Form Div1702 – Fill Out and Use This PDF

Form Div1702 – Fill Out and Use This PDF

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State of Minnesota

County of:

In Re the Marriage of:

Name of Husband (First, Middle, Last)

	District Court

Judicial District:
Court File Number:
Case Type:	Dissolution with Children

and

Name of Wife (First, Middle, Last)

Joint Petition, Agreement, and Judgment and Decree for Marriage Dissolution

With Children

1.Information about Husband: Full Name:

FirstMiddleLast

Address:

	Street Address			Apt. No.

	City		County	State	Zip Code
Date of Birth: __________________________
	Month	Day Year
Husband’s former or other names:
(Or write “none)			First	Middle	Last

Husband’s social security number is listed on Confidential Form 11.1 and submitted along with the Joint Petition.

2.Information about Wife: Full Name:

FirstMiddleLast

Address:

		Street Address				Apt. No.

		City		County	State	Zip Code
Date of Birth: __________________________
		Month Day		Year
DIV1702 State	ENG		Rev 10/10	www.mncourts.gov/forms		Page 1 of 41

Wife’s former or other names:

(Or write “none”)
(Or write “none”)	First	Middle	Last

	First	Middle	Last

Wife’s social security number is listed on Confidential Form 11.1 and submitted along with the Joint Petition.

3.Our Marriage

Husband and Wife were married on: (month, day, year)

in the City of					, County of		, State
of			, Country of

4.180 Day Requirement

Husband has been living in Minnesota for the past six (6) months: Wife has been living in Minnesota for the past six (6) months:

YES YES

NO NO

5.Armed Forces

Husband is an active duty member of the armed forces:

YES

If YES, has the member of the armed forces been stationed in Minnesota for the past six

(6) months?	YES	NO
Wife is an active duty member of the armed forces: YES			NO

If YES, has the member of the armed forces been stationed in Minnesota for the past six

(6) months?

YES

6.Marriage Cannot be Saved

There has been an irretrievable breakdown of our marriage relationship.

7.Physical Living Situation

Do Husband and Wife live together at this time?		YES	NO
If NO, the date of separation was:				.
	Month	Day	Year

If YES , Husband and Wife are living together at this time because:

DIV1702 State

ENG

Rev 10/10

www.mncourts.gov/forms

Page 2 of 41

8.Other Proceedings

a. A separate court case for dissolution, legal separation, annulment, custody, parenting

time, or paternity has already been started by Husband or Wife in Minnesota or another

state:

YES

NO.

If YES, the type of court case is:

and it was started in

County in the State of

and the Court file number is

, and the outcome of the case

is:

Open

Closed

Unknown or

b. Has a County started a Support case involving the Husband and the Wife or their

children?	YES		NO.	If YES, the case was started in
County in the State of					and the Court file number is
		. The case is		Dismissed	Pending	an Order for Support was
issued.

9.Protection or Harassment Order

a.An Order for Protection or a Harassment/Restraining Order is in effect regarding

Husband and Wife:			YES	NO. If YES, the Order protects:		Husband
	Wife	the child(ren).		The Order was filed in			County
on					, and the Court file number is
	Month	Day	Year

A copy of the Order is submitted along with this Joint Petition.

b. If an Order for Protection is in effect, does the Order for Protection include a child

support obligation?

YES

10.Juvenile Court Case

A Juvenile Court case (child protection, delinquency or foster care) involving husband’s

children involved in the Juvenile Court case is:

DIV1702 State

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www.mncourts.gov/forms

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11.Children Husband and Wife have Together (Joint Children)

“Child” means a living person under age 18, or under age 20 and still in high school.

a.List all joint children born before the marriage or born or adopted during the marriage. If there are no joint children, or if Wife is not currently pregnant, you are using the wrong form. Use Joint Petition, Agreement and Judgment and Decree Without Children.

Full Name of Child	Date of	Age	Child Currently Lives With
	Birth
			Husband	Wife	Both parents
			OR
			________________________________
			(write in name)
			Husband	Wife	Both parents
			OR
			________________________________
			(write in name)
			Husband	Wife	Both parents
			OR
			________________________________
			(write in name)
			Husband	Wife	Both parents
			OR
			________________________________
			(write in name)
			Husband	Wife	Both parents
			OR
			______________________________
			(write in name)

The social security number of the child(ren) is/are listed on Confidential Form 11.1 and submitted along with the Joint Petition.

If a child is living with someone other than a parent, write the child’s address below:

Address:________________________________________________________________

Street Address			Apt. No.

City	County	State	Zip Code

b. Has each child born to or adopted by husband and wife together lived in Minnesota

for the past six (6) months?

YES

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If NO, name the child or children, name the State(s) the child has lived in during the past 6

months, and the dates the child lived in each state:

12.Adult Dependent Children : Child support may be ordered for a joint child over the age of 18 who cannot support him/herself because of a physical or mental condition.

Is there an adult joint child born to or adopted by Husband and Wife who is not able to

support himself or herself because of a physical or mental condition?

YES

If YES, the full name, date of birth and age of each adult dependent is:

Full Name of Dependent

Date of Birth

Age

The social security number of the adult dependent child(ren) is / are listed on Confidential Form 11.1 and submitted along with the Joint Petition.

b. Do Wife and Husband agree that husband is the biological father of the unborn child?

YES	NO
If NO,	Wife	Husband claims husband is not the biological father of the child.

14.Husband’s Children from Other Relationship (Nonjoint Children)

Does Husband have minor child(ren) from another marriage or relationship?

YES

If YES, the full name, date of birth and age of each child is:

DIV1702 State

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www.mncourts.gov/forms

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Full Name of	Date of	Does Child Live		Is Husband Court-Ordered to
Child and Age	Birth	with Husband?		pay Child Support for this Child?
		YES	NO	YES	NO

		YES	NO	YES	NO

		YES	NO	YES	NO

		YES	NO	YES	NO

15.Wife’s Children from Other Relationship (Nonjoint Children)

a. Does Wife have minor child(ren) born prior to the marriage from another marriage

or relationship?

YES

If YES, the full name, date of birth and age of each child born prior to the marriage

is:

Full Name of	Date of	Does Child Live		Is Wife Court-Ordered to pay
Child and Age	Birth	with Wife?		Child Support for this Child?
		YES	NO	YES	NO

		YES	NO	YES	NO

		YES	NO	YES	NO

		YES	NO	YES	NO

b. Has Wife given birth, since marrying Husband, to a minor child who is not a child of

the Husband?

YES

If YES, answer (i) , (ii), (iii) and ( iv):

(i)List the full name, date of birth and age of each child born to Wife since marrying Husband, who is not a child of the Husband:

Full Name of Child and	Date of	Does Child		Is Wife Court-Ordered to
Age	Birth	Live with		pay Child Support for this
		Wife?		Child?
		YES	NO	YES	NO

		YES	NO	YES	NO

(ii) Is there a Court Order naming someone other than the Husband as the father of

the child(ren) listed in (i) above?

YES

If YES, submit a copy of the Order. The Order is for:

Full Name of Child(ren)

DIV1702 State

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(iii) Have the Wife and biological Father signed a Minnesota Recognition of


Parentage for any of the children listed in (i) above?	YES	NO
If YES, state the full name of the child:			and
attach a copy of the Recognition of Parentage.
If NO, why not?

(iv)Has the Husband signed the “Husband’s Non-Paternity Statement ” for any of

the children listed at (i) above?

YES

If YES, state the name of the child:

and submit a copy of the “Husband’s Non-Paternity Statement.”

If NO, why not?

16.Custody

It is in the child’s best interests and we agree that legal custody be granted as follows: (check one)

□Joint legal custody to both parents

□Sole legal custody to □ Husband □ Wife

It is in the child’s best interests and we agree that physical custody be granted as follows: (check one)

□Joint physical custody to both parents

□Sole physical custody to □ Husband □ Wife

17.Parenting Time

a. It is in the best interests of the children that:

Husband’s parenting time with the joint child(ren) be: (check one)

unsupervised supervised reserved

Wife’s parenting time with the joint child(ren) be: (check one)

unsupervised

supervised

reserved

If parenting time is unsupervised for both parents, skip to Question 18.

DIV1702 State

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www.mncourts.gov/forms

Page 7 of 41

b. supervised parenting time

(Option 1) Supervision is necessary because unsupervised parenting time is likely to endanger the child's physical or emotional health or impair the child's emotional development. The circumstances supporting this finding are:

(Option 2) We agree that supervised parenting time is necessary because

It is in the best interests of the child(ren) that supervision of parenting time be arranged as follows: (State who should supervise parenting time, and if there is a cost involved, who should pay the cost, and any other important details)

c. Reserved Parenting time

We agree that parenting time should be reserved because:

18.Public Assistance: (Note: If either person is receiving public assistance from the State of Minnesota or

applies for it after this proceeding is started, notice of this marriage dissolution action must be given to the county’s collections and support office. See Minnesota Statutes Section 518A.44)

a. Husband receives public assistance from the State of Minnesota:

If YES, the assistance is from________________________County.


MFIP in the amount of $	per month
Tribal TANF in the amount of $		per month

Yes

(check all that apply)

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www.mncourts.gov/forms

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General Assistance in the amount of $		per month
Medical Assistance
Child Care Assistance	MinnesotaCare
b. Wife receives public assistance from the State of Minnesota:		Yes	No

If YES, the assistance is from _______________________County. (check all that apply)


MFIP in the amount of $		per month

Tribal TANF in the amount of $		per month
General Assistance in the amount of $			per month
Medical Assistance
Child Care Assistance	MinnesotaCare

c. The joint children of the parties receive public assistance from the State of

Minnesota:

Yes

If YES, the assistance is from

MFIP	Medical Assistance

IV-E Foster Care

County. (Check all that apply):

Tribal TANF MinnesotaCare

19.Supplemental Security Income (SSI)

Supplemental Security Income (SSI) is a Federal income supplement program. It is available to low- income people if they are over age 65, or blind, or disabled.

a. Husband receives Supplemental Security Income (SSI):						No	Yes in the
amount of $			per month.
b. Wife receives Supplemental Security Income (SSI):					No	Yes	in the amount
of $		per month.
c. The joint child(ren) of the parties receive(s) Supplemental Security Income (SSI):
No	Yes in the amount of $			per month. What is the name of the
child receiving SSI?

20.Husband’s Employment


a. Husband is employed:	Yes	No Husband is self-employed:
b. Husband works at least 40 hours per week:			Yes	No

Yes

DIV1702 State

ENG

Rev 10/10

www.mncourts.gov/forms

Page 9 of 41

If Husband is unemployed or working less than 40 hours / week, answer these questions:

i.Why is Husband unemployed or working less than 40 hours / week?

ii.What is Husband’s past work experience (type of jobs, hours, pay, length of time at the job) and what are Husband’s professional qualifications or licenses?

c.Current Employment: (if Husband currently has more than two jobs, use an attachment for the additional jobs.)

Name of Husband’s Employer (If self-employed, list name and business address)

Employer’s Street Address

City

State

Zip Code

Name of Husband’s Employer if self-employed, list name and business address)

Employer’s Street Address

City

State

Zip Code

Questions about Current Jobs	1st Job		2nd Job

Is Husband paid by the hour or	hourly	salary	hourly	salary
salaried?

What is the average number of
hours Husband works per week?	________________hours		________________hours
	________________hours		________________hours

How much overtime pay does
Husband receive per week on	$_____________________		$____________________
average?	$_____________________		$____________________
average?

DIV1702 State

ENG

Rev 10/10

www.mncourts.gov/forms

Page 10 of 41

Question	Answer
Form Name	Form Div1702
Form Length	41 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	10 min 15 sec
Other names	DIV1702, Nonjoint, Minnesota, 518A

and wife’s child(ren) has taken place in Minnesota or another state.

If YES, the case is in

County in the State of _________________

and the Court file number is

. The name of the child or