packet “n” summary dissolution worksheet

Packet “N”

Summary Dissolution WORKSHEET FIRST READ: Summary Dissolution Checklist to determine this is the right

form packet for you and your spouse

BEGIN BY FILLING OUT SENSITIVE DATA FORM

Form 215a Affidavit of Inability to Pay _____Form 215b Affidavit of Inability to Pay _____Form 216 Petition for Summary Dissolution _____Form 217 Marital and Property Settlement Agreement-

“Exhibit A” Form 218 Findings of Fact, Conclusions of Law and Final

Decree of Dissolution _____Form 219 Order for Name Change _____Form 220 Vital Statistics Form _____Form 221 Request and Order for Final Hearing

(Revision Date: 12/2015)

DISCLAIMER

Documents are not legal advice. These documents are adaptations of the documents distributed by the Montana Supreme Court Commission on Self-Represented Litigants and have been approved by the Judges of the 4th Judicial District. These documents do not constitute legal advice, and no information contained in these documents can be relied upon to replace the advice of competent legal counsel licensed to practice in Montana.

CHECKLIST FOR SUMMARY DISSOLUTION Page 1 of 2 4th Judicial District Forms - Pro se Summary Dissolution (Revision Date: 12/15)

Check list for Summary Dissolution

Summary Dissolution is covered in Montana Code Annotated § 40-4-130. Before filing for summary dissolution, make sure you have met the following criteria. If you have not met all the criteria listed below, you should file for a joint dissolution or simply a dissolution of marriage. All of the following must apply: _____ One of the parties has lived in the Montana for at least 90 days before filing.

_____Both parties agree to attend the Final Hearing which will be scheduled at

least 20 days after the completed Dissolution documents are filed.

_____ The marriage is broken and both parties agree that the marriage should be

dissolved.

_____ The wife is not pregnant and:

____ There are no children born before or during the marriage or adopted by the

parties during the marriage

____ Neither party has any real property.

(This does not apply to the lease of a residence occupied by either party if the lease

does not include an option to purchase and if it terminates within one year from the

date of the filing of the Petition)

____ There are no unpaid, unsecured obligations in excess of $20,000 incurred by either

or both of the parties after the date of their marriage.

(An unsecured obligation is any financial obligation that does not require you to

put up collateral that could be taken back if you fail to make the agreed upon

payments. An example of an “unpaid/unsecured obligation” is credit card debt.)

____ The total fair market value of assets, excluding secured obligations, is less

than $50,000.

CHECKLIST FOR SUMMARY DISSOLUTION Page 2 of 2 4th Judicial District Forms - Pro se Summary Dissolution (Revision Date: 12/15)

(A “secured obligation” is any loan or credit in which property is pledged as

security in the event payment is not made. An example of a “secured obligation”

is a car payment.)

____ The parties have agreed on how they shall divide up the assets, including

how they plan to complete any transfers.

____ The parties waive any right to maintenance.

____ The parties, upon entry of final judgment of dissolution of marriage,

irrevocably waive their respective rights to appeal the terms of the dissolution and

their rights to move for a new trial on the dissolution.

____ The parties desire that the court dissolve the marriage.

INSTRUCTION FOR SUMMARY DISSOLUTION Page 1 of 4 4th Judicial District Forms (revised 12/15)

INSTRUCTIONS & CHECKLIST PACKET “N” – SUMMARY DISSOLUTION

BEFORE YOU BEGIN: READ THE INSTRUCTIONS It is in your best interests to consult an attorney regarding the dissolution of your marriage. The services of an attorney may be obtained through lawyer referral services by calling 406-449-6577, or by contacting Montana Legal Services at 1-800-666-6899. Under Mont. Codes Ann. §§ 40-4-130 through 40-4-136, neither party to the marriage may obtain maintenance (alimony) from the other. Upon entry of final judgment, each party’s rights and obligations with respect to the marriage, including property and maintenance rights, are permanently adjudicated without right of appeal. Neither party is barred from asking the Court to set aside the final judgment in cases of fraud, duress, accident, mistake, or other grounds recognized by law or in equity or to make a motion pursuant to the Montana Rules of Civil Procedure. Neither party may legally marry another person until the final hearing is held and the Judge of District Court signs the Final Decree. Note: You may use a pen with blue ink to fill out your forms. When your originals are drafted in blue ink you will be able to tell which documents are the originals and which are copies. Also, put N/A (“not applicable”) in any spaces that don’t apply to your situation.

THE SENSITIVE DATA FORM The Montana Supreme Court has enacted Court Rules for Privacy and Public Access to Court Records in Montana. These rules apply to all court records. There is certain information which should be maintained as confidential. Fill out the SENSITIVE DATA FORM in this packet to keep the following sensitive information confidential.

1) Complete Social Security Numbers 2) Complete Financial Account Numbers 3) Full Birth Dates

File this form with your Petition. Keep a copy in a safe place.

The Clerk will keep the Sensitive Information Form separately. The public will not have access to this document, unless the court orders it.

Note: This packet may be used when the parties AGREE on property and debt

settlement and distribution. The parties file the action TOGETHER. Both parties must appear at the final hearing which will be scheduled at least

20 days after the dissolution documents are filed.


******************************************************************* One the top left side of the first page of each document, fill in the requested information for each party. In the left side of the box, on the first page of each document, fill in your full legal name. Fill out this information the same way on the first page of every form. If you provide your email address confirm with the Clerk of Court that you would

like Orders either physically mailed or emailed to you. STEP 1. – Read and Fill Out the Forms

□ Summary Dissolution Checklist Carefully go over the Summary Dissolution Checklist. If you do not meet all

the requirements on the checklist you will need a different group of documents or “packet” to obtain your dissolution of marriage.

□ Form #215a & 215b-Affidavit of Inability to Pay Filing Fees and Other Costs:

Look at the table on page 2 of this document. If one Co-Petitioner qualifies financially but the other Co-Petitioner does not qualify, do not fill out these forms as you will not qualify for the $200 filing fee waiver. If both parties do qualify financially, according to the table on page 2, both parties must fill out their own form and submit it to the Clerk of District Court when you file your other completed documents. On page 4 you MUST list the VALUES of the property you have control over. The value is what you would sell the group of item for at a yard sale or what you would pay for the group of items at a yard sale. You do not have to list the value of your spouse’s property if you do not have access to that property. This document must be signed in front of a notary public.

□ Form #216 – Petition for Summary Dissolution Fill in every section. Both parties sign this document in front of a notary public.

□ Form #217 – Marital Property Settlement Agreement – EXHIBIT A Fill in every section. Both parties sign this document in front of a notary public. Attach this form to your Petition for Summary Dissolution, Form #216.


□ Form #218 – Findings of Fact, Conclusions of Law and Final Decree of Dissolution

Fill in every section. Do not date or sign this document. This is for the Judge to date and sign.

□ Form #219 – Order for Name Change

If you decide to restore your name to a former name, fill out this form. Make sure to spell out your full name on this form.

□ Form #220 – Vital Statistic Form Follow the instructions on the Instruction page.

□ Form #221 – Request and Order for Final Hearing Fill out as much information as you can. Leave the date and time for the hearing blank. The Clerk of District Court will fill-in the Final Hearing date and time and mail or email the day and time of your Final Hearing to you.

STEP 2. – Make Copies

□ If you would like a copy of each document for your records, make your copies

before you file the original documents with the Clerk of District Court. If you need a copy later, the Clerk charges $1.00 per page for the first 10 pages and $.50 per page thereafter.

□ Make 2 copies of Form #218 and file the copies with the original. This is your

Final Decree and each party will be required to have a certified copy. The Clerk’s office charges $10 for each certified copy. However, if you supplied 2 copies of the Final Decree, the Clerk will certify each copy for $2.00.

□ If you are filing an Order for Name Change, make two copies of this Order

too and file the copies with your original.


STEP 3. – File Your Legal Documents With the Clerk of District Court

□ Take all your Original documents, and copies of the Final Decree and Order for Name Change (if applicable), to the Clerk of District Court. The cost of filing your Dissolution documents is $200.00 (subject to change). The Clerk can accept cash, money order, credit card or personal check. If both parties financially qualify and the Judge approves your Affidavit of Inability to Pay, your filing fee will be waived.

□ The Clerk will file date stamp all your documents (copies and originals). The

Clerk will keep the originals and the copies of Form# 218 and Form# 219 (if applicable) if you provide copies. These copies will later be certified and returned to you.

STEP 4. – Hearing

□ You will be notified of the day and time of your Final Hearing. Both parties must appear. Arrive 15 minutes early and go to the Clerk’s office and look at the bulletin board to see which courtroom your hearing is being held. Go to that courtroom and quietly take a seat.

CAUTION: LEAVE YOUR CELL PHONE AT HOME OR IN YOUR CAR. IF YOU MUST BRING YOUR CELL PHONE WITH YOU, TURN IT

OFF BEFORE ENTERING THE COURTROOM. STEP 5. – Final Decree

□ After your Final Hearing take whatever the Judge gives you and go to the Clerk of District Court’s office.

□ Once the Final Decree is filed each party will need a certified copy of the

Final Decree and the wife will need a certified copy of her Order for Name Change. Copies of the certified copies cost $10 per copy. However, if you have already supplied 2 extra copies of the Final Decree, the Clerk will certify your copies for $2.00 each.

□ There may be additional fees to be paid to the Clerk of District Court unless

the Judge initially approved you Affidavits of Inability to Pay Fees and Other Costs.

Sensitive Data Form – Summary Dissolution Page 1 of 2 4th Judicial District Forms – Summary Dissolution (Revision Date: 12/15)

____________________________________ Name ____________________________________ Address ____________________________________ City State Zip Code ____________________________________ Phone Number ____________________________________ Email Address WIFE, CO-PETITIONER ____________________________________ Name ____________________________________ Address ____________________________________ City State Zip Code ____________________________________ Phone Number ____________________________________ Email Address HUSBAND, CO-PETITIONER PRO SE MONTANA FOURTH JUDICIAL DISTRICT COURT MISSOULA COUNTY

In re the Marriage of: ___________________________________, Co-Petitioner, and ___________________________________, Co-Petitioner.

Cause No.: _________________ Department No. _____________

SENSITIVE DATA FORM “CONFIDENTIAL”

Pursuant to the Privacy and Access rules of the Montana Supreme Court (AF 06-0377) sensitive data should not be filed or included in a case record, except on this form. Sensitive data is defined as social security numbers, bank account numbers, credit card numbers, other financial account numbers, and dates of birth for the parties. The Clerk will secure this form separately from other case records and will prohibit access to this information except as provided by Section 4.60(c) of the Rules on Public Access to Court Records (available at www.courts.mt.gov).

Sensitive Data Form – Summary Dissolution Page 2 of 2 4th Judicial District Forms – Summary Dissolution (Revision Date: 12/15)

Co-Petitioner, Wife: (Full Legal Name)

Full Date of Birth

Social Security Number Co-Petitioner - Husband: (Full Legal Name)

Full Date of Birth

Social Security Number Information on Financial Accounts (that are listed under “assets and debts” in court documents):

Code Name: (Last 4 digits of Account Number)

Financial Account Description (type of account and name on account)

Full Financial Institution Account Number

FA #

FA #

FA #

FA #

FA #

FA #

FA #

FA # DATED this _______ day of ____________________, 20___. _____________________________________ Co-Petitioner - Wife _____________________________________ Co-Petitioner - Husband

Note: Both parties will have access to this Sensitive Data Form.

FORM #215a – AFFIDAVIT OF INABILITY TO PAY FILING FEES AND OTHER COSTS AND ORDER 4th Judicial District Forms – Summary Dissolution (Revision date 12/15) Page 1 of 6

_______________________________ Name _______________________________ Address _______________________________ City State Zip Code _______________________________ Phone Number _______________________________ Email Address [ ] WIFE [ ] HUSBAND CO-PETITIONER

MONTANA FOURTH JUDICIAL DISTRICT COURT MISSOULA COUNTY

In re the Marriage of:

______________________________, Co-Petitioner, and

______________________________, Co-Petitioner.

Dept. _______ Cause No. ____________________ AFFIDAVIT OF INABILITY TO PAY FILING FEES AND OTHER COSTS

[WRITE CLEARLY -- ANSWER ALL QUESTIONS. USE N/A IF NOT APPLICABLE.] STATE OF MONTANA ) :ss. COUNTY OF ______________) I, __________________________________________________________, (Your Name) 1. I have a good cause of action or defense and am unable to pay the costs. 2. I request that the Court issue an order waiving prepayment of my fees. 3. I understand the court may order me to answer questions about my finances. 4. I understand if the court waives my fees, I may still have to pay later if I cannot

give the court proof of my financial eligibility or if my financial situation improves before this case is over.

I am: Single________ Married________ Divorced________ Separated________

FORM # 215a


5. I am asking the court to waive my fees because I receive (check all that apply):

□ SSI $_________________ □ Food stamps $_________________□ TANF (Welfare) $_________________□ Medicaid $_________________

AND/OR

□ The gross monthly income for all household members (before deduction for taxes)that I support or who help support me is less than listed in the table below. I amincluding all sources of income (such as child support, benefits, unemployment,dividends, interest, business rental income, etc.) [Mark the box below that describesyour household size and monthly income before taxes.]

□ I am the only person living in my household and I make less than $1,128.00 a month.

□ There are (2) people living in the household and together we make less than $1,517.00/month.







Are persons dependent on you for support? Yes_______ No_______If yes, list each person and that person's age and relationship to you:

AND/OR □ I have unusual medical or care expenses or am experiencing an emergency (describe): ___________________________________________________________________________ ___________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


EMPLOYMENT INFORMATION Employed: Yes_____ No_____ Self-Employed: Yes_____ No_____ Hourly wage $__________ Hours you work per week___________ Type of employment______________________ Length of current Employment____________ Employer's name and address_______________________________________________

Is there any reason, such as disability, family responsibilities, or pursuit of an education that prevents you from being able to work full-time?

__ Yes, please explain: __________________________________________________. __ No. Note: You may be asked for documentation before the court makes a decision on granting your request to waive the filing fees.

If unemployed: Month/Year last employed_____________________ Last hourly wage $____________ Why did you leave your last employment?___________________________________________________________

ASSETS REAL ESTATE Do you own or are you buying any land or other real estate? Yes________ No_______ If yes, what is the approximate current market value? $__________________________ What was the purchase price? $____________________________________________ When did you purchase the land or other real estate? ___________________________ Is it paid for? Yes________ No_________ If not, how much do you owe on the land or other real estate? $___________________________

FINANCIAL ACCOUNTS: Do you have:

Checking accounts? Yes_________ No_________ If yes, total amount $___________

Savings accounts? Yes_________ No_________ If yes, total amount $____________ List the banks where the accounts are held: ______________________________________________________________________________________________________________________________________________________________________ Do you have stocks or bonds? Yes__________ No__________ If yes, what is the total amount of the stocks or bonds $_________________________

Do you have wages due but not received? Yes________ No _________ If yes, list total amount $___________________________________

FORM #215a -INABILITY TO PAY FILING FEES AND OTHER COSTS AND ORDER4th Judicial District Forms – Summary Dissolution (Revision date 12/15) Page 4 of 6

Is there money owed to you? Yes__________ No__________ If yes, total amount owed to you: $______________________ ______________________________________________________________________

MOTOR VEHICLES: (You must check one box)

□ I do not own my own vehicle□ I own vehicle(s) as listed below:1. ___________________________ Year Make Model Value $________________ Loan Balance $________________ Monthly Payment $________________

2. ___________________________ Year Make Model Value $________________ Loan Balance $________________ Monthly Payment $________________



PERSONAL PROPERTY: List the value of your personal property for each category. The value can be what you would sell all the items, in each category, at a yard sale. “Other personal property” includes clothing, kitchen items, bathroom items, books, DVDs, etc…

Sporting Equipment $______________ Guns $______________

Boats $______________ Trailers/Campers $____________

Tools $______________ Electronics $____________

Furniture $__________________ Appliances $____________

Other personal property $_______________ ATV/motorcycles $____________

Describe and value other personal property you are buying:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


MONTHLY EXPENSES

List your monthly expenses: Rent $_________ House Payment $____________ Food $_________ Clothing $____________ Phone $_____________ Utilities: Water $_________ Gas $____________ Electric $_____________ Insurance: Health $_________ Auto $____________ Electronic: Cable $_________ Satellite TV $________ Internet $_____________ Other (List each item): 1. ________________________________ 2. _______________________________

3. ________________________________ 4. ________________________________

DEBTS: Credit Card Debt $______________ Medical Debt $______________ --Describe: _____________________________ ______________________________________________________________________ Other (List each item): 1. ________________________________ 2. ________________________________

3. ________________________________ 4. ________________________________

Please complete the following:

_____I prepared all of the pleadings and papers to be filed in this case myself, and no one has been, or will be, paid on my behalf. I have not paid anyone or any organization for the preparation and processing of these documents or for the forms to be used in this case.

_____I further declare that I am the person above named, that I have read the foregoing questions and information and know the same to be true to the best of my knowledge, and that IF ANY PART OF THE ABOVE IS MADE FALSELY, I AM SUBJECT TO PROSECUTION FOR PERJURY.

___________________________________________________________________ (Signature of Affiant)

SUBSCRIBED AND SWORN TO before me, a notary public, this

_______ day of _______________________, 20_______.

____________________________________________________________________

Notary Public for State of Montana Residing at_______________________________ My Commission Expires: ________________


Hon. ___________ Fourth Judicial District Missoula County Courthouse 200 West Broadway Missoula, Montana 59802 (406) 258-4780Fax (406) 258-4899



______________________________, Co-Petitioner,

and

______________________________, Co-Petitioner.

Dept. No. Cause No.: DR-

ORDER ON INABILITY TO PAY FILING FEES AND

OTHER COSTS

Having considered the information contained in [ ] Wife [ ] Husband

Co-Petitioner’s Affidavit of Inability to Pay Filing Fees and Other Costs, IT IS

HEREBY ORDERED that, pursuant to §25-10-404, MCA et seq., all officers of the

Court shall perform all services associated with this action, including filing, issuance

and service of all pleadings and Court orders, without demanding or receiving fees in

advance. Leave to file the Petition expires thirty (30) days from the date of this Order.

Dated this ______ day of ____________________, 20 ___.

____________________________________ DISTRICT COURT JUDGE

FORM #215b – AFFIDAVIT OF INABILITY TO PAY FILING FEES AND OTHER COSTS AND ORDER 4th Judicial District Forms – Summary Dissolution (Revision date 12/15) Page 1 of 6

_______________________________ Name _______________________________ Address _______________________________ City State Zip Code _______________________________ Phone Number _______________________________ Email Address [ ] WIFE [ ] HUSBAND CO-PETITIONER



______________________________, Co-Petitioner,

and

______________________________, Co-Petitioner.

Dept. _______ Cause No. ____________________

AFFIDAVIT OF INABILITY TO PAY FILING FEES AND OTHER COSTS

[WRITE CLEARLY -- ANSWER ALL QUESTIONS. USE N/A IF NOT APPLICABLE.]

STATE OF MONTANA ) :ss.

COUNTY OF ______________)

I, __________________________________________________________, (Your Name)

1. I have a good cause of action or defense and am unable to pay the costs.2. I request that the Court issue an order waiving prepayment of my fees.3. I understand the court may order me to answer questions about my finances.4. I understand if the court waives my fees, I may still have to pay later if I cannot

give the court proof of my financial eligibility or if my financial situationimproves before this case is over.

I am:

Single________ Married________ Divorced________ Separated________

FORM #215b


5. I am asking the court to waive my fees because I receive (check all that apply):

□ SSI $_________________ □ Food stamps $_________________□ TANF (Welfare) $_________________□ Medicaid $_________________

AND/OR

□ The gross monthly income for all household members (before deduction for taxes)that I support or who help support me is less than listed in the table below. I amincluding all sources of income (such as child support, benefits, unemployment,dividends, interest, business rental income, etc.) [Mark the box below that describesyour household size and monthly income before taxes.]

□ I am the only person living in my household and I make less than $1,128.00 a month.








Are persons dependent on you for support? Yes_______ No_______If yes, list each person and that person's age and relationship to you:

AND/OR □ I have unusual medical or care expenses or am experiencing an emergency (describe):

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4th Judicial District Forms – Summary Dissolution (Revision date 12/15) Page 3 of 6

EMPLOYMENT INFORMATION Employed: Yes_____ No_____ Self-Employed: Yes_____ No_____ Hourly wage $__________ Hours you work per week___________ Type of employment______________________ Length of current Employment____________ Employer's name and address_______________________________________________

Is there any reason, such as disability, family responsibilities, or pursuit of an education that prevents you from being able to work full-time?

__ Yes, please explain: __________________________________________________. __ No. Note: You may be asked for documentation before the court makes a decision on granting your request to waive the filing fees.

If unemployed: Month/Year last employed_____________________ Last hourly wage $____________ Why did you leave your last employment?___________________________________________________________

ASSETS REAL ESTATE Do you own or are you buying any land or other real estate? Yes________ No_______ If yes, what is the approximate current market value? $__________________________ What was the purchase price? $____________________________________________ When did you purchase the land or other real estate? ___________________________ Is it paid for? Yes________ No_________ If not, how much do you owe on the land or other real estate? $___________________________

FINANCIAL ACCOUNTS: Do you have:

Checking accounts? Yes_________ No_________ If yes, total amount $___________

Savings accounts? Yes_________ No_________ If yes, total amount $____________

List the banks where the accounts are held: ______________________________________________________________________________________________________________________________________________

Do you have stocks or bonds? Yes__________ No__________ If yes, what is the total amount of the stocks or bonds $_________________________

Do you have wages due but not received? Yes________ No _________ If yes, list total amount $___________________________________

FORM #215b – AFFIDAVIT OF INABILITY TO PAY FILING FEES AND OTHER COSTS AND ORDER

FORM #215b - AFFIDAVIT OF INABILITY TO PAY FILING FEES AND OTHER COSTS AND ORDER4th Judicial District Forms – Summary Dissolution (Revision date 12/15)

Page 4 of 6

Is there money owed to you? Yes__________ No__________ If yes, total amount owed to you: $______________________ ______________________________________________________________________

MOTOR VEHICLES: (You must check one box)

□ I do not own my own vehicle□ I own vehicle(s) as listed below:1. ___________________________ Year Make Model Value $________________ Loan Balance $________________ Monthly Payment $________________




PERSONAL PROPERTY: List the value of your personal property for each category. The value can be what you would sell all the items, in each category, at a yard sale. “Other personal property” includes clothing, kitchen items, bathroom items, books, DVDs, etc…

Sporting Equipment $______________ Guns $______________

Boats $______________ Trailers/Campers $____________

Tools $______________ Electronics $____________

Furniture $__________________ Appliances $____________

Other personal property $_______________ ATV/motorcycles $____________

Describe and value other personal property you are buying: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


MONTHLY EXPENSES

List your monthly expenses: Rent $_________ House Payment $____________ Food $_________ Clothing $____________ Phone $_____________ Utilities: Water $_________ Gas $____________ Electric $_____________ Insurance: Health $_________ Auto $____________ Electronic: Cable $_________ Satellite TV $________ Internet $_____________ Other (List each item): 1. ________________________________ 2. _______________________________

3. ________________________________ 4. ________________________________

DEBTS: Credit Card Debt $______________ Medical Debt $______________ --Describe: _____________________________ ______________________________________________________________________ Other (List each item): 1. ________________________________ 2. ________________________________

3. ________________________________ 4. ________________________________

Please complete the following:

_____I prepared all of the pleadings and papers to be filed in this case myself, and no one has been, or will be, paid on my behalf. I have not paid anyone or any organization for the preparation and processing of these documents or for the forms to be used in this case.

_____I further declare that I am the person above named, that I have read the foregoing questions and information and know the same to be true to the best of my knowledge, and that IF ANY PART OF THE ABOVE IS MADE FALSELY, I AM SUBJECT TO PROSECUTION FOR PERJURY.

___________________________________________________________________ (Signature of Affiant)

SUBSCRIBED AND SWORN TO before me, a notary public, this

_______ day of _______________________, 20_______.

____________________________________________________________________

Notary Public for State of Montana Residing at_______________________________ My Commission Expires: ________________


Hon. ___________ Fourth Judicial District Missoula County Courthouse 200 West Broadway Missoula, Montana 59802 (406) 258-4780 Fax (406) 258-4899


In re the Marriage of: ______________________________, Co-Petitioner, and ______________________________,

Co-Petitioner.

Dept. No. Cause No.: DR-

ORDER ON INABILITY TO PAY FILING FEES AND

OTHER COSTS

Having considered the information contained in [ ] Wife [ ] Husband

Co-Petitioner’s Affidavit of Inability to Pay Filing Fees and Other Costs, IT IS

HEREBY ORDERED that, pursuant to §25-10-404, MCA et seq., all officers of the

Court shall perform all services associated with this action, including filing, issuance

and service of all pleadings and Court orders, without demanding or receiving fees in

advance. Leave to file the Petition expires thirty (30) days from the date of this Order.

Dated this ______ day of ____________________, 20 ___.


FORM #216 - PETITION FOR SUMMARY DISSOLUTION Page 1 of 3 4th Judicial District Forms – Summary Dissolution (Revision Date: 12/15)

____________________________________ Name ____________________________________ Address ____________________________________ City State Zip Code ____________________________________ Phone Number ____________________________________ Email Address WIFE, CO-PETITIONER PRO SE ____________________________________ Name ____________________________________ Address ____________________________________ City State Zip Code ____________________________________ Phone Number ____________________________________ Email Address HUSBAND, CO-PETITIONER PRO SE MONTANA FOURTH JUDICIAL DISTRICT COURT MISSOULA COUNTY


Cause No.: _________________ Department No. _____________ PETITION FOR SUMMARY DISSOLUTION

The Petitioners jointly request this Court to issue a decree for summary dissolution of

marriage based upon the contents of this petition and subsequent hearing. The parties certify to

the Court that:

1. One or both of the parties have lived in Montana for least ninety (90) days or have otherwise

FORM #216


met residency requirements; wife having resided in Montana since ____________________,

and husband since ____________________.

2. We were married on _________________, ______, in the state of _____________________.

The marriage is registered in _______________________________ County.

3. The occupation of the wife is _____________________________ and the occupation of the

husband is _____________________________.

4. We both want our marriage dissolved because irreconcilable differences have caused the

irretrievable breakdown of our marriage.

5. We both agree to appear at a hearing before this Court.

6. There are no children from our relationship born before or during the marriage or adopted

during the marriage and the wife is not now pregnant.

7. Our property and debts are below the limits required by Mont. Code Ann. § 40-4-130 and

neither of us has any interest in any real property.

8. We are qualified to seek summary dissolution of our marriage and have entered into a written

Marital Property Settlement Agreement distributing our debts and property and have

executed all documents necessary to effect and complete the agreement. A copy of the

Marital Property Settlement Agreement is attached as “Exhibit A”.

9. (Optional) The wife seeks to restore her former name to____________________________.

10. Upon entry of the judgment for summary dissolution of marriage, we both waive any right to

maintenance or to appeal the terms of the dissolution or to request a trial.

STATE OF MONTANA )

County of _______________)

__________________________, being first duly sworn, deposes and says that she has read the foregoing Petition for Summary Dissolution of Marriage, knows the contents thereof and that the same is true to the best of her knowledge and belief. _______________________________ Co-Petitioner Wife SUBSCRIBED AND SWORN to before me this day of , 20____. ___________________________________ Notary Public for the State of Montana Printed Name: _______________________


(Notary Seal) Residing at __________________________ My Commission Expires________________ STATE OF MONTANA )

County of _______________)

__________________________, being first duly sworn, deposes and says that he has read the

foregoing Petition for Summary Dissolution of Marriage, knows the contents thereof and that the

same is true to the best of his knowledge and belief.

_______________________________ Co-Petitioner Husband SUBSCRIBED AND SWORN to before me this day of , 20____. ___________________________________ (Notary Seal) Notary Public for the State of Montana Printed Name: _______________________ Residing at __________________________ My Commission Expires________________

ATTACH YOUR COMPLETED, SIGNED AND NOTARIZED MARITAL PROPERTY

SETTLEMEMT (FORM #217) TO THIS DOCUMENT

FORM #217 - MARITAL AND PROPERTY SETTLEMENT AGREEMENT Page 1 of 5 4th Judicial District Forms – Summary Dissolution (Revision Date: 12/15)

____________________________________ Name ____________________________________ Address ____________________________________ City State Zip Code ____________________________________ Phone Number ____________________________________ Email Address WIFE, CO-PETITIONER ____________________________________ Name ____________________________________ Address ____________________________________ City State Zip Code ____________________________________ Phone Number ____________________________________ Email Address HUSBAND, CO-PETITIONER MONTANA FOURTH JUDICIAL DISTRICT COURT MISSOULA COUNTY

In re the Marriage of: ____________________________________, Co-Petitioner, and ____________________________________, Co-Petitioner.

Cause No.: _________________ Department No. _____________ MARITAL AND PROPERTY SETTLEMENT AGREEMENT

THIS AGREEMENT is made and entered into this ____ day of ______________, 20____, by and between __________________________________________, hereinafter referred to as “Wife” and ____________________________________________________, hereinafter referred to as “Husband,” RECITALS A. Wife and Husband were married on ____________________, in ________________

County, ____________________. B. [ ] No children have been born as a result of this marriage.

FORM #217


C. [ ] Wife is not pregnant. EXHIBIT A D. The parties’ marriage is irretrievably broken in that there is serious marital discord which

adversely affects the attitude of one or both of the parties toward the marriage, and there is no reasonable prospect of reconciliation. Wife and Husband stipulate, through this Agreement, to a just settlement of their respective property rights, marital liabilities, and their respective rights, duties and obligations arising out of the dissolution of their marriage.

E. [ ] Wife has been represented by .

[ ] Husband has been represented by . [ ] Wife [ ] Husband has/have not been formally represented by an attorney.

AGREEMENT

For and in consideration of the mutual covenants contained herein, Wife and Husband agree as follows:

1. DIVISION OF ASSETS. Property belonging to the parties on the date of marriage shall

remain their separate property. The parties acknowledge that they have acquired or maintained various items of personal and intangible property during the course of their marriage which has been equitably distributed between them. Each party shall retain ownership and possession of the personal property items in their separate possession and shall assume the debt against those personal property items. The equitable division of the assets and liabilities is as follows:

WIFE - ASSETS Description Value

A. B. C. D. E. F. G. H. I. J. K. TOTAL ASSETS $ HUSBAND - ASSETS Description Value

A. B. C.


D. E. F. G. H. I. J. K. TOTAL ASSETS $

WIFE - LIABILITIES Description Amount

A. B. C. D. E. F. G. H. I. TOTAL LIABILITIES $

HUSBAND - LIABILITIES Description Amount

A. B. C. D. E. F. G. H. I. TOTAL LIABILITIES $

Special Arrangements / Agreements:


2. APPORTIONMENT OF LIABILITIES. Unless otherwise specified, each party agrees to be solely responsible for the liabilities associated with each asset awarded to such party as provided in Section 1 hereof and any other debt in their separate names.

3. FULL DISCLOSURE AND WAIVER OF FORMAL DISCOVERY. The parties have

accurately, fully, and completely disclosed to each other all income, assets, and liabilities of which they are aware. The property referred to in this Agreement represents all of the property in which either party has an interest.

4. MAINTENANCE. The parties waive any right to maintenance. 5. ATTORNEY’S FEES. Each party shall remain solely liable for all attorney’s fees and costs

incurred by that party in connection with the summary dissolution proceedings, through the date of entry of a Decree of Dissolution approving this Agreement. Although a summary dissolution is not subject to appeal, either party may seek court action to enforce, modify or interpret provisions of this Agreement.

6. MUTUAL RELEASE. In consideration of the execution of this Agreement and its terms and

conditions, each party releases and forever discharges the other party, his or her personal representatives and assigns, from any and all rights, claim, demand, or obligation at any time hereafter for any purpose. Each of the parties waives all rights of inheritance in the estate of the other and any right to act as personal representative of the will or estate of the other party. Each of the parties hereby waives the right to claim or receive any family allowance, exempt property allowance or homestead allowance from the estate of the other party. Each party waives any and all additional rights which he or she has or may have by reason of the parties’ marriage, including rights of dower and curtsy, except as otherwise specifically provided herein.

7. ENFORCEMENT OF AGREEMENT. This Agreement shall be made an integral part of any

Decree of Dissolution of marriage of the parties, and shall be enforceable through execution, contempt citation, or any other remedy or procedure provided by law.

8. FUTURE INSTRUMENTS. Each party has executed any and all documents which are now

necessary or which may become necessary in the future to carry into full force and effect the terms and conditions of this Agreement.

9. VOLUNTARY AGREEMENT. This Agreement is voluntary. Each party has read and

approved the same in its entirety. Neither party is acting under duress, menace, fraud, or undue influence in the execution of this Agreement.

10. MODIFICATION. Except as provided under Montana law, this Agreement, and the Decree of

Dissolution to be entered in conformity herewith, may not be modified or amended without the express written consent, duly executed, of both parties.

11. ENTIRE UNDERSTANDING. This Agreement contains the entire understanding of the parties.

There are no promises, understandings, agreements, or representations between the parties other


than those expressly set forth in this Agreement. 12. BINDING NATURE OF AGREEMENT. This Agreement shall inure to the benefit of and be

binding upon the heirs, successors, executors, administrators, personal representatives, and assigns of the parties.

CONSENT TO ENTRY Both parties consent to the entry of the Decree of Dissolution by the OF DECREE: Fourth Judicial District Court, Missoula County, Missoula, Montana. EFFECTIVE DATE. This Agreement shall become effective and enforceable immediately upon

the execution hereof by both parties. ______________ _______________________________________ DATE Co-Petitioner, Wife STATE OF MONTANA )

:ss COUNTY OF MISSOULA ) This instrument was acknowledged before me on this day of , 20 , by .

Notary Public for the State of Montana Printed Name: Residing at: My Commission Expires:

______________ ______________________________________ DATE Co-Petitioner, Husband STATE OF MONTANA )

:ss COUNTY OF MISSOULA ) This instrument was acknowledged before me on this day of , 20 , by .

Notary Public for the State of Montana Printed Name: Residing at: My Commission Expires:

FORM #218 - FINDINGS OF FACT, CONCLUSIONS OF LAW AND FINAL DECREE Page 1 of 2 4th Judicial District Forms - Summary Dissolution (Revision Date 10/15)

Hon. ___________________ Fourth Judicial District Missoula County Courthouse 200 West Broadway Missoula, Montana 59802 (406) 258-4780 Fax (406) 258-4899 MONTANA FOURTH JUDICIAL DISTRICT COURT MISSOULA COUNTY


Cause No.: _________________ Department No.: ____________

FINDINGS OF FACT, CONCLUSIONS OF LAW AND FINAL DECREE OF SUMMARY DISSOLUTION

The Petition for Summary Dissolution was filed with this Court on the _____ day of

_______________, 20____. Both petitioners agreed to appear in Court in an open hearing and testify in

support of the Petition for Dissolution of Marriage. After considering all evidence and pleadings, the

Court finds:

FINDINGS OF FACT

1. That the parties have both signed the Petition for Summary Dissolution.

2. That there are irreconcilable differences causing the irretrievable breakdown of the

marriage.

3. That the parties meet the requirements and qualify for dissolution of marriage under Mont.

Code. Ann. § 40-4-130.

4. That the parties have no children of the relationship born or adopted before or during the

marriage and the wife is not now pregnant.

FORM #218

FORM #218- FINDINGS OF FACT, CONCLUSIONS OF LAW AND FINAL DECREE Page 2 of 2 4th Judicial District Forms - Summary Dissolution (Revision Date 12/15)

5. That the parties have entered into a written Martial and Property Settlement Agreement

(“Exhibit A”) and have executed all documents required to enact its provisions.

6. That all requirements set out in the summary dissolution statutes have been met.

CONCLUSIONS OF LAW

1. The Court has jurisdiction over this cause.

2. The marriage of the parties is irretrievably broken.

3. The parties waive any right to maintenance and upon entry of this final decree irrevocably

waive their respective rights to appeal or move for a trial on the terms of the dissolution of the

marriage.

FROM THE FOREGOING FINDINGS AND CONCLUSIONS,

THE COURT ENTERS THE FOLLOWING DECREE:

1. The marriage of the parties is dissolved.

2. The former name of the wife is restored, if requested, to ________________________.

3. The assets and debts of the parties shall be distributed between them equitably in accordance

with “Exhibit A” (the Marital and Property Settlement Agreement) attached to the Petition.

ENTERED this _____ day of __________________________, 20_____.

_______________________________

DISTRICT COURT JUDGE

FORM #219 - ORDER FOR NAME CHANGE Page 1 of 1 4th Judicial District Forms –Summary Dissolution (Revision Date 12/15)

Hon. ___________ Fourth Judicial District Missoula County Courthouse 200 West Broadway Missoula, Montana 59802 (406) 258-4780 Fax (406) 258-4899

MONTANA FOURTH JUDICIAL DISTRICT COURT,

MISSOULA COUNTY In re the Marriage of:

______________________________,

Co-Petitioner,

and

______________________________,

Co-Petitioner.

Dept. No.

Cause No.:

ORDER FOR NAME CHANGE

The Court hereby ORDERS that Co-Petitioner, Wife, ____________________,

whose date of birth is: ____________________________, shall be restored to the

name of:___________________________. This document shall be SEALED by

order of the Court.

SO ORDERED this _________ day of ____________________, 20___.

___________________________________ DISTRICT COURT JUDGE

FORM #219

FORM #220 - VITAL STATISTICS REPORTING FORM Page 1 4th Judicial District Forms – Summary Dissolution (Revision Date: 12/15)

INSTRUCTIONS First Box: Fill in the County where your dissolution is filed. The Judicial District for Missoula County is 4th. Check the box next to Dissolution of Marriage and fill in the County that issued your Marriage License, the City, County, and State where the Marriage originated and the Date of the Marriage. Lastly, check the box next to Without Child Support Order. Parts 1 and 2: Provide information about the parties. You do not need to include your Social Security Numbers. Fill in the remaining blanks in parts 1 and 2. Then skip to part 9. Part 9: Provide information about the person completing this form and sign.

FORM # 220


MONTANA STATE CASE REGISTRY AND VITAL STATISTICS REPORTING FORM

DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES

County / Tribe __________________________________ Judicial District No._______ Cause No. _______________

Date Decree/ Order Signed _____________________________ ☐ Dissolution of Marriage

County that Issued Marriage License___________________ City, County, State of Marriage ________________________ Date of Marriage ___________________________________ ☐ With Child Support Order☐ Without Child Support Order (Complete Parts 1, 2 & 9

only) ☐ Modification of child Support Order

☐ Child Support Order, without Dissolution(Includes Temporary Support Orders and Paternity Orders with Child Support)

☐ Legal Separation with Child Support Order☐ Dependent Neglect / Juvenile Delinquency☐ Invalid Marriage - Specify Legal Grounds for Action

__________________________________________

1 Mother/Wife: ☐ Payer ☐ Payee ☐ B oth ☐ N / A Maiden N am e: _______________________________

Name:_____________________________________________ SSN:_______________ Telephone:(____)__________ Last First Middle/Suffix

Mailing Address:________________________________________________________________________________ Street City State Zip

Residential Address (if different from above): _________________________________________________________ Date of Birth: ___________________________ Place of Birth: _____________________________ Race: _______

State / Foreign CountryDriver’s License # / State _____________________________ Occupation: _________________________________ Number of this marriage (1st, 2nd, etc.):_____ Date, City & State of previous marriage(s): ____________________

2 Father/Husband: ☐ Payer ☐ Payee ☐ B oth ☐ N /AName:_____________________________________________ SSN:_______________ Telephone:(____)__________

Last First Middle/Suffix

Mailing Address:_________________________________________________________________________________ Street City State Zip

Residential Address (if different from above): __________________________________________________________ Date of Birth: ___________________________ Place of Birth:____________________________ Race:_______

State / Foreign CountryDriver’s License # / State _____________________________ Occupation:_________________________________ Number of this marriage (1st, 2nd, etc.):_____ Date, City & State of previous marriage(s): _____________________

☐ Other Payee: If support is to be paid to another payee, check here and complete Part 4.


3 Names of Children Included in the Support Order Residing Last First Middle Date of Birth Sex SSN With ** _________________________________________ _________________ M F ___________________ M F B O _________________________________________ _________________ M F ___________________ M F B O _________________________________________ _________________ M F ___________________ M F B O _________________________________________ _________________ M F ___________________ M F B O _________________________________________ _________________ M F ___________________ M F B O _________________________________________ _________________ M F ___________________ M F B O

* M = Mother F = Father B = Both O = Other

If any of the above-named children are not residing with a parent, list the child’s name and address : ________________________________________________________________________________________________________ ________________________________________________________________________________________________________

4 Other Payee: Name of person/agency owed support if not parent:______________________________________________________

Last Name or Agency Name First Middle

Mailing Address:________________________________________________________Telephone: (___)__________ Street City State Zip

Residential Address (if different from above): _________________________________________________________

5 Protective Order: Is a party to this action protected from another party to the action by an order of protection? ☐ N oIf yes, enter name(s) of protected party(ies):___________________________________________________________

6 Employer/Income Source Information: Provide information about the payer’s employment or periodic source of income. (Attach additional pages if needed.) ☐ Check here if this order requires both parties to pay support and skip Parts 6 & 7 and com plete Parts 8, 9, 10 & 11.

_______________________________________________________________________________________________ Name of Employer or Source of Income Telephone

_______________________________________________________________________________________________ Street City State Zip

7 Support Order: Date Order Signed:_________________

Check type of support and enter appropriate information If applicable, arrears due at time of order: $ ____________

Support Type Total Due Frequency Begin Date End Date Judgment Penalty* Fees* Interest*

☐ Child Support: $_________ per __________ _______ ________ $_______ $______ $_______ $______


☐ Medical Support: $__________ per __________ ________ ________ $_______ $______ $_______ $______

☐Spousal Support : $_________ per __________ ________ ________ $_______ $______ $_______ $______ (Alimony)

Is payer exempt from income withholding under MCA §40-5-315? ☐ Yes ☐ NoList any special terms/conditions of the support order(s): _________________________________________________ _______________________________________________________________________________________________ Was the mother represented by an attorney? ☐ Yes ☐ No Was the father represented by an attorney? ☐ Yes ☐ No

Information from child support guidelines worksheet: Mother “Income after Deductions”: $_________ “Credit for Payment of Expenses”: $_____

Father “Income after Deductions”: $_________ “Credit for Payment of Expenses”: $_____

8 Health Insurance: (Attach additional pages if needed.) Is health insurance provided for the children? ☐ Yes ☐ No ( If yes answer last question in this section) Name and relationship of party providing insurance: ________________________________ Policy No. ___________ Name of insurance carrier or health benefit plan :________________________________________________________ Address of insurance carrier or health benefit plan: _____________________________________________________ Names of children covered: _______________________________________________________________________ Terms/conditions of coverage: ______________________________________________________________________ If children are not covered, is coverage available through:

Father’s employer? ☐ Y es ☐ N o Mother’s employer? ☐ Yes ☐ No

9 This form was completed by: Name / Title: _________________________________________________________ Telephone: ________________ Signature: __________________________________ Date: __________________

Complete next page if both parties are ordered to pay child support. Information contained in this form is private and confidential. It may only be shared with courts, agencies and individuals authorized by MCA 40-5-923.

Multiple Payers: Complete Parts 10 and 11 only if the order requires both parties to pay support.

10 Mother’s Employer/Income Source Information: Provide information about the mother’s employment or periodic source of income. (Attach additional pages if needed.) _______________________________________________________________________________________________ Name of Employer or Source of Income Telephone

_______________________________________________________________________________________________ Street City State

Zip

Father’s Employer/Income Source Information: Provide information about the father’s employment or periodic source of income. (Attach additional pages if needed.) _______________________________________________________________________________________________ Name of Employer or Source of Income Telephone

_______________________________________________________________________________________________ Street City State

Zip

11 Support Order: Date Order Signed:_________________

Mother’s Support Obligation If applicable, arrears due at time of order: $ _____

Check type of support and enter appropriate information


Support Type Total Due Frequency Begin Date End Date Judgment Penalty * Fees* Interest* (*list amounts if included in judgment)

☐ Child Support $_________ per __________ ________ ________ $_______ $______ $_______ $______

☐ Medical Support : $________ per __________ ________ ________ $_______ $______ $_______ $______

☐ Spousal Support $__________ per __________ ________ ________ $_______ $______ $_______ $______ (Alimony)

Is the mother exempt from income withholding under MCA §40-5-315?

Father’s Support Obligation If applicable, arrears due at time of order: $ ________

Check type of support and enter appropriate information Support Type Total Due Frequency Begin Date End Date Judgment Penalty* Fees* Interest*

(*list amounts if included in judgment)

☐ C hild Support $__________ per __________ ________ ________ $_______ $______ $_______ $______

☐ Medical Support: $_________ per _________ ________ ________ $_______ $______ $_______ $______

☐ Spousal Support: $__________ per _________ ________ ________ $_______ $______ $_______ $______ (Alimony)

Is the father exempt from income withholding under MCA §40-5-315?

List any special terms/conditions of the support order(s): _________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________

Was the mother represented by an attorney? ☐ Y es ☐ N o Was the father represented by an attorney? ☐ Yes ☐ No

Information from child support guidelines worksheet: Mother: “Income after Deductions”: $_________ “Credit for Payment of Expenses”: $_________ Father: “Income after Deductions”: $_________ “Credit for Payment of Expenses”: $_________

☐ Yes ☐ No

☐ Yes ☐ No

FORM #221 – REQUEST FOR HEARING - SUMMARY DISSOLUTION Page 1 of 3 4th Judicial District Forms – Summary Dissolution (Revision Date: 12/15)

____________________________________ Name ____________________________________ Address ____________________________________ City State Zip Code ____________________________________ Phone Number ____________________________________ Email Address WIFE, CO-PETITIONER

____________________________________ Name ____________________________________ Address ____________________________________ City State Zip Code ____________________________________ Phone Number ____________________________________ Email Address HUSBAND, CO-PETITIONER



___________________________________, Co-Petitioner,

and

___________________________________, Co-Petitioner.

Cause No.: _________________ Department No. _____________

REQUEST FOR HEARING

COMES NOW the Petitioners and respectfully request that this Court schedule a hearing

for the purpose of obtaining a Final Decree of Summary Dissolution in the above entitled cause.

FORM #221


The Petitioners estimate that the hearing will only be 15 minutes and that the Petitioners will be

the only people to testify.

DATED this ____ day of_____________________, 20_____.

_______________________________ Wife, Petitioner Pro Se

_______________________________ Print Name

_______________________________ Husband, Petitioner Pro Se

_______________________________ Print Name


Hon. ___________ Fourth Judicial District Missoula County Courthouse 200 West Broadway Missoula, Montana 59802 (406) 258-4780 Fax (406) 258-4899 MONTANA FOURTH JUDICIAL DISTRICT COURT MISSOULA COUNTY


Cause No.: _________________ Department No. _____________ ORDER GRANTING HEARING

IT IS HEREBY ORDERED that the final hearing in this matter is scheduled for the ____

day of _______________________, 20___, at ________ o’clock ___.m.

DATED this _____ day of ____________________________, 20____.
