Form Vs243 PDF Details

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QuestionAnswer
Form NameForm Vs243
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesks worksheet divorce form, ks worksheet annulment, ks worksheet divorce, kansas worksheet divorce pdf

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KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT

Office of Vital Statistics

WORKSHEET FOR DIVORCE OR ANNULMENT REGISTRATION

This worksheet may be used to collect the information to be reported on the Certificate of Divorce or Annulment or through the electronic filing process. It may also be used to provide the District Court information if the court is filing the official record for the parties.

This worksheet is not to be forwarded to the Office of Vital Statistics.

1.

HUSBAND/SPOUSE NAME (First, Middle, Last)

 

 

2.

HUSBAND/SPOUSE LAST NAME PRIOR TO FIRST MARRIAGE

 

 

 

 

 

 

3. DATE OF BIRTH (Month, Day, Year)

4 RESIDENCE-STATE

 

5

COUNTY

 

 

 

 

 

 

 

 

6.

WIFE/SPOUSE NAME (First, Middle, Last)

 

 

7.

WIFE/SPOUSE LAST NAME PRIOR TO FIRST MARRIAGE

 

 

 

 

 

 

8.

DATE OF BIRTH (Month, Day, Year)

9. RESIDENCE-STATE

 

10. COUNTY

 

 

 

 

 

 

11. PLACE OF THIS MARRIAGE - STATE OR

12. COUNTY

13. DATE OF THIS MARRIAGE

14. NUMBER OF CHILDREN UNDER 18 IN THIS

 

FOREIGN COUNTRY

 

(Month, Day, Year)

 

HOUSEHOLD AS OF DATE IN ITEM 18

 

 

 

 

 

 

 

15 PETITIONER

 

Husband/Spouse Wife/Spouse Both Other (Specify)

_______

17ATTORNEY’S ADDRESS (Street and Number or Rural Route, City or Town, State, Zip Code)

16NAME OF PETITIONER’S ATTORNEY (Type)

18 DATE DECREE FILED (Month, Day, Year)

19 TYPE OF DECREE-(Specify)

Divorce

Annulment

20. COUNTY OF DECREE

21. CASE NUMBER

THE INFORMATION BELOW WILL NOT APPEAR ON CERTIFIED COPIES OF THE RECORD.

K.S.A. 65-2422B, REQUIRES THE DIVORCE REPORT TO INCLUDE THE SOCIAL SECURITY NUMBER OF BOTH PARTIES TO MAKE SUCH INFORMATION AVAILABLE TO THE SECRETARY OF KANSAS DEPARTMENT OF CHILDREN & FAMILIES FOR THE PURPOSE OF ESTABLISHING, MODIFYING, OR ENFORCING A SUPPORT OBLIGATION.

 

22. HUSBAND/SPOUSE SOCIAL SECURITY NUMBER & GENDER

 

 

 

 

23. WIFE/SPOUSE SOCIAL SECURITY NUMBER & GENDER

 

 

 

_____/_____/______

 

 

Male

Female

 

_____/_____/______

 

 

 

 

Male

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24. NUMBER OF THIS MARRIAGE First, Second, etc.

 

 

 

 

 

 

25. IF PREVIOUSLY MARRIED, LAST MARRIAGE ENDED

 

 

 

 

(Specify below)

 

 

 

 

By Death, Divorce, or Annulment (Specify below)

 

Date (Month, Day, Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24a. HUSBAND/SPOUSE

 

 

 

 

25a. HUSBAND/SPOUSE

 

 

 

 

 

25b HUSBAND/SPOUSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24b. WIFE/SPOUSE

 

 

 

 

25c. WIFE/SPOUSE

 

 

 

 

 

25d. WIFE/SPOUSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

26. HISPANIC ORIGIN (Check the box or boxes that best describes

 

 

27. RACE (Check one or more boxes to indicate what race(s) you consider yourself to be.)

 

whether you are Spanish, Hispanic, or Latino. Check the “no” box if

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

you are not Spanish, Hispanic, or Latino.)

 

 

 

27a. HUSBAND/SPOUSE

 

 

 

 

27b. WIFE/SPOUSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

26a. HUSBAND/SPOUSE

 

 

26b. WIFE/SPOUSE

 

White

 

 

Korean

 

 

 

White

 

Korean

 

 

 

 

 

 

 

 

 

 

 

 

 

No, not Spanish/

 

 

No, not Spanish/

 

Black or

 

 

Vietnamese

 

 

 

Black or

 

Vietnamese

 

Hispanic/Latino

 

 

Hispanic/Latina

 

 

African American

 

 

 

 

 

 

 

 

African American

 

 

 

Yes, Mexican/Mexican

 

 

Yes, Mexican/Mexican

 

American Indian or

 

Other Asian (Specify)

 

 

 

American Indian or

Other Asian (Specify)

 

American/Chicano

 

 

American/Chicana

 

 

Alaska Native

 

 

 

 

 

 

 

 

 

Alaska Native

 

 

 

Yes, Puerto Rican

 

 

Yes, Puerto Rican

 

 

(Name of the enrolled

 

 

 

 

(Name of the enrolled

 

 

 

 

 

 

or principal tribes)

 

 

 

 

 

 

 

 

or principal tribes)

 

 

 

Yes, Cuban

 

 

Yes, Cuban

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes, Central American

 

 

Yes, Central American

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Native Hawaiian

 

 

 

 

 

 

Native Hawaiian

Yes, South American

 

 

Yes, South American

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Asian Indian

 

 

Guamanian or

 

 

 

Asian Indian

 

Guamanian or

Yes, other Spanish/

 

Yes, other Spanish/

 

 

 

 

 

 

 

 

 

 

Chamorro

 

 

 

 

 

 

 

 

 

Chamorro

 

 

 

 

Hispanic/Latino (Specify)

 

 

Hispanic/Latina (Specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chinese

 

 

Samoan

 

 

 

Chinese

 

Samoan

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Filipino

 

 

Other Pacific Islander

 

 

 

Filipino

 

Other Pacific Islander

Unknown

 

 

Unknown

 

 

 

 

 

 

 

 

 

 

Japanese

 

 

 

(Specify)

 

 

 

Japanese

 

 

(Specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other (Specify)

 

 

 

 

 

 

 

 

Other (Specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unknown

 

 

 

 

 

 

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

28. EDUCATION (Check the box that best describes the highest degree or level of school completed.)

 

 

 

 

 

 

 

 

 

28a. HUSBAND/SPOUSE EDUCATION8th grade or less

 

 

 

 

 

 

9th - 12th grade; no diploma

 

High school graduate or GED

 

 

 

 

Some College credit, but no degree

 

Associate degree (e.g., AA,AS)

 

Bachelor’s degree (e.g., BA, AB, BS)

 

Unknown

 

 

Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)

Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)

 

28b. WIFE/SPOUSE EDUCATION 8th grade or less

 

 

 

 

 

 

9th - 12th grade; no diploma

 

High school graduate or GED

 

 

 

 

Some College credit, but no degree

 

Associate degree (e.g., AA,AS)

 

Bachelor’s degree (e.g., BA, AB, BS)

 

Unknown

 

 

Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)

Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)

VS243 Rev.11/19

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Writing part 1 of vital statistics worksheet

2. Once the last part is done, you should put in the needed specifics in HUSBANDSPOUSE SOCIAL SECURITY, WIFESPOUSE SOCIAL SECURITY NUMBER, Male, Female, Male, Female, NUMBER OF THIS MARRIAGE First, By Death Divorce or Annulment, Date Month Day Year, IF PREVIOUSLY MARRIED LAST, a HUSBANDSPOUSE, a HUSBANDSPOUSE, b HUSBANDSPOUSE, b WIFESPOUSE, and c WIFESPOUSE so you can move forward to the third part.

The best way to prepare vital statistics worksheet stage 2

People generally make errors while completing Female in this part. Ensure you go over whatever you type in right here.

3. In this particular stage, look at EDUCATION Check the box that best, Some College credit but no degree, th th grade no diploma, High school graduate or GED, Some College credit but no degree, th th grade no diploma, High school graduate or GED, Unknown, b WIFESPOUSE EDUCATION th grade, Unknown, and VS Rev. Each of these will have to be filled out with greatest focus on detail.

Best ways to fill in vital statistics worksheet portion 3

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