Instructions for Divorce – Without Children

Only Pro-Se forms from our website will be accepted

CONTENTS: Instructions (3 pages); Civil Information Sheet (1 page); Petition (2 pages);

Temporary Order (6 pages); Temporary Ex Parte Order (2 pages); Domestic
Relations Affidavit (6 Pages); Notice of Intent to Appear (2 pages); Entry of
Appearance & Waiver of Service (1 page); Summons (1 page); Decree of
Divorce (6 pages); and Certificate of Divorce or Annulment (1 page)

Read Directions Completely – Please Type or Print Neatly

COURT STAFF CANNOT PROVIDE ASSISTANCE OR ADVICE
IN COMPLETING FORMS

Caution: Use of forms without the assistance of a lawyer could harm your legal rights.
You may want to have a lawyer review your completed forms before you file them with
the court. These are basic forms and may not cover every situation.

1. Petitioner: Complete the Civil Information Sheet (Person Filing Petition will
always be designated the Petitioner; Respondent is person who has been filed
against and will always be designated the Respondent)

2. Petitioner: Complete the Petition except for the case and court numbers.
Paragraph 8 may be omitted).

3. Sign the Petition in front of a Notary. Bring Petition for Judge’s signature.

4. Petitioner: If needed, complete the Temporary Order and bring for Judge’s
signature. No line can be blank. If it states Husband/Wife you must circle
whatever is applicable.

5. Petitioner: Complete Rule 401 Affidavit for Ex Parte Temporary Order. Sign
in front of a Notary.

6. Petitioner: Complete Domestic Relations Affidavit (sign in front of a Notary)

and present with Temporary Order for Judge’s signature.

PETITIONS/TEMPORARY ORDERS/DOMESTIC RELATIONS AFFIDAVITS

CAN BE BROUGHT FOR APPROVAL TO THE 4TH FLOOR
ON
WEDNESDAY AND THURSDAY AFTERNOONS
BETWEEN 1:30 P.M. AND 3:30 P.M.

7. File the original and 2 copies of Items 2 through 5 with the Clerk of the District
Court (7th floor of the Sedgwick County Courthouse). The filing fee is $197.00. It
can be paid by money order, cashier’s check, cash or personal check.

8. Obtain case and court numbers from the Clerk of the District Court when you file.
9. Notify Respondent (spouse) by providing a copy of the Petition, Temporary
Order, Domestic Relations Affidavit, Notice of Intent to Appear and Entry of
Appearance & Waiver of Service, and Proposed Journal Entry and Decree of
Divorce by: waiver, sheriff’s service, special process server, certified mail-return
receipt or by publication.

a) By Waiver: Respondent completes the Entry of Appearance and

Waiver of Service and signs it in front of a Notary or Deputy Clerk. If the
Respondent is given a copy of the Petition before it is filed he/she may
complete and sign (notarized) the Entry of Appearance and Waiver of
Service and it may be filed at the same time as the Petition.

b) By Sheriff’s Service: Complete a Summons provided with this packet.

File it along with a $15.00 money order, cashier’s check or cash payable to
__(Name of County where service will take place)_ County Sheriff's Office.
The Clerk will issue the paperwork to the Sheriff’s Office.

c) By Special Process Server: Petitioner should look in the yellow pages

of the phone book under “Process Servers.”

d) By Mail: Complete a Summons provided with this packet and mail it

along with a copy of Items 2 through 5 to Respondent. Mail copies of
Items 2 through 5 by certified mail – return receipt requested. The form:
Return of Service for Certified Mail, must be filed with the Clerk of the
District Court after service by certified mail (green card) is returned to you.
Respondent must sign for documents.

e) By Publication: If the Respondent cannot otherwise be located, service

on the Respondent can be obtained by publication. To obtain service by
publication, Petitioner can pick up the appropriate forms from the Clerk.

SECOND PHASE—NO SOONER THAN 60 DAYS AFTER

THE FILING OF THE INITIAL PETITION

10. NO SOONER than sixty (60) days after the filing of the Petition, the Decree of
Divorce must be filled out completely and signed by the parties. NOTE: The
parties do not have to sign the Decree in front of a Notary, and they may sign the
Decree individually or together, and they may sign it either before or after
Petitioner has brought the Decree to the courthouse.

11. Petitioner: Complete the Affidavit of Petitioner and sign it in front of a notary.
This Affidavit must be presented with the completed Decree of Divorce.

12. Petitioner: Complete a Certificate of Divorce as it must be filed with the Clerk of
the District Court at the time you file your Decree.
13. Decree of Divorce can be brought to the 4th floor for approval on Wednesday and
Thursday afternoons between 1:30 pm and 3:30 pm.

14. After getting approval, file the original Decree, Affidavit and the Certificate of
Divorce with the Clerk of the District Court. After the Judge has signed your
Decree, make two copies of the Decree—one copy for yourself and you must
mail one copy to the Respondent. If there is Title to Real Estate Involved, you
must file two extra copies with the Clerk of the District Court.

Additional District Court Clerk Fees

That May Apply: .25 Copies per page

1.00 Certified Copy of Paperwork

12.50 Garnishments

62.00_Motion Filing Fee

ATTENTION: If Divorce is not completed within 120 days, your case may be
dismissed after proper notice from the Courts at the address provided by
Petitioner at the time of filing.
EXHIBIT A
For Office Use Only
CIVIL COVER SHEET
The civil information sheet neither replaces nor supplements the filing and service of pleadings or other papers as required by law.
This form is required for use by the Clerk of the District Court for the purposes of initiating the civil docket sheet. This information
will not be available to the public and this document will be stored in a separate location from the case file and then destroyed within
a reasonable time. A new case will not be accepted without a cover sheet attached. (THIS FORM MUST BE TYPED OR PRINTED
LEGIBLY). This form can be found at www.kscourts.org.
NATURE OF SUIT (Click or mark in one circle only - If the case involves more than one of the following categories, indicate the category
having the highest dollar value)
CIVIL If a CH 61: $ ________________________ (Judgment Demand Amount)
TORT CONTRACT REAL PROPERTY ● STATE TAX
● Asbestos Product Liability ● Buyer Plaintiff ● Eminent Domain WARRANT
● Automobile Tort ● Employment Dispute - Discrimination ● Mortgage Foreclosure
● Intentional Tort ● Employment Dispute - Other ● Other Real Property
● Legal Malpractice ● Fraud
● Medical Malpractice ● Landlord/Tenant - Unlawful Detainer MISCELLANEOUS
● Other Professional Malpractice ● Landlord/Tenant Dispute - Other ● 60-1507
● Premises Liability ● Seller Plaintiff (debt collection) ● Habeas Corpus
● Slander/Libel/Defamation ● Other Contract ● Other Writs
● Tobacco Product Liability
● Toxic/Other Product Liability CIVIL APPEALS ● OTHER CIVIL
● Other Tort ● Administrative Agency
● Other Civil Appeal ● SMALL CLAIMS
DOMESTIC
● MARRIAGE DISSOLUTION/DIVORCE ● PROTECTION FROM ABUSE ● PROTECTION FROM STALKING ● UIFSA
● OTHER DOMESTIC RELATIONS ● NON-D
DIVORCE SUPPORT. CUSTODY OR VISITATION ● PATERNITY
PROBATE/ESTATE
GUARDIAN /CONSERVATOR ● DETERMINATION OF DESCENT ● ELDER ABUSE ● ADOPTION
● Conservatorship/Trusteeship
● Guardianship - Adult ● SEXUALLY VIOLENT PREDATOR ● OTHER PROBATE / ESTATE
● Guardianhip - Minor
● Guardian/Conservator - Adult ● DECEDENT ESTATE ● CARE AND TREATMENT
● Guardian/ConServatOr - Minor

JURY DEMAND ● YES (Check yes only if jury demand is included in petition or as a separate pleading) ● NO
SUMMONS ATTACHED: ● YES ● NO
SERVICE BY: PROCESS SERVER/ATIORNEY SHERIFF IN STATE _____________ SHERIFF OUT OF STATE _______________
County State
SHERIFF'S PROCESS FEE ATTACHED ● YES ● NO
PLAINTIFF / SUBJECT INFORMATION DEFENDANT / OTHER PARTY INFORMATION
(ATTACH ADDITIONAL SHEET, IF NECESSARY) (ATTACH ADDITIONAL SHEET, IF NECESSARY)

NAME: ________________________________________________ NAME: _____________________________________ ____________

ADDRESS: ______________________________________________ ADDRESS: _______________________________________________
PHONE: ________________________ SEX: __________________ PHONE: _________________________ SEX: __________________
SSN: ______________________ DOB _____________________ __ SSN ________________________ DOB _____________________
DL OR STATE ID NO: _______________________________________ DL OR STATE ID NO: ______________________________________
State and Number State and Number

ALIAS NAMES USED: ___________________________________ ALIAS NAMES USED: ___________________________________

___________________________________________________ ___________________________________________________
ATTORNEYS ATTORNEYS (if known)
(Firm Name, Address, Telephone Number and Supreme Court ID Number) (Firm Name, Address, Telephone Number and Supreme Court ID Number)

___________________________________________________ ___________________________________________________
___________________________________________________ ___________________________________________________
___________________________________________________ ___________________________________________________
FOR DOMESTIC CASES - NAME, DATE OF BIRTH AND SOCIAL SECURITY NUMBER OF EACH DEPENDENT CHILD:
(Name) (Date of Birth) (Social Security Number)

The requirement that Social Security numbers be included on domestic cases is mandatory, and authorized by the Supreme Court and federal law. On non-domestic cases, the Social Security number is not
mandatory. The number is used for purposes of identification and may be disclosed as permitted by law. This form is not considered to be a public record.
PS-2533
 IN THE 18TH JUDICIAL DISTRICT, DISTRICT COURT
SEDGWICK COUNTY, KANSAS
FAMILY LAW DEPARTMENT

IN THE MATTER OF THE MARRIAGE OF )

)
______________________________, )
)
and ) Case No.____________________
)
_______________________________. )
__________________________________________)
Petition Pursuant to K.S.A. Chapter 60

PETITION FOR DIVORCE

(With no minor children of this marriage)

The Petitioner states:

1. Petitioner is now and has been a resident in the State of Kansas for more than sixty

(60) days before this Petition is filed and is currently a resident of Sedgwick County, Kansas.

2. Respondent is now living at:

Street address: _____________________________

City, state, zip: _____________________________

Telephone: _____________________________

3. Petitioner and Respondent were married on the following date:_______________,

_____ (marriage date and year) in the following city and state: _______________________,and

have been married since that date.

4. Petitioner and Respondent should be divorced because they are incompatible, and they

are no longer able to live together.

5. That venue in Sedgwick County, Kansas, is proper, and this Court has jurisdiction over

both parties hereto and the subject matter herein.

 6. Petitioner and Respondent do not now have any children born of their marriage who

are under the age of eighteen (18) years and the Wife is not pregnant at the time this Petition is

filed.

7. During their marriage, Petitioner and Respondent have obtained property and debt that

should be distributed between Petitioner and Respondent as they may agree, or as the court may

decide if the parties cannot agree.

8. Petitioner requests that Wife be restored to the following last name: ______________.

WHEREFORE, Petitioner prays that upon final hearing Petitioner be granted a divorce,

that the property and debt of the parties be distributed between them and that the Court issue

such other orders as are appropriate.

_________________________________
Petitioner Pro Se (signature)
Street address:__________________
City,State,Zip:__________________
Telephone: __________________

VERIFICATION

STATE OF Kansas )
COUNTY OF SEDGWICK ) ss.

I swear or affirm, under penalty of perjury, that I am the Petitioner in this case, and that
the statements made in this Petition are true.

Executed this _____ day of __________________, 20_____.

_________________________________
Petitioner, Pro Se

SUBSCRIBED AND SWORN to before me, a Notary Public, this ______ day of
__________________________, 20_____.

__________________________________
Notary Public
My appointment expires: _____________
 IN THE EIGHTEENTH JUDICIAL DISTRICT
DISTRICT COURT, SEDGWICK COUNTY, KANSAS
FAMILY LAW DEPARTMENT

)
_____________________________ )
Petitioner, )
)
vs. ) Case No. _____ DM ______
)
)
______________________________ )
Respondent. )
____________________________________)

RULE 401 AFFIDAVIT FOR EX PARTE TEMPORARY ORDER

__________________________, of lawful age, states under oath:

1. _____ That I have moved out of the marital residence.

_____ That the Respondent has moved out of the marital residence.
_____ That neither party has moved out of the marital residence.

2. _____ That I have alternative housing available.

_____ That the Respondent has alternative housing available.
_____ That neither party has alternative housing available.
_____ That both parties have alternative housing available.

3. _____ That I do not have financial resources to obtain alternative housing.

_____ That the Respondent does not have financial resources to obtain
alternative housing.
_____ That both parties have financial resources to obtain alternative housing.

4. ____ That I have the following health conditions:

_____ That the Respondent has the following health conditions:
_____ That neither party has health conditions.

5. That I am: That my spouse is:

_____ employed full-time. _____ employed full-time.
_____ employed part-time. _____ employed part-time.
_____ a stay at home parent. _____ a stay at home parent
_____ unemployed. _____ unemployed.

6. _____ That sole legal custody of the minor child(ren) is not requested.
7. _____ That I currently have residential custody of the minor child(ren).
_____ That the Respondent currently has residential custody of the minor
child(ren).
_____ The Respondent and I currently have residential custody of the minor
child(ren).

8. _____ That I have left the marital residence with the minor child(ren).
_____ That I have left the marital residence without the minor child(ren).
_____ That Respondent has left the marital residence with the minor child(ren).
_____ That Respondent has left the marital residence without the minor
child(ren).
_____ That neither party has left the marital residence.

9. _____ That the child(ren) has/have special needs, which I have been providing.
_____ That the child(ren) does/do not have special needs.

_____________________________
Petitioner

STATE OF KANSAS
ss:
SEDGWICK COUNTY

BE IT REMEMBERED that on this ____ day of _____, 20__, before me a Notary

Public, in and for said County and State, personally appeared, who is personally known
to me to be the same person who executed the foregoing instrument, and duly
acknowledged the execution of the same.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official

seal on the day and year last above written.

_____________________________
NOTARY PUBLIC

My Appointment Expires:
 IN THE EIGHTEENTH JUDICIAL DISTRICT
DISTRICT COURT, SEDGWICK COUNTY, KANSAS
FAMILY LAW DEPARTMENT

IN THE MATTER OF THE MARRIAGE OF )

)
______________________________, )
)
and ) Case No.____________________
)
_______________________________. )
__________________________________________)
Petition Pursuant to K.S.A. Chapter 60

TEMPORARY ORDER
(With no minor children of this marriage)

NOW on this _________day of _____________, 20_____, comes the Petitioner,

_________________, (who is hereinafter designated as "Husband/Wife" or "Petitioner") and

hereby requests that the Court issue proper orders so that Petitioner and Respondent,

________________________, (who is hereinafter designated as "Husband/Wife" or

"Respondent"), may temporarily live separate and apart from each other and make orderly

provisions for the period of time until dismissal of this action, further order of this Court, or trial

of this case. After reviewing the Court file and hearing statements of counsel, the Court

ORDERS, ADJUDGES and DECREES:

I. SPOUSAL MAINTENANCE

A. _____ Not Applicable

B. _____ Husband/Wife is ordered to pay ___________ per month as and for spousal

maintenance of Husband/Wife beginning ___________________. Said obligation shall

terminate upon the death of either Husband or Wife. Said support shall be paid through the
Kansas Payment Center at the address listed in Article II.

II. ADDRESS FOR PAYMENTS AND ROLE OF COURT TRUSTEE

A. _____ Not Applicable

B. _____ The address for spousal maintenance payments is as follows:

Kansas Payment Center

Box 758599
Topeka, KS 66675 8599

The case number shown on the first page of this order shall be placed on all checks or

money orders and said checks or money orders shall be made payable to the Kansas Payment

Center and include the county designation (SG).

The Kansas Payment Center shall forward said payments to Husband/Wife at ________

____________________________________________(city, state, zip) and it shall be the

responsibility of Husband/Wife to inform the Clerk of any change in address.

No commission shall be credited to the Court Trustee for payments under this order.

III. FAILURE TO PAY SPOUSAL MAINTENANCE

A. _____ Not Applicable

B. _____ Should the payor fail to be current with the spousal maintenance obligations as

set out herein so that there is an arrearage in an amount equal to or greater than the amount of

spousal maintenance payable for two months if only spousal support is ordered, an

income withholding order shall be issued by the Court upon proper application. The income

withholding order shall require any payor of income to the party in arrears to withhold income

from each pay period in the necessary and lawful amounts to pay the current spousal

maintenance obligation and to reduce the accrued arrearage.

The above orders for spousal maintenance may be enforced by garnishment unless the
Husband/Wife requests a hearing to contest the issuance of an Order of Garnishment within

seven (7) days after the service of the within order of spousal maintenance upon Husband/Wife.

IV. RESIDENCE

A. _____ Not Applicable

B. _____Husband/Wife shall have the temporary possession of the residence located at –

__________________________________________________(city, state, zip) and the

Husband/Wife shall have vacated the said residence within twenty four (24) hours after the

service of this Order.

The Husband/Wife, ___________________(name of person leaving dwelling), is

granted the right to remove from the dwelling personal effects necessary for personal hygiene

and personal clothing for the Husband/Wife.

Husband/Wife is hereby given notice that their return to said residence without the

permission or upon the invitation of Husband/Wife could be considered a Criminal Trespass

under K.S.A. 21 3721 and appropriate municipal ordinance, for which he or she could be

prosecuted.

If Husband/Wife has not voluntarily vacated this dwelling after twenty four (24) hours

of being served with the Temporary Orders, then any duly authorized law enforcement officer of

the State of Kansas is requested to use reasonable and necessary means to evict Husband/Wife

from this dwelling.

V. PERSONAL PROPERTY

A. _____ Not Applicable

B. _____ Husband shall remain in temporary possession of the following items of

property:
 A. _____ Not Applicable

B. _____ Wife shall remain in temporary possession of the following items of property:

Any duly authorized law enforcement officer of the State of Kansas is requested to use

reasonable and necessary means to prevent Husband/Wife from interfering with the

Wife’s/Husband's removal of his/her personal clothing and such personal effects as set forth

herein.

VI. DEBTS

A. _____ Not Applicable

B. _____ Husband shall be temporarily responsible for the periodic payment of the

following debts:

(Description of Debts to be paid by Husband) (Amount Owed)

_______________________________________ __________________

_______________________________________ __________________

_______________________________________ __________________

_______________________________________ __________________
 A. _____ Not Applicable

B. _____ Wife shall be temporarily responsible for the periodic payment of the

following debts:

(Description of Debts to be paid by Wife) (Amount Owed)

_______________________________________ __________________

_______________________________________ __________________

_______________________________________ __________________

_______________________________________ __________________

_______________________________________ ____________________

Each party shall be responsible for individual debts and obligations incurred after the

date the Petition herein is filed.

VII. RESTRAINT

The parties are jointly restrained and enjoined from molesting or interfering with the

privacy or rights of each other in any manner. Furthermore, they are restrained from disposing,

encumbering or changing the nature of any property of the parties or of each of them without

prior Court approval other than for reasonable living expenses or attorney fees.

In addition, the parties are restrained and enjoined from canceling any utility services

and/or deposits or canceling or modifying (including changing beneficiaries) of any existing

pension benefits, medical, health, automobile, homeowner's or renter's, life, or disability

insurance coverage's involving any family members or their property.

VIII. RECONCILIATION

In event of a reconciliation of the parties before trial, the filing party shall promptly

notify his or her attorney, or if petitioner does not have an attorney, shall promptly prepare and
present to this Court a Journal Entry of Dismissal.

IX. ENFORCEMENT

Nothing in this Temporary Order shall be construed as a final decision concerning the

property or rights of either party. The ultimate decision relating to all such matters will be made

at the time of trial. This Temporary Order shall remain in effect until the trial of this case unless

modified by the Court upon the motion of either party. DISOBEDIENCE OF THIS ORDER OF

THE COURT IS PUNISHABLE AS INDIRECT CONTEMPT OF COURT AND MAY BE

PUNISHED BY CONFINEMENT IN JAIL. Any duly authorized law enforcement officer of the

State of Kansas is directed to use reasonable and necessary means to enforce the provisions of

this Temporary Order.

X. HEARING

Husband/Wife may appear before this Court at 1:30 pm on any Monday, or at

9:30 am or 1:30 pm on Tuesday, on the 4th floor of the Sedgwick County Courthouse, 525 North

Main, Wichita, Kansas, for the purpose of modifying any of the orders contained herein.

If Husband/Wife intends to appear, Husband's/Wife's counsel, or if not represented

the other party, must be notified by Husband/Wife completing and filing one of the attached

form(s) with the Clerk of the Court and by serving the other copy of the form to

Husband's/Wife's counsel, or if not represented the other party, not later than seven (7) business

days before the time specified for the court hearing.

_________________________________
JUDGE OF THE DISTRICT COURT
FAMILY LAW DEPARTMENT

APPROVED:

_______________________
Petitioner, Pro Se
 IN THE EIGHTEENTH JUDICIAL DISTRICT
DISTRICT COURT, SEDGWICK COUNTY, KANSAS
FAMILY LAW DEPARTMENT

IN THE MATTER OF THE MARRIAGE OF )

)
______________________________, )
)
and ) Case No.____________________
)
______________________________, )
__________________________________________)
Petition Pursuant to K.S.A. Chapter 60

DOMESTIC RELATIONS AFFIDAVIT OF

_________________________________
(Name of Party)

1. Petitioner’s Residence: __________________________________

__________________________________
DOB: _______________________
SSN: XXX-XX-______________

2. Respondent’s Residence: __________________________________

__________________________________
DOB: ________________________
SSN: XXX-XX-_______________

3. Date of Marriage: ________________________

Date of Separation: ________________________

4. Number of marriage:

Petitioner: ___
Respondent: ___

5. _____ Not Applicable

_____Names and dates of birth of minor children of previous relationships and facts as
to custody and support payments paid or received, if any, living at home:

Name SSN DOB Custodian

____________________ XXX-XX-____ ____________ ________

 ____________________ XXX-XX-____ ____________ ________

ATTACH SHEET FOR ADDITIONAL CHILDREN IF NEEDED: ___Yes ___No

6. Petitioner is employed by: ___________________________

Respondent is employed by: ___________________________

A. Wage Earner Petitioner Respondent

(1). Gross Wages $___________ $__________
(2). Other Income $___________ $__________
(3). Subtotal Gross Income $___________ $__________

(4). Federal Withholding $___________ $__________

(claiming ___exemptions)
(5). Federal Income Tax $___________ $__________
(6). OASDHI $___________ $__________
(7). Kansas Withholding $___________ $__________
(8). Subtotal Deductions $___________ $__________

(9). Net Income $___________ $__________

B. Self-employed Petitioner Respondent

(1). Gross Income $___________ $__________
(2). Other Income $___________ $__________
(3). Subtotal Gross Income $___________ $__________

(4). Reasonable Business Expenses

(Itemize on attached ex.) $___________ $__________
(5). Self-Employment Tax $___________ $__________
(6). Estimated Tax Payments
(Claim ___ exemptions) $___________ $__________
(7). Federal Income Tax $___________ $__________
(8). Kansas Withholding $___________ $__________
(9). Subtotal Deductions $___________ $__________
(10). Net Income
(Line B.3 minus line B.9) $____________ $__________

Pay Period: (Weekly, Bi-weekly, Monthly) _______________ _______________

Petitioner Respondent
7. Liquid Assets of the Parties:

ITEM ACCT # AMOUNT JOINT OR INDIVIDUAL

(Specify)

A. Checking Account ____________ ______________________

B. Savings Account ____________ ______________________
C. Cash ____________ ______________________
D. Other ____________ _____________________

8. The monthly expenses of each party are: (Please indicate with an asterisk all figures
which are estimates rather than actual figures taken from records):

A. MONTHLY
Petitioner Respondent
(Actual or (Actual or
ITEM Estimated) Estimated)

1. Rent (if applicable)* $___________ $__________

2. Food $___________ $__________
3. Utilities:
Trash Service $___________ $__________
Newspaper $___________ $__________
Telephone $___________ $__________
Gas $___________ $__________
Water $___________ $__________
Lights $___________ $__________
4. Insurance:
Life $___________ $__________
Health $___________ $__________
Car $___________ $__________
House/Renters $___________ $__________
Other: $___________ $__________
5. Medical and Dental $___________ $__________
6. Prescription Drugs $___________ $__________
7. Child Care (work related) $___________ $__________
8. Child Care (non-work related) $___________ $__________
9. Clothing $___________ $__________
10. School Expenses $___________ $__________
11. Hair Cuts and beauty $____________ $___________
12. Car Repair $____________ $___________
13. Gas and Oil $____________ $___________
14. Personal Property Tax $____________ $___________
15. Miscellaneous (specify)
___________________ $____________ $___________
___________________ $____________ $___________
 ___________________ $____________ $___________
___________________ $____________ $___________
16. Debt Payments (specify)
___________________ $____________ $___________
___________________ $____________ $___________
___________________ $____________ $___________

*show house payments, mortgage payments, etc. in Section 8.B

B. Monthly payments to banks, loan companies, or on credit accounts (indicate

actual or estimate, use asterisk for secured) (indicate creditor, when incurred,
amount of payment, last payment, balance, and responsible party). Do not list
any payments included in Part 8.A above.

Amount of
Payment/
When Date of Responsibility
Creditor Incurred Last Payment Balance Petitioner Respondent

_____________________ ___________ ________ _______ ________

_____________________ ___________ ________ _______ ________
_____________________ ___________ ________ _______ ________
_____________________ ___________ ________ _______ ________
Subtotal of Payment $_______ $_______
Total $_______ $_______

C. Total Living Expenses Petitioner Respondent

(actual or (actual or
estimated) estimated)

1. Total funds available to

Petitioner & Respondent
(from Number 6) $__________ $__________
2. Total Needed (from number
8A and 8B) $__________ $__________
3. Net Balance $__________ $__________
4. Projected child support $__________ $__________

D. Payments or contributions received, or paid, for support of others. Specify

source and amount.

Source Petitioner Respondent

_______________________________ ________ _________

_______________________________ ________ _________
_______________________________ ________ _________
 9. How much does the party who provides health care pay for family coverage $_________
per _________.
How much does it cost the provider to furnish health care insurance only on the provider?
$____________ per ____________.

FURNISH THE FOLLOWING INFORMATION IF APPLICABLE:

10. All other personal property including retirement benefits (including but not limited to
qualified plans such as profit-sharing, pension, IRA, 401(k), or other savings-type
employee benefits, non-qualified plans, and deferred income plans, and ownership
thereof (joint or individual), including policies of insurance, identified as to nature or
description, ownership (joint or individual), and actual or estimated value.
__________________________________________________________________
__________________________________________________________________

11. List real property identified as to description, ownership (joint or individual) and
actual or estimated value.

__________________________________________________________________

12. Identify the property, if any, acquired by each of the parties prior to marriage or
acquired during marriage by a will or inheritance.

________________________________________________________________

13. List debt obligations, including maintenance, not listed in Section II above, identified
as to name or names, of obligor or obligors and obliges, balance and rate at which
payable; and, if secured, identify the encumbered property.

________________________________________________________________

14. List health insurance coverage and the right, pursuant to ERISA 601-609, 29 U.S.C.
1161-1168 (1986) to continued coverage by the spouse who is not a member of the
covered employee group.

_________________________________________________________________

_____________________________
Party Pro Se (Signature)
Street Address: ________________
City, State, Zip:________________
Telephone: ___________________
 VERIFICATION

STATE OF KANSAS )
) ss:
SEDGWICK COUNTY )

I swear or affirm under penalty of perjury that this affidavit and attached schedules are
true and complete to the best of my knowledge and ability.

________________________________
Party, Pro Se

SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public, on this _____ day

of __________________, 20__.

_______________________________
Notary Public

My Appointment Expires: _______________

 IN THE EIGHTEENTH JUDICIAL DISTRICT
DISTRICT COURT, SEDGWICK COUNTY, KANSAS
FAMILY LAW DEPARTMENT

IN THE MATTER OF THE MARRIAGE OF )

)
______________________________, )
)
and ) Case No.____________________
)
_______________________________. )
__________________________________________)
Petition Pursuant to K.S.A. Chapter 60 )

NOTICE OF INTENT TO APPEAR

This is to notify you that I intend to appear to seek modification of the Temporary Order
at: (check one):

___ 1:30 pm Monday ___ 1:30 pm Tuesday

___ 9:30 am TuesdayBBB9:30 am Monday (Both Parties Self-Represented Only)

on the _____ day of ______________________, 20___, at the fourth floor of the Sedgwick
County Courthouse, 525 North Main, Wichita, Kansas, for the following reason(s): (Check all
that apply, must check at least one) pursuant to K.S.A. 60 207(b).

___ RESIDENCE ___ MAINTENANCE

___ PROPERTY DIVISION ___ OTHER, PLEASE LIST_____________

______________________________________
Husband/Wife (Respondent)

______________________________________
Address

______________________________________
Phone Number

FILE ORIGINAL WITH CLERK OF THE DISTRICT COURT, 7TH FLOOR, SEDGWICK
COUNTY COURTHOUSE, AND MAIL A COPY TO:

_____________________________________________________________________________
(NAME OF ATTORNEY FOR PETITIONER OR PETITIONER PRO SE)
______________________________________________________________________________
(ADDRESS)
 CERTIFICATE OF SERVICE

I hereby certify that on the _____ day of ______________________, 20____, I mailed a

copy of the above Notice of Intent to Appear to the Attorney or Petitioner Pro Se named above at

the address given above by Certified Mail—Return Receipt Requested.

______________________________________
Husband/Wife (Signature)
 IN THE EIGHTEENTH JUDICIAL DISTRICT
DISTRICT COURT, SEDGWICK COUNTY, KANSAS
FAMILY LAW DEPARTMENT

IN THE MATTER OF THE MARRIAGE OF )

)
)
_________________________________________________, )
) Case No.___________________________
and )
)
_________________________________________________, )
)
___________________________________________ ______ )
Pursuant to K.S.A. Chapter 60

ENTRY OF APPEARANCE AND WAIVER OF SERVICE

COMES NOW the Respondent and voluntarily enters an appearance in this action. Respondent states that
service of summons is waived and that Respondent acknowledges receipt of the Petition filed in this case, together
with a copy of the proposed Decree of Divorce. Respondent agrees that this divorce action may be heard by the
Court without any further notification to Respondent.

__________________________________________________
Respondent’s signature (must be signed in presence of notary)

(Please print): street address: __________________________________________________

city, state, zip: __________________________________________________

telephone: __________________________________________________

ACKNOWLEDGEMENT

STATE OF KANSAS )
COUNTY OF SEDGWICK ) ss.

BE IT REMEMBERED that on this _____ day of ___________________, 20_____, before me, a Notary
Public, in and for said county and state, personally appeared the Respondent in this action, known by me to be the
identical person who executed the foregoing instrument and acknowledged to me that he/she executed same as a
voluntary act and deed for the uses and purposes therein set forth.

IN WITNESS WHEREOF, I have set my hand and affixed my seal, the day and year last written.

_____________________________________________
Notary Public
My appointment expires:
IN THE EIGHTEENTH JUDICIAL DISTRICT
DISTRICT COURT, SEDGWICK COUNTY, KANSAS
FAMILY LAW DEPARTMENT

____________________________________________________

____________________________________________________
Plaintiff (s)

VS.

____________________________________________________

____________________________________________________
Defendant (s) __________________________________CASE NO.

SUMMONS
To the above-named Defendant:
You are hereby summoned and required to serve upon ______________________________________________________________________________ , plaintiff's attorney,
whose address is _____________________________________________________________________________________________________ , a pleading to the petition which is
herewith served upon you, within 20 days after service of this summons upon you, exclusive of the day of service. If you fail to do so, judgment by default will be taken against you for the
relief demanded in the petition. Your pleading must also be filed with the court. As provided in subsection (a) of K.S.A. 60-213, and amendments thereto, your answer must state as a
counterclaim any related claim which you may have against the plaintiff, or you will thereafter be barred from making such claim in any other action.
REASONABLE ACCOMMODATIONS WILL BE PROVIDED IN
ACCORDANCE WITH THE AMERICANS WITH DISABILITIES ACT. Clerk of the District Court of Sedgwick County, Kansas

Dated _______________________________________ By ________________________________________________________________ , Deputy

RETURN ON SERVICE OF SUMMONS

I hereby certify that I have served the within summons:
[1] Personal Service. By delivering on the _______________ day of ______________________________ , ________ , a copy of the summons and a copy of the petition to each
of the within-named defendants _______________________________________________________________________________________________________________________
[2] Residence Service. By leaving on the _______________ day of ______________________________ , ________ , for each of the within-named defendants ____________
________________________________________________________________________________________________________________________________________________
a copy of the summons and a copy of the petition at the respective dwelling place or usual place of abode of such defendants with some person of suitable age and discretion residing
therein.
[3] Agent Service. By delivering on the _______________ day of ______________________________ , ________ , a copy of the summons and a copy of the petition to
each of the following agents authorized by appointment or by law to receive service of process ____________________________________________________________________
________________________________________________________________________________________________________________________________________________
[4] Residence Service and Mailing. By leaving a copy of the summons and a copy of the petition at the dwelling house or usual place of abode and mailing by first-class mail to
each of the following defendants a notice that such copy has been so left _____________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
[5] Certified Mail Service. I hereby certify that I have served the within summons: (1) By mailing on the _______________ day of ______________________________ , ________ , a copy of the sum-
mons and a copy of the petition in the above action as certified mail return receipt requested to each of the within-named defendants; (2) the name and address on the envelope containing the process mailed
as certified mail return receipt requested were as follows:
____________________________________________________________________________________________________________________________________________________________________
By _________________________________________________________________________
[6] Certified Mail Service Refused. I hereby certify that on the _______________ day of ______________________________ , ________ , I mailed a copy of the summons and petition in the above
action by first-class mail, postage prepaid, addressed to _________________________________ at ___________________________________________________________________________________
By _________________________________________________________________________
[7] No Service. The following defendants were not found in this county:
____________________________________________________________________________________________________________________________________________________________________

Dated: ___________________________________________________ , 20 ______ .

_______________________________________________________________ Sheriff

By: ____________________________________________________________ Deputy

1305-43 (Rev. 2/00) PS-1143
 IN THE EIGHTEENTH JUDICIAL DISTRICT
DISTRICT COURT, SEDGWICK CONTY, KANSAS
FAMILY LAW DEPARTMENT

IN THE MATTER OF THE MARRIAGE OF )

)
____________________________, )
) Case No.____________
and )
)
____________________________, )
)
__________________________________________)
Petition Pursuant to K.S.A. Chapter 60

AFFIDAVIT OF PETITIONER
(Without minor children of this marriage)

STATE OF KANSAS )
) SS:
SEDGWICK COUNTY )

I, ________________, of lawful age, being first duly sworn on oath, state:

1. That I am the Petitioner in the foregoing matter;

2. That I have read the Petition and it is true and correct to the best of my

belief and knowledge;

3. That the division of property and debt is fair just and equitable, and that in

arriving at this decision I have taken into consideration the value of all

assets, length of marriage, and source of property and debt;

4. That I am hereby requesting the Court approve the Property Division

provided therein;

5. That I hereby request the Court waive the requirement of Local Court Rule

405 and accept my testimony through this Affidavit;

6. Further that I herein waive my right to a record.

FURTHER AFFIANT SAITH NAUGHT.

______________________________
Petitioner

SUBSCRIBED AND SWORN to before me this ____ day of __________, 20__.

______________________________
Notary Public

My appointment expires:
 IN THE EIGHTEENTH JUDICIAL DISTRICT
DISTRICT COURT, SEDGWICK COUNTY, KANSAS
FAMILY LAW DEPARTMENT

IN THE MATTER OF THE MARRIAGE OF )

)
______________________________, )
)
and ) Case No.____________________
)
_______________________________. ) TITLE TO REAL ESTATE
__________________________________________) INVOLVED: ___Yes ___No
Petition Pursuant to K.S.A. Chapter 60

JOURNAL ENTRY OF JUDGMENT

AND DECREE OF DIVORCE
(With no minor children of this marriage)

NOW, on this _____ day of _______________________, 20___, the above matter comes

before the Court for final hearing. Petitioner appears in person, pro se. Respondent (does not

appear) (appears in person) (appears through counsel), and does not contest these

proceedings. Both parties consent to the waiving of a record. There are no other appearances.

WHEREUPON, after reviewing matters of record, and considering all of the pleadings,

and otherwise being duly advised, the Court finds, orders and decrees:

1. The Petition in this case was filed on the following date: __________________.

2. More than sixty (60) days have passed since the filing of the Petition in this case.

3. Petitioner has been a bona fide resident of the State of Kansas for more than sixty

(60) days preceding the filing of the Petition in this case.

4. That the Respondent has received a copy of the Petition in this case by:

(CHECK ONLY ONE)

_____a) waived service of summons; _____b) was served with summons by the Sedgwick

County Sheriff; ___c) was served by special process server; ____d)was served with summons by
certified-mail return receipt requested; or _____e) was served by publication.

5. Service of process upon Respondent has been duly accomplished, and is valid,

binding and legal in all respects, and is hereby approved by the Court.

6. This Court has jurisdiction over the parties to and the subject matter of this

divorce matter.

7. Venue in Sedgwick County, Kansas is proper.

8. Petitioner and Respondent were married on ________________________, and

have been married since that date.

9. Petitioner and Respondent are incompatible, and they are hereby divorced on that

ground.

10. Petitioner and Respondent do not now have any living children born of this

marriage who are under the age of eighteen (18) years, and the wife was not pregnant at the time

the Petition in this case was filed, nor is she pregnant at this time.

11. SPOUSAL MAINTENANCE

A. _____ Not Applicable; however, the Court reserves jurisdiction over this issue
for one year after the filing of this Decree

B. _____ Husband/Wife is ordered to pay ___________ per month as and for spousal

maintenance of Husband/Wife beginning ___________________(date) for the period of

_____years and concluding on ____________________ (date). Said obligation shall

terminate upon the death of either Husband or Wife. Said support shall be paid through the

Kansas Payment Center at the address listed in Article II.

12. ADDRESS FOR PAYMENTS AND ROLE OF COURT TRUSTEE

A. _____ Not Applicable

 B. _____ The address for spousal maintenance payments is as follows:

Kansas Payment Center

Box 758599
Topeka, KS 66675 8599

The case number shown on the first page of this order shall be placed on all checks or

money orders and said checks or money orders shall be made payable to the Kansas Payment

Center and include the county designation (SG).

The Kansas Payment Center shall forward said payments to Husband/Wife at

____________________________________________(city, state, zip) and it shall be the

responsibility of Husband/Wife to inform the Clerk of any change in address.

No commission shall be credited to the Court Trustee for payments under this order.

13. FAILURE TO PAY SPOUSAL MAINTENANCE

A. _____ Not Applicable

B. _____ Should the payor fail to be current with the spousal maintenance obligations as

set out herein so that there is an arrearage in an amount equal to or greater than the amount of

spousal maintenance payable for one month or two months if only spousal support is ordered, an

income withholding order shall be issued by the Court upon proper application. The income

withholding order shall require any payor of income to the party in arrears to withhold income

from each pay period in the necessary and lawful amounts to pay the current spousal

maintenance obligation and to reduce the accrued arrearage.

The above orders for spousal maintenance may be enforced by garnishment unless the

Husband/Wife requests a hearing to contest the issuance of an Order of Garnishment within

seven (7) days after the service of the within order of spousal maintenance upon Husband/Wife.
 14. RESIDENCE

A. _____ Not Applicable

B. _____Husband/Wife shall have permanent possession of the residence located at

__________________________________________________(city, state, zip) with the value of

the property being $________________. Husband/Wife shall be responsible for payment of the

mortgage loan and will hold the other party harmless.

15. PERSONAL PROPERTY

A. _____ Not Applicable

B. _____ Husband shall have permanent possession of his personal papers, clothing
and any other property in his possession and the following items of property now in possession
of the Wife: (Description & Estimated Value)

A. _____ Not Applicable

B. _____ Wife shall have permanent possession of her personal papers, clothing and
any other property in her possession and the following items of property now in possession of
the Husband: (Description and Estimated Value)

Both parties shall be awarded their own retirement benefits from any current or past

employer, free and clear of any claim of the other.

 16. DEBTS—Each party is responsible for the debts held in his or her own

name, and shall hold the other party harmless for said debt, except the following:

A. _____ Not Applicable

B. _____ Husband is Ordered to be responsible for the periodic payment of the

following debts:

(Description of Debts to be paid by Husband) (Amount Owed)

_______________________________________ __________________

_______________________________________ __________________

_______________________________________ __________________

_______________________________________ __________________

A. _____ Not Applicable

B. _____ Wife is Ordered to be responsible for the periodic payment of the

following debts:

(Description of Debts to be paid by Wife) (Amount Owed)

_______________________________________ __________________

_______________________________________ __________________

_______________________________________ __________________

_______________________________________ __________________

_______________________________________ ____________________

Each party shall hold the other harmless from any and all debts incurred on any

property assigned to that party. The division of assets and liabilities, as described herein is fair,

just and equitable.

Both parties mutually agree that they shall execute such releases, bills of sale, deed or

other instruments of transfer as may be necessary to comply with this Journal Entry of Judgment
and Decree of Divorce. In the event of failure to do so within ten (10) days from the filing of

this decree, then this decree shall operate as such a transfer.

17. The wife’s last name is restored to: ____________________________.

18. The parties are prohibited from contracting marriage, within or outside the

State of Kansas, with any third person until thirty (30) days from the date of the filing of this

Journal Entry of Judgment and Decree of Divorce with the Clerk of the District Court, unless an

appeal is taken, and then until receipt of the Mandate from the Appellate Courts of the State of

Kansas in accordance with K.S.A. 60-2106(c). Any marriage contracted before the expiration of

that period shall be voidable unless both parties waive appeal.

IT IS SO ORDERED.

__________________________________
JUDGE OF THE DISTRICT COURT
FAMILY LAW DEPARTMENT

Approved:

_____________________________ _________________________________
Petitioner Pro Se Respondent Pro Se
_____________________________ _________________________________
Street Address Street Address
_____________________________ _________________________________
City, State, Zip City, State, Zip
_____________________________ _________________________________
Telephone Telephone
 STATE OF KANSAS
KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT
Office of Vital Statistics
CERTIFICATE OF DIVORCE OR ANNULMENT
CASE NUMBER State File Number
1. HUSBAND’S NAME (First, Middle, Last) 2. DATE OF BIRTH (Month, Day, Year)

3. RESIDENCE-STATE 4. COUNTY

5. WIFE’S NAME (First, Middle, Last) 6. WIFE’S LAST NAME PRIOR TO FIRST MARRIAGE

7. DATE OF BIRTH (Month, Day, Year) 8. RESIDENCE-STATE 9. COUNTY

10. PLACE OF THIS MARRIAGE - STATE 11. COUNTY 12. DATE OF THIS MARRIAGE 13. NUMBER OF CHILDREN UNDER 18 IN THIS
OR FOREIGN COUNTRY (Month, Day, Year) HOUSEHOLD AS OF DATE IN ITEM 17

14. PETITIONER 15. NAME OF PETITIONER’S ATTORNEY (Type)

■ Husband ■ Wife ■ Both ■ Other (Specify) _______________________________

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

17. DATE DECREE FILED 18. TYPE OF DECREE-(Specify) 19. COUNTY OF DECREE 20. DATE FILED BY STATE REGISTRAR
(Month, Day, Year) (Month, Day, Year)
■ Divorce ■ Annulment

THE INFORMATION BELOW WILL NOT APPEAR ON CERTIFIED COPIES OF THE RECORD.
K.S.A. 65-24228, REQUIRES THE DIVORCE REPORT TO INCLUDE THE SOCIAL SECURITY NUMBER OF BOTH PARTIES TO MAKE SUCH INFORMATION AVAILABLE TO THE SECRETARY OF
SOCIAL AND REHABILITATION SERVICES FOR THE PURPOSE OF ESTABLISHING, MODIFYING, OR ENFORCING A SUPPORT OBLIGATION.

21. HUSBAND’S SOCIAL SECURITY NUMBER 22. WIFE’S SOCIAL SECURITY NUMBER:

23. NUMBER OF THIS MARRIAGE (First, 24. IF PREVIOUSLY MARRIED, LAST MARRIAGE ENDED
Second, etc. (Specify below)
By Death, Divorce, or Annulment (Specify below) Date (Month, Day, Year)
23a. HUSBAND 24a. HUSBAND 24b. HUSBAND

23b. WIFE 24c. WIFE 24d. WIFE

25. HISPANIC ORIGIN (Check the box or boxes that best 26. RACE (Check one or more boxes to indicate what race(s) you consider yourself to be.)
describes whether you are Spanish, Hispanic, or Latino.
Check the “no” box if you are not Spanish, Hispanic or 26a. HUSBAND 26b. WIFE
Latino.) ■ White ■ Korean ■ White ■ Korean
25a. HUSBAND 25b. WIFE ■ Black or ■ Vietnamese ■ Black or ■ Vietnamese
African American African American
■ No, not Spanish/ ■ No, not Spanish/
Hispanic/Latino Hispanic/Latino ■ American Indian or ■ Other Asian (Specify) ■ American Indian or ■ Other Asian (Specify)
Alaska Native Alaska Native
■ Yes, Mexican/Mexican ■ Yes, Mexican/Mexican
(Name of the enrolled ___________________ (Name of the enrolled) _____________________
American/Chicano American/Chicano
or principal tribes) or principal tribes)
■ Yes, Puerto Rican ■ Yes, Puerto Rican
__________________ ___________________ __________________ _____________________
■ Yes, Cuban ■ Yes, Cuban
__________________ ■ Native Hawaiian __________________ ■ Native Hawaiian
■ Yes, Central American ■ Yes, Central American
■ Asian Indian ■ Guamanian or Chamorro ■ Asian Indian ■ Guamanian or Chamorro
■ Yes, South American ■ Yes, South American
■ Chinese ■ Samoan ■ Chinese ■ Samoan
■ Yes, other Spanish/ ■ Yes, other Spanish/
■ Filipino ■ Other Pacific Islander ■ Filipino ■ Other Pacific Islander
Hispanic/Latino (Specify) Hispanic/Latino (Specify)
(Specify) (Specify)
■ Japanese ■ Japanese
____________________ ___________________
___________________ _____________________
■ Other (Specify) ■ Other (Specify)
■ Unknown ■ Unknown
___________________ _____________________
__________________ __________________
■ Unknown ■ Unknown
__________________ __________________

27. EDUCATION (Check the box that best describes the highest degree or level of school completed.)
27a. HUSBAND’S 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)

27b. WIFE’S 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)

VS230 Rev. 04/07/04 PS-2534