MASHANTUCKET PEQUOT TRIBAL COURTRev. 01/2017 OFFICE OF THE TRIBAL COURT CLERK

P.O. BOX 3126 MASHANTUCKET, CT 06338-3126

Tribal Court

FOR COURT USE ONLY DOCKET NO.

, Plaintiff

v.DIVORCE / ANNULMENT

COMPLAINT (DISSOLUTION OF MARRIAGE)

, Defendant

Plaintiff's Name (Last, First, Middle Initial) Defendant's Name (Last, First, Middle Initial)

1. Plaintiff's Birth Name (if different from above) 2. Defendant's birth name (if different from above)

3. Date of Marriage 4. Town and State or Country where marriage took place

5. ("X" all that apply)

(X applicable box(es)) Plaintiff Defendant is a member of the Mashantucket Pequot Tribe.

(X one) The marriage has broken down irretrievably and the Plaintiff seeks a decree of dissolution.

The marriage is void or voidable under the laws of the Tribe or of the state in which the marriage was performed.

"X" and complete all that apply for items 6-11. Attach additional sheets if needed.

6. No children were born to either the Plaintiff or Defendant after the date of this marriage.

7. There are no children of this marriage under the age of 18.

8. The following children are either: (a) the biological and/or adoptive children of both parties; or (b) have been born to one of the parties on or after the date of the marriage and are claimed to be children of the marriage. (List only children who have not yet reached the age of 18.)

Name of Child (First, Middle Initial, Last) Date of Birth (Month, Day, Year)

9. The following children were born on or after the date of the marriage to the ("X" all that apply): Plaintiff Defendant and are not children of the other party to this marriage.

(List only children who have not yet reached the age of 18.)

Instructions: Complete this form. Attach completed Family Court Summons (processed by Tribal Court Clerk). Have papers served and return to Tribal Court with filing fee and Return of Service.

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MASHANTUCKET PEQUOT TRIBAL COURTRev. 01/2017 OFFICE OF THE TRIBAL COURT CLERK

P.O. BOX 3126 MASHANTUCKET, CT 06338-3126

Name of Child (First, Middle Initial, Last) Date of Birth (Month, Day, Year)

10. If there is a court order regarding custody or support for any child listed above, name the child(ren) below andspecify the person or agency awarded custody or ordered to pay support:

Child's name Name of person or agency awarded custody Name of person ordered to pay support

Child's name Name of person or agency awarded custody Name of person ordered to pay support

Child's name Name of person or agency awarded custody Name of person ordered to pay support

11. The ("X" all that apply) Plaintiff Defendant is pregnant with a child due to be born on __________________.

The other parent of the unborn child is the: Plaintiff Defendant Unknown

Not the Plaintiff Not the Defendant

The Court is asked to order:

A divorce (dissolution of marriage).

An annulment pursuant to 6 M.P.T.L. ch. 4 § 2(b).

A fair division of property and debts.

Alimony.

Child support.

Orders regarding health coverage and educational support of the minor child(ren).

Attorney's fees.

Name change to:______________________________________________________________

Regarding Parental Decision-making Responsibility:

Sole custody.

Joint legal custody.

A parenting responsibility plan which includes a plan for the parental decision-making regarding the minor child(ren).

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MASHANTUCKET PEQUOT TRIBAL COURTRev. 01/2017 OFFICE OF THE TRIBAL COURT CLERK

P.O. BOX 3126 MASHANTUCKET, CT 06338-3126

Regarding Physical Custody:

Primary residence with:___________________________________________________________________

Visitation.

A parenting responsibility plan which includes a plan for the schedule of physical care of the minor child(ren).

And anything else the Court deems fair.

• If this is a first Complaint you must have the papers served on the opposing party and then filethe Return of Service with the Tribal Court.

• If this is an Amended Complaint or Cross Complaint, you must mail or deliver a copy of thepapers to anyone who has filed an appearance and you must complete the certification below.

CERTIFICATION

I hereby certify that a copy of these papers was mailed or otherwise delivered on (date)_____________________ to all attorneys and self-represented parties of record.

Name and address of each attorney or self-represented party that copy was mailed or delivered to:

*If necessary, attach additional sheet or sheets with name and address which the copy was mailed or delivered to.

Signed (signature of filer) Print or type name of person filing Dated signed

Address Phone Additional phone/cell/fax numbers Email

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