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Petitioner Respondent has been a resident of this state for at least six months and1. RESIDENCE (Dissolution only)
of this county for at least three months immediately preceding the filing of this Petition for Dissolution of Marriage.
2. STATISTICAL FACTS
c. Time from date of marriage to date of separation (specify):
a. Date of marriage:
b. Date of separation:
3. DECLARATION REGARDING MINOR CHILDREN (include children of this relationship born prior to or during the marriage or
adopted during the marriage):
There are no minor children.
The minor children are:
Continued on Attachment 3b.
c. If there are minor children of the Petitioner and Respondent, a completed Declaration Under Uniform Child Custody Jurisdiction
and Enforcement Act (UCCJEA) (form FL-105) must be attached.
A completed voluntary declaration of paternity regarding minor children born to the Petitioner and Respondent prior to
the marriage is attached.
NOTICE: You may redact (black out) social security numbers from any written material filed with the court in this case
other than a form used to collect child or spousal support.
Page 1 of 2
Form Adopted for Mandatory Use
Judicial Council of California
FL-100 [Rev. January 1, 2005]
Family Code, §§ 2330, 3409;
FOR COURT USE ONLYATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.:FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
CITY AND ZIP CODE:
Dissolution of Marriage
Nullity of Marriage
Petitioner requeststhat the assets and debts listed
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