responsibility for payment of these debts and obligations should be fairly divided

between us.

15. I wish my former name, _______________________________________,(former or maiden name, including first, middle and last names)

to be restored to me.

16. I want this dissolution of marriage proceeding heard by a district court judge.

of 7


17. Check the box that applies:

There are no existing restraining orders, protection orders, or

criminal no-contact orders regarding either party.

OR

There are one or more existing restraining orders, protection

orders, or criminal no-contact orders regarding one or more of the

parties. Details are as follows:

(a) Type(s) of order(s): restraining; protection;

criminal no-contact.

(b) Name of court, case number, and date of order for each

order:

________________________________________________(name of court, case number and date of each order)

________________________________________________

________________________________________________

18. A Parenting Plan has has not (check one) been developed.

19. Child custody, parenting time, or other access, and child support are not

contested.

I request the Court:

A. Dissolve my marriage.

B. Fairly divide the property and debts between my spouse and me.

of 7


C. Check the box that applies:

Award ______________ sole legal and sole physical (“me” or “my spouse”)

custody of the child(ren).

Award my spouse and me joint legal custody of the child(ren) and award sole physical custody of the child(ren) to ____________.

(“me” or “my spouse”)

Award my spouse and me joint legal and joint physical

D.

custody of the child(ren).

Order a parenting plan that sets forth parenting time with each parent.

E. Award child support according to Nebraska Child Support

Guidelines.

F. Restore to me my former name of

____________________________________________________. (former or maiden name, including first, middle and last names)

G. Grant any further relief that may be just.

VERIFICATION

STATE OF NEBRASKA ) ) ss

COUNTY OF ___________________ ) (county where signed)

I, _______________________________, first being sworn upon oath, depose (your full name)

Date

Signature

Your Full Name Your Full Street Address/P.O. Box

City/State/ZIP Code

Phone Email Address

of 7


and say that I am the plaintiff in the above entitled matter and have read the foregoing

complaint and state that the facts contained therein are true.

________________________________ (Signature of Plaintiff)

SUBSCRIBED AND SWORN to before me this _____ day of _______________,

20___.

________________________________ Notary Public

Case No CI: undefined_2: undefined_4: undefined_5: undefined_6: County Nebraska: undefined_7: undefined_8: My marriage is irretrievably broken: welfare may be affected by this divorce Their names and years of birth are: undefined_9: name of child: childs year of birth: name of child_2: childs year of birth_2: name of child_3: childs year of birth_3: name of child_4: 1: 2: 3: 4: 5: 1_2: 2_2: 3_2: 4_2: 5_2: THE CHILDREN HAVE LIVED 1: THE CHILDREN HAVE LIVED 2: THE CHILDREN HAVE LIVED 3: THE CHILDREN HAVE LIVED 4: THE CHILDREN HAVE LIVED 5: name of court: case number: date of child custody determination if any: name of court_2: case number_2: date of child custody determination if any_2: NAME 1: NAME 2: ADDRESS: undefined_10: able to provide support for the children: undefined_11: order: name of court case number and date of each order 1: name of court case number and date of each order 2: me or my spouse: me or my spouse_2: former or maiden name including first middle and last names: City State ZIP code: county where signed: Check Box1: OffCheck Box2: OffCheck Box3: OffCheck Box4: OffCheck Box5: OffCheck Box7: OffCheck Box8: OffCheck Box9: OffCheck Box10: OffCheck Box11: OffCheck Box12: OffCheck Box13: OffCheck Box14: OffCheck Box15: OffCheck Box16: OffCheck Box17: OffButton3: Your full name: Street Address: Telephone number: Email: Date565: COUNTYDISTRICTDD: [DISTRICT]DROPDOWNCOUNTY: [IN THE COURT OF ______________ COUNTY, NEBRASKA ]fullcountystatement: IN THE COURT OF ______________ COUNTY, NEBRASKA chosencourt: DISTRICTButton2:

dissolution of dc 6:5 1 rev. 06/19 marriage (with ...dc 6:5.1 rev. 06/19 pro se committee 6. neither...

Documents