DIVORCE APPLICATION

Name:________________________________

Social Security #:___________________

Name:________________________________

Social Security #:___________________

Date of Marriage: _________________

Place of Marriage:____________________

Residential Address:_______________________________________
_____________________________________________________

Residential Address:_________________________________
______________________________________________

Mailing Address:________________________________________________
_____________________________________________________

Mailing Address:__________________________________________
______________________________________________

City:_____________________ State:_______ Zip:____________

City:_______________ State:_______ Zip:____________

Telephone # : (_______) __________- _______________________________

Telephone # : (____) _______- ______________

Are You Employed?              [  ] Yes   [ ]No

Are You Employed?   [  ] Yes   [ ]No

Name of Employer:______________________________________________

Name of Employer:________________________________________

Business Address:______________________________________________
______________________________________________________________

Business Address:________________________________________
_______________________________________________________

City:_____________________ State:_______ Zip:____________

City:_______________ State:_______ Zip:____________

Driver's License:____________________________ State_:______________ 

Driver's License:________________________ State:______________ 

Date of Birth:  _______/_______/_______

Date of Birth:  _______/_______/_______

Ethnicity: [        ] White (Not Hispanic)  

Ethnicity: [        ] White (Not Hispanic)    

[ ] Other:_____________________________________________

[ ] Other:________________________________________

                                    IF THIS CASE INVOLVES CHILDREN, PLEASE COMPLETE THE FOLLOWING:
                                                              CHILDREN INVOLVED IN THIS CASE
Name:_________________________________________________     SSN:_____/_____/_______      DOB:__________________________
Name:_________________________________________________     SSN:_____/_____/_______      DOB:__________________________
Name:_________________________________________________     SSN:_____/_____/_______      DOB:__________________________
Name:_________________________________________________     SSN:_____/_____/_______      DOB:__________________________
Name:_________________________________________________     SSN:_____/_____/_______      DOB:__________________________

If more than five children list their names on a separate sheet of paper and attach.
Does this case involve family violence?    [   ] Yes   [  ]No     Are you requesting Child Support Enforcement Services from the District Attorney's Office (IV-D) Services?   [   ] Yes   [  ]No

Court Personnel Only:     [ ]Non- Custodial Parent          [ ] Custodial Parent
WITNESS NAME____________________________________________
                                                                                                                                                  ^{(FIRST)                                                     (MIDDLE                                                            (LAST)}
Residential Address:_______________________________________ Apt.#______    Reno/Sparks, Nevada   ZIP:_____________________
____________________________________________________

 SSN:__________________________ DL#:__________________________ Passport #:__________/______________
                                                                                                                                                  ^County/State
Date Arrive In Reno/Sparks, Nevada:____________     Tel:(___) ___-____

Note: WIFE WANT TO RESTORED FORMER NAME:               [ ]Yes / [ ]No

If yes, wife full name prior to get married:_______________________________________________________
                                                           ^{(FIRST)                                                (MIDDLE                                                                (LAST)}                                                                                        
That prior to filling my divorce in Nevada I've been a resident for the past six (6) weeks,
that I intend to stay in Nevada for indefinite period of time.
 

                _________________________________                                         ________________________
                          SIGNATURE                                                              DATE