How to File for Divorce in Massachusetts – Forms Included
Transcription
How to File for Divorce in Massachusetts – Forms Included
HowtoFileforDivorceinMassachusetts–FormsIncluded The following information explains “How to File for Divorce in Massachusetts” via a 1A No Fault Divorce. In order to file for divorce, you and your spouse need to complete the following court forms: 1. Joint Petition for Divorce 2. Certified copy of civil marriage certificate 3. R‐408‐Certificate of Absolute Divorce or Annulment Statistical Information 4. Separation Agreement (see below) 5. Affidavit of Irretrievable Breakdown 6. Filing Fee of $215 7. Financial Statements ‐ Short form or Long form. For those who make less than $75,000 per year, complete a short form. If you make over $75,000, complete the long form. 8. To file for divorce, you will also need a certified copy of your marriage certificate which you may have or you may obtain from the city or town in which you were married. Couples with children also need to complete the following additional forms: 9. Child Support Guidelines Worksheet 10. Affidavit of Care and Custody 11. Couples with children also need to attend a mandatory parent education program. Read more about the requirement here. The yellow certificate of completion is needed when filing for divorce. All court required forms are attached to this document. Additional forms are available online here and at the Probate and Family Court Department in your county. For help with completing divorce forms, contact Josh Hoch at 800‐348‐4888 x23 or [email protected]. What is a Separation Agreement? A Separation Agreement is a written document that describes the terms of the divorce. Once signed, it becomes the legal document that will be used for a no‐fault divorce in Massachusetts. Parties to a divorce can draft their own Separation Agreement as long as they address topics including: Property, assets, accounts, life insurance, trusts, vehicles, debts and liabilities, alimony, taxes, living situation, inheritance, and health insurance. If children are involved, the Separation Agreement also needs to address a parenting plan, custody, child support, education, religion, and more. For help drafting a Separation Agreement, contact Josh Hoch at 800‐348‐4888 x23 or [email protected]. Once all forms are completed, signed, and the Separation Agreement is notarized, make 3 copies. One set will be filed in court and each spouse should keep a copy. You should now be ready to go to court to file for divorce. One spouse may bring all of the completed paperwork to the Probate and Family Court Department. In exchange for you handing over the completed forms and a filing fee of $215, you and your spouse will 4 FANEUIL HALL ‐ FOURTH FLOOR BOSTON, MA 02109‐1632 www.mwi.org | 800.348.4888 | [email protected] receive a court date. Both of you should attend the court date for a brief hearing where a judge may grant the divorce. 120 days from seeing the judge, the divorce will be final. For more information or for an overview of the court process click here. For many, completing divorce documents is overwhelming. Don’t let this be a reason to delay your divorce. Contact MWI for assistance at 800‐348‐4888 x23. 4 FANEUIL HALL ‐ FOURTH FLOOR BOSTON, MA 02109‐1632 www.mwi.org | 800.348.4888 | [email protected] Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. JOINT PETITION FOR DIVORCE PURSUANT TO G.L. c. 208, § 1 A and Petitioner A Petitioner B (Street address) (Street address) (State) (City/Town) (Zip) (City/Town) (State) (Zip) 1. Petitioners were lawfully married at on and last lived together at on 2. The minor or dependent child(ren) of this marriage is/are: (Name of child and date of birth) (Name of child and date of birth) (Name of child and date of birth) (Name of child and date of birth) 3. Petitioners certify that no previous action for divorce, annulment or affirmation of marriage, separate support, desertion, living apart for justifiable cause, or custody of child(ren) has been brought by either against the other except: 4. On or about , an irretrievable breakdown of the marriage under G.L. c. 208, § 1A occurred and continues to exist. 5. Wherefore, the petitioners request that the Court: grant a divorce on the ground of irretrievable breakdown approve the notarized separation agreement executed by the parties incorporate and merge the agreement executed by the parties incorporate but not merge said agreement, which shall survive and remain as an independent contract allow petitioner A to resume the former name of allow petitioner B to resume the former name of Date (Signature of attorney or petitioner A, if pro se) (Signature of attorney or petitioner B, if pro se) (Print name) (Print name) (Street address) (Street address) (City/Town) (State) (Zip) (City/Town) Tel. No. Tel. No. B.B.O. # B.B.O. # CJ-D 101A (9/07) (State) (Zip) C.G.F Docket No. Division The Commonwealth of Massachusetts Department of Public Health Registry of Vital Records and Statistics CERTIFICATE OF ABSOLUTE DIVORCE OR ANNULMENT (G.L. Chap. 208, Sec. 46) R-408 Husband-Name First Middle Last 1. HUSBAND Usual Residence-Street Address City, Town, or Location 2a. 2b. County State Date of Birth (mo., day, yr.) Number of this Marriage (1st, 2nd, specify) 2c. 2d. 3. 4. Wife-Name First Middle Last Maiden Name 5a. WIFE 5b. Usual Residence-Street Address City, Town, or Location 6a. 6b. County State Date of Birth (mo., day, yr.) Number of this Marriage (1st, 2nd, specify) 6c. 6d. 7. 8. Date of this Marriage (mo., day, yr.) Number of Children Born Alive of this Marriage Number of Children under Age 18 in this Family 9. 10a. 10b. FOR COURT USE ONLY County of Judgment Title of Court 11. 11a. JUDGMENT Date of Judgment Nisi Type of Judgment - Date of Judgment Absolute (mo., day, yr.) Divorce or Annulment (mo., day, yr.) 12. 13. 14. Docket Number Name of Plaintiff Cause for which Granted 15. 16. 17. Signature of Certifying Official Title of Official 18a. 18b. Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. AFFIDAVIT OF IRRETRIEVABLE BREAKDOWN Petitioner V. Petitioner Petitioners state that our marriage has suffered an irretrievable breakdown which began on or about . (Date) In particular, our marriage has suffered an irretrievable breakdown because: Signed under the penalties of perjury. Date . PETITIONER PETITIONER (Signature) (Signature) (Please Print) (Please Print) (Street address) (Street address) (City/Town) (Affid. Irretrievable Breakdown 4/07) (State) (Zip) (City/Town) (State) (Zip) C.G.F. Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. FINANCIAL STATEMENT (Short Form) INSTRUCTIONS: if your income equals or exceeds $75,000.00 annually, you must complete the LONG FORM financial statement, unless otherwise ordered by the court. Plaintiff/Petitioner V. Defendant/Petitioner 1. PERSONAL INFORMATION Your Name Address Social Security No. (Street address) Tel. No. (City/Town) Date of Birth Occupation (State) (Zip) No. of children living with you Employer Employer's Address (Street address) (City/Town) Tel. No. (State) Do you have health insurance coverage? Yes (Zip) No if yes, name of health insurance provider 2. GROSS WEEKLY INCOME/RECEIPTS FROM ALL SOURCES a) Base pay from Salary $ Wages b) Overtime $ c) Part-time job $ d) Self-employment (attach a completed schedule A) $ e) Tips $ f) Commissions Bonuses $ g) Dividends Interest $ h) Trusts Annuities $ i) Pensions Retirement funds $ $ j) Social Security k) Disability Unemployment insurance Worker's compensation $ l) Public Assistance (welfare, A.F.D.C. payments) $ m) $ Child Support Alimony (actually received) n) Rental from income producing property (attach a completed Schedule B) $ o) Royalties and other rights $ p) Contributions from household member(s) $ q) Other (specify) $ $ r) Total Gross Weekly Income/Receipts (add items a-q) CJ-D 301 S (7/07) Page 1 of 4 $ C.G.F. Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. FINANCIAL STATEMENT (Short Form) 3. ITEMIZED DEDUCTIONS FROM GROSS INCOME a) Federal income tax deductions (claiming exemptions) $ b) State income tax deductions (claiming exemptions) $ c) F.I.C.A. and Medicare $ d) Medical Insurance $ e) Union Dues $ f) Total Deductions (a through e) 4. ADJUSTED NET WEEKLY INCOME $ 2(r) minus 3(f) $ 5. OTHER DEDUCTIONS FROM SALARY/WAGES a) Credit Union Loan repayment Savings $ b) Savings $ c) Retirement $ d) Other-Specify (i.e. Child Support, Deferred Compensation or 401K) e) Total Deductions (a through d) $ 6. NET WEEKLY INCOME $ 4 minus 5(e) $ 7. GROSS YEARLY INCOME FROM PRIOR YEAR $ (attach copy of all W-2 and 1099 forms for prior year) Number of Years you have paid into Social Security 8. WEEKLY EXPENSES a) Rent or Mortage (PIT) l) Life Insurance $ b) Homeowners/Tenant Insurance $ c) Maintenance and Repair $ d) Heat $ e) Electricity and/or Gas $ f) Telephone $ g) Water/Sewer $ h) Food $ i) House Supplies $ j) Laundry and Cleaning $ k) Clothing $ $ $ $ $ $ $ $ m) Medical Insurance n) Uninsured Medicals o) Incidentals and Toiletries p) Motor Vehicle Expenses q) Motor Vehicle Payment r) Child Care s) Other (explain) $ $ t) Total Weekly Expenses (a through s) $ 9. COUNSEL FEES a) Retainer amount(s) paid to your attorney(s) $ b) Legal fees incurred, to date, against retainer(s) $ c) Anticipated range of total legal expense to litigate this action CJ-D 301 S (7/07) Page 2 of 4 $ to $ C.G.F. Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. FINANCIAL STATEMENT (Short Form) 10. ASSETS (attach additional sheet if necessary) a) Real Estate Location Title held in the name of Fair Market Value $ = Equity $ - Mortgage $ b) Motor Vehicles Fair Market Value $ - Motor Vehicle Loan $ = Equity $ Fair Market Value $ - Motor Vehicle Loan $ = Equity $ c) IRA, Keogh, Pension, Profit Sharing, Other Retirement Plans: Financial Institution or Plan Name and Account Number $ $ $ d) Tax Deferred Annuity Plan(s) $ e) Life Insurance: Present Cash Value $ f) Savings & Checking Accounts, Money Market Accounts, Certificates of Deposit-which are held individually, jointly, in the name of another person for your benefit, or held by you for the benefit of your minor child(ren): Financial Institution or Plan Name and Account Number $ $ $ g) Other (e.g. stocks, bonds, collections) $ $ $ h) Total Assets (a through g) 11. LIABILITIES (Do not list expenses shown in item 8 above.) Creditor Nature of Debt Date Incurred Amount Due Weekly Payment a) $ $ b) $ $ c) $ $ d) $ $ e) Total Liabilities CJ-D 301 S (7/07) $ Page 3 of 4 $ C.G.F. Division Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Docket No. FINANCIAL STATEMENT (Short Form) CERTIFICATION I certify under the penalties of perjury that the information stated on this Financial Statement and the attached schedules, if any, is complete, true, and accurate. Date Signature INSTRUCTIONS: In any case where an attorney is appearing for a party, said attorney MUST complete the Statement by Attorney. STATEMENT BY ATTORNEY I the undersigned attorney, am admitted to practice law in the Commonwealth of Massachusetts--am admitted pro hoc vice for the purposes of this case-and am an officer of the court. As the attorney for the party on whose behalf this Financial Statement is submitted, I hereby state to the court that I have no knowledge that any of the information contained herein is false. Date (Signature of attorney) (Print name) (Street address) (City/Town) (State) (Zip) Tel. No. B.B.O. # CJ-D 301 S (7/07) Page 4 of 4 C.G.F. Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. FINANCIAL STATEMENT (Long Form) INSTRUCTIONS: If your income is less than $75,000.00 annually, you must complete the SHORT FORM financial statement, unless otherwise ordered by the court. vs. Plaintiff/Petitioner I. Defendant/Petitioner PERSONAL INFORMATION Your Name Social Security No. Address (Street address) Tel. No. (City/Town) Date of Birth Occupation (State) (Zip) No. of children living with you Employer Employer's Address (Street address) (City/Town) Employer's Phone No. (State) Do you have health insurance coverage? Yes (Zip) No If yes, name of health insurance provider II. GROSS WEEKLY INCOME/RECEIPTS FROM ALL SOURCES a) Base pay from Salary $ Wages b) Overtime $ c) Part-time job $ d) Self-employment (attach a completed schedule A) $ e) Tips $ f) Commissions Bonuses $ g) Dividends Interest $ h) Trusts Annuities $ Retirement funds $ i) Pensions $ j) Social Security k) Disability Unemployment insurance Worker's compensation $ l) Public Assistance (welfare, A.F.D.C. payments) $ m) $ Child Support Alimony (actually received) n) Rental from income producing property (attach a completed Schedule B) $ o) Royalties and other rights $ p) Contributions from household member(s) $ q) Other (specify) $ $ r) Total Gross Weekly Income/Receipts (add items a-q) CJ-D 301 L (4/07) Page 1 of 9 $ C.G.F. Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. FINANCIAL STATEMENT (Long Form) III. WEEKLY DEDUCTIONS FROM GROSS INCOME TAX WITHOLDING $ a) Federal tax witholding/estimated payments Number of withholding allowances claimed $ b) State tax witholding/estimated payments Number of withholding allowances claimed OTHER DEDUCTIONS c) F.I.C.A. $ d) Medicare $ e) Medical Insurance $ f) Dental Insurance $ g) Vision Insurance $ h) Union Dues $ i) Child Support $ j) Spousal Support $ k) Retirement $ l) Savings $ m) Deferred Compensation $ n) Credit Union (Loan) $ o) Credit Union (Savings) $ p) Charitable Contributions $ q) Life Insurance $ r) Other (specify) $ $ $ s) Total Weekly Deductions from Pay (Add items a-r) IV. NET WEEKLY INCOME a) Enter total gross weekly income/receipts from II(r) $ b) Enter total weekly deductions from pay from III(s) -$ =$ c) Net Weekly Income V. $ $ GROSS INCOME FROM PRIOR YEAR (attach copy of all W-2 and 1099 forms for prior year) Number of years you have paid into Social Security CJ-D 301 L (4/07) Page 2 of 9 C.G.F. Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. FINANCIAL STATEMENT (Long Form) VI. WEEKLY EXPENSES NOT DEDUCTED FROM PAY Rent $ Mortgage (Principal, Interest - Taxes and Insurance, if escrowed) $ Property taxes and assessments $ Homeowner/Tenant Insurance $ Maintenance Fees $ Condominium Fees Heat $ Electricity $ Propane $ Natural Gas $ Telephone Water $ Sewer Food $ House Supplies $ Laundry $ Dry Cleaning $ Clothing $ Life insurance $ Medical insurance $ Dental insurance $ Vision insurance $ Uninsured Medical $ Uninsured Dental $ Motor Vehicle Expenses $ Fuel $ Insurance $ Maintenance $ Loan payment(s) $ Entertainment $ Vacation $ Cable TV $ Child Support (attach a copy of the order, if issued by a different court) $ Child(ren)'s Day Care Expense $ Child(ren)'s Education $ Education (self) $ CJ-D 301 L (4/07) Page 3 of 9 C.G.F. Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. FINANCIAL STATEMENT (Long Form) Employment related expenses (which are not reimbursed) Uniforms $ Travel $ Required continuing education $ Other (specify) $ Lottery tickets $ Charitable Contributions $ Child(ren)'s allowance $ Extraordinary travel expenses for visitation with child(ren) $ Other (specify) $ $ $ $ TOTAL WEEKLY EXPENSES NOT DEDUCTED FROM PAY VII. COUNSEL FEES Retainer amount(s) paid to your attorney(s) $ Legal fees incurred, to date, against the retainer(s) $ Anticipated range of total legal expense to litigate this action $ to $ VIII. ASSETS INSTRUCTIONS: If additional space is needed for any answer or to disclose additional assets not listed below please attach additional pages. A. REAL ESTATE Real Estate-Primary Residence Address (Street address) (City/Town) (State) Title held in the name of Purchase Price of the Property $ Year of Purchase Current Assessed Value of the Property $ Date of Last Assessment $ Fair Market Value of the Property Outstanding 1st mortgage - $ Outstanding 2nd mortgage or home equity loan - $ Equity = $ CJ-D 301 L (4/07) Page 4 of 9 C.G.F. Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. FINANCIAL STATEMENT (Long Form) Real Estate-Vacation or Second Home (including interest in time share) Address (Street address) (City/Town) (State) Title held in the name of $ Purchase Price of the Property Year of Purchase Current Assessed Value of the Property $ Date of Last Assessment $ Fair Market Value of the Property Outstanding 1st mortgage - $ Outstanding 2nd mortgage or home equity loan - $ Equity = $ B. MOTOR VEHICLES including cars, trucks, ATV's, snowmobiles, tractors, motorcycles, boats, recreational vehicles, aircraft, farm machinery etc. Type Make Model Purchase Price of vehicle $ Year of Purchase Fair Market Value $ Outstanding Loan - $ Equity = $ Type Make Model Purchase Price of vehicle $ Year of Purchase Fair Market Value $ Outstanding Loan - $ Equity = $ C. PENSIONS Institution Account Number Listed Beneficiary Current Balance/Value Defined Benefit Plan $ Defined Contribution Plan $ CJ-D 301 L (4/07) Page 5 of 9 C.G.F. Commonwealth of Massachusetts Division The Trial Court Probate and Family Court Department Docket No. FINANCIAL STATEMENT (Long Form) D. OTHER ASSETS. List assets which are held individually, jointly, in the name of another person for your benefit, or held by you for the benefit of your minor child(ren). Institution Account Number Current Balance/Value $ Checking Account(s) $ $ Savings Account(s) $ $ Cash on Hand $ Certificate(s) of Deposit $ $ Credit Union Account(s) $ $ Funds Held in Escrow $ $ Stocks $ $ Bonds $ $ Bond Fund(s) $ $ Notes Held $ $ Cash in Brokerage Account(s) $ $ Money Market Account(s) CJ-D 301 L (4/07) Listed Beneficiary $ Page 6 of 9 C.G.F. Commonwealth of Massachusetts Division The Trial Court Probate and Family Court Department Docket No. FINANCIAL STATEMENT (Long Form) Institution Account Number Listed Beneficiary Current Balance/Value $ U.S. Savings Bond(s) $ $ IRAs $ $ Keough $ $ Profit Sharing $ $ Deferred Compensation $ $ Other Retirement Plans $ Annuity (please specify $ whether a tax deferred annuity or a tax sheltered annuity) $ Life Insurance Cash Value (please specify whether $ a term or a whole universal life insurance policy) $ $ Judgments/Liens $ Pending Legacies and/or Inheritances $ Jewelry $ Contents of Safe or Safe Deposit Box $ Firearms $ Collections $ Tools/Equipment $ Crops/Livestock $ Home Furnishings $ Arts and Antiques $ Other (please specify): $ Other (please specify): $ $ TOTAL ASSETS CJ-D 301 L (4/07) Page 7 of 9 C.G.F. Commonwealth of Massachusetts Division The Trial Court Probate and Family Court Department Docket No. FINANCIAL STATEMENT (Long Form) IX. LIABILITIES : List loans, credit card debt, consumer debt, installment debt, etc. which are NOT listed elsewhere. CREDITOR NATURE OF DEBT DATE INCURRED $ TOTAL LIABILITIES CJ-D 301 L (4/07) AMOUNT DUE Page 8 of 9 WEEKLY PAYMENT $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ C.G.F. Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. FINANCIAL STATEMENT (Long Form) CERTIFICATION BY AFFIANT I certify under the penalties of perjury that the information stated on this Financial Statement and the attached Schedules, if any, is complete, true, and accurate. I UNDERSTAND THAT WILLFUL MISREPRESENTATION OF ANY OF THE INFORMATION PROVIDED WILL SUBJECT ME TO SANCTIONS AND MAY RESULT IN CRIMINAL CHARGES BEING FILED AGAINST ME. Date Signature COMMONWEALTH OF MASSACHUSETTS County of Then personally appeared the above and declared the foregoing to be true and correct, before me this day of Notary Public My Commission Expires: INSTRUCTIONS: In any case where an attorney is appearing for a party, said attorney MUST complete the Statement by Attorney. STATEMENT BY ATTORNEY I, the undersigned attorney, am admitted to practice law in the Commonwealth of Massachusetts-am admitted pro hoc vice for the purposes of this case-and am an officer of the court. As the attorney for the party on whose behalf this Financial Statement is submitted, I hereby state to the court that I have no knowledge that any of the information contained herein is false. Date (Signature of attorney) (Print name) (Street address) (City/Town) (State) (Zip) Tel. No. B.B.O. # CJ-D 301 L (4/07) Page 9 of 9 C.G.F. Case Name Date Prepared Docket Number Name of Preparer CHILD SUPPORT GUIDELINES WORKSHEET All amounts are $ / week, rounded to the nearest dollar 1. INCOME Recipient Payor a. Gross Weekly income $ b. Minus Child Care cost paid $ ( ) $ ( ) c. $ ( ) $ ( ) d. Minus Dental/Vision insurance cost paid $ ( ) $ ( ) e. Minus Other Support Obligations paid $ ( ) $ ( ) f. Minus Health insurance cost paid Available income = $ $ $ g. Combined Available Income Recipient 1(f) + Payor 1(f) = $ 2. CHILD SUPPORT CALCULATION a. Combined amount for one child (See Table A) b. Adjustment for number of children covered by this order (See Table B) c. x Number of children = Combined support amount 2(a) x 2(b) d. Recipient's % of combined income Recipient 1(f) ÷ 1(g) $ ( Payor's proportional weekly support amount 2(c) - 2(e) g. Weekly support amount as % of Recipient income 2(f) ÷ Recipient 1(f) $ % e. Minus Recipient's share of combined support amount 2(c) x 2(d) f. . = $ = $ ) % h. Payor's final weekly support amount if 2(g) is 10% or more, then enter 2(f) here Otherwise, enter the lesser of 2(f) OR (10% + 2(g)) x Payor 1(f) TABLE A: CHILD SUPPORT OBLIGATION SCHEDULE All amounts are $ / week, rounded to the nearest dollar COMBINED AVAILABLE INCOME FROM LINE 1(g) Minimum Maximum $→ $100 $101 → $200 $201 → $320 $321 → $500 $501 → $1,000 $1,001 → $1,500 $1,501 → $2,500 $2,501 → $3,500 $3,501 → $4,808 CHILD SUPPORT AMOUNT (1 CHILD) At court discretion, but not less than $80/month 21% 24% $77 + 26% above $320 $124 + 25% above $500 $249 + 22% above $1,000 $359 + 19% above $1,500 $549 + 17% above $2,500 $719 + 15% above $3,500 Child Support Guidelines Child Support Guidelines Chart TABLE B: ADJUSTMENT FOR NUMBER OF CHILDREN CHILDREN ADJUSTMENT 1 2 3 4 5 1.00 1.20 1.27 1.32 1.35 AFFIDAVIT DISCLOSING CARE OR CUSTODY PROCEEDING Pursuant to Trial Court Rule IV BMC ________________ Division TRIAL COURT OF MASSACHUSETTS DOCKET NUMBER Name of Case _______________________ District Court ________________ Division Juvenile Court ________________ Division Prob & Family Court ________________ Division Superior Court ________________ Division Section 1 I, _________________________________________________ hereby declare, to the best of my knowledge, information, and belief that all information on this form is true and complete: Section 2 The name(s) of the child(ren) whose care or custody is at issue in this case are: A. ________________________ B. ___________________________ C. ____________________________ (LAST, FIRST) (LAST, FIRST) (LAST, FIRST) U se only the letter appearing in front of the child’s nam e above when referring to the child in com pleting the rem aining sections. Section 3 The party filing this affidavit may request certain addresses to be kept confidential if the address is a shelter for battered persons and their dependent child(ren, or the party filing this affidavit believes that he/she or the child(ren) are in danger of physical or emotional abuse, or the party is filing an action under G.L. c. 209A. If you believe that this provision applies to you, check the box at right, complete sections 10 and 11 on the reverse side of this page and DO NOT complete sections 4 and 5 below. Section 4 The address(es) of the above-name child(ren) whose care and custody is at issues in this case is/are: Address(es) Address\ CHILD A ____________________________________ ______________________________________________________ CHILD B ____________________________________ ______________________________________________________ CHILD C ____________________________________ ______________________________________________________ Section 5 My address is: _______________________________________________________________________________________ Section 6 I 9 have 9 have not participated in and I 9 know 9 do not know of other care or custody proceedings involving the above-names child(ren) in Massachusetts or in any state or country. Certified copies of any pleadings or determinations in a care or custody proceeding outside of Massachusetts listed in sections 7 and 8 must be filed with this affidavit unless already filed with this court or an extension for filing these documents has been granted by this court. Section 7 The following is a list of all pending or concluded proceedings I have participated in or know if involving the care or custody of the above named child(dren): [W]itness [P]arty Letter of Child Court Docket no. Status [O]ther [N]one CHILD _____ __________________________ _____________ _____________________________ [ ] CHILD _____ __________________________ _____________ _____________________________ [ ] CHILD _____ __________________________ _____________ _____________________________ [ ] Section 8 The names and addresses of parties to care or custody proceedings involving any of the above-named child(ren) or thise claiming a legal right to these child(ren) during the last two years (not including myself) are: Letter of Child Name of Party/Claimant Current (or last known) Address of Party/Claimant CHILD _____ _______________________________________ _____________________________________________ CHILD _____ _______________________________________ _____________________________________________ CHILD _____ _______________________________________ _____________________________________________ Section 9 If the box at the right is checked, this affidavit discloses the adoption of one or more of the abovenamed child(ren) and I am requesting the court to impound this affidavit. See instructions. This affidavit must be personally signed by the party listed in section 1 above, unless he/she is under 18 years of age or has been adjudged incompetent in which case the attorney of record must sign. A revised affidavit must be filed with the court if new information is discovered subsequent to this filing. Signed this __________________________ day of ______________________________, 20_______ under the penalties of perjury. X ___________________________________________________ SIGNATURE OF PARTY OR ATTORNEY OF RECORD FOR JUVENILE/INCOMPETENT _____________________________________ PRINTED NAME OF PERSON SIGNING _____________________________________________________________________________________________________________________________________________________________________ ADDRESS OF ATTORNEY OR RECORD FOR JUVENILE/INCOMPETENT THE PARTY FILING THIS AFFIDAVIT MUST FURNISH A COPY OF IT TO ALL OTHER PARTIES TO THIS ACTION. O C AJ-1 TCR IV (07/95) READ BEFORE COMPLETING AFFIDAVIT A. WHAT IS AN “AFFIDAVIT DISCLOSING CARE OR CUSTODY PROCEEDING”? It is a document signed under the penalties of perjury which lists information required by Trial Court Rule IV concerning children involved in a care or custody proceeding. B. WHO MUST FILE THIS AFFIDAVIT? The party to a petition (including a modification petition) or complaint involving the care, custody, visitation, or change of name of a child pursuant to G.L. c. 119 (except delinquency actions under G.L. c. 201, G.L. c. 207, G.L. c. 208, G.L. c. 209, G.L. c. 209A, G.L. c. 209C, G.L. c. 210, or any other provision of law concerning the care or custody of a child must file this affidavit. This affidavit must be signed by the party unless the party is under 18 years of age or has been adjudged incompetent in which case the attorney or record must sign this affidavit on behalf of the juvenile or incompetent party. C. WHEN MUST THIS AFFIDAVIT BE FILED? The person filing the petition or complaint must file this affidavit at the time of filing and the other party must file this affidavit with the first pleading. This affidavit should be filed upon issuance of a CHINS petition pursuant to G.L. c. 119, not upon application for such a petition. This affidavit need not be filed if the petition or complaint is for support only. D. WHERE MUST THIS AFFIDAVIT BE FILED? The completed affidavit must be filed, in person or by mail, with the Clerk-Magistrate or Register of Probate in the court in which this action is being brought. E. WHEN MUST A REVISED AFFIDAVIT BE FILED? A revised affidavit must be filed with the Clerk-Magistrate or Register of Probate if new information is discovered subsequent to the filing of ths affidavit. F. WHAT MUST BE FILED AS PART OF THIS AFFIDAVIT? Certified copies of each pleading and of any determination entered in a foreign county or in a state other than Massachusetts must be filed with this affidavit unless these documents are on file with the court in this case, or an extension has been granted by the court for filing these documents. INSTRUCTIONS FOR COMPLETING AFFIDAVIT When completing this affidavit if additional space is needed for any of the sections, attach a separate sheet which includes your name (printed), the docket number and the sections to which you are referring. You must also sign and date the sheet. The party filing this affidavit must complete the section entitles “Name of Case” and indicate the Court Department and Division in which the case is being brought. The docket number should be also be listed, if known. DO NOT COMPLETE SECTIONS 2, 3, 4, 8 AND 10 IF THIS IS AFFIDAVIT IS BRING FILED WITH A PETITION FOR ADOPTION. Section 1 You must print your first and last name. If this affidavit is filed by an attorney on behalf of an incompetent person or a juvenile, the name of the party on which behalf this affidavit is being completed must be listed. Section 2 List the names of all child(ren) involved in this care or custody proceeding. All future references to the child(ren) listed in this section should be with the letter in front of the child’s name (e.g. If John Smith is listed next to the letter A, all references to John Smith will be as Child A). Section 3 Check the box if this section applies to you. If this box is checked, do not complete Sections 4 and 5. You must complete Sections 10 and 11 on the reverse side of page 1. Sections 4 & 5 List the present and all prior addresses during the last two years of the above-named child(ren) and your present address. If legal custody of a child has been awarded to a social service agency, list the name and address of the agency with legal custody. Section 6 Check the appropriate box. Section 7 List all pending or concluded proceedings which you have participated in or know of involving the care or custody of the child(ren) named in this affidavit. Indicate the letter of the child; the court in which the case was heard, the docket number, the person(s) to whom custody was awarded, and the date of the award, and the nature of your participation in the proceeding by listing “W” for witness, “P” for party, “O” for other or “N” for none. If specific information required in this section is not known, you or your attorney should contact the court where the case was heard to obtain such information. In the case of a petition for adoption, list all information except the person(s) to whom custody was awarded, the date of the award and the nature of your participation. Under the heading “Status of Case”, indicate type of case. Section 8 List the name(s) and current residential address(es), if known, otherwise the last known address(es) of parties to care or custody proceedings or persons claiming a legal right to the above named child(ren) during the last two years. Do not include yourself. Section 9 Check this box if this affidavit discloses the adoption of a child and you are requesting the court to impound this affidavit. If this provision is applicable, you should contact the Clerk-Magistrate or Register of Probate for assistance concerning the appropriate motion to be filed. Section COMPLETE ONLY IF YOU CHECKED THE BOX IN SECTION 3. 10 & 11 List the present and all prior addresses during the last two years of the child(ren) listed in Section 2 of this affidavit and your present address. If legal custody of a child has been awarded to a social service agency, list the name and address of the agency with legal custody. Section 12 List the attorneys and guardians ad litem/investigators previously appointed in Section 7. SignatureThe party listed in Section 1 must date and sign this affidavit except for an incompetent or juvenile, in which case the attorney of record on behalf of the juvenile or incompetent party must date and sign this affidavit and print his/her name and address. TH S AFFID AV IT M U S T B E FILE D W ITH TH E C O UR T AN D A C O PY FU R NIS HE D B Y TH E P AR TY FILIN G IT TO ALL O TH ER PAR TIE S TO TH E AC TIO N . COMMONWEALTH OF MASSACHUSETTS THE TRIAL COURT PROBATE AND FAMILY COURT DEPARTMENT WARE Parents and Children in Divorce, Child & Family Services, Mary Lane Hospital, 85 South Street, (413) 737-4718, Contact: John Maloney WATERTOWN Families Divided, Divorcestep, Watertown High School, 50 Columbia St., (508) 358-7688, Contact: Michele Diamond, www.divorcestep.com WEST SPRINGFIELD Parents & Children in Divorce, Child & Family Service West Springfield Center 425 Union St., Level D, (413) 737-4718, Contact: John Maloney WESTBOROUGH Divorce that Works for Children, Parenting Solutions, 6 Colonial Drive, (508) 366-7557, Contact: Sylvia Sirignano or Glenn Smith Children Cope with Divorce, Burroughs JCC, 45 Oak Street, (508) 755-3101, Contact: Kristy Fiorillo. Website: www.jfsworcester.org [2 sessions of 2.5 hours each] WESTON Families Divided, Divorcestep, Regis College, Upper Student Union, Alumnae Hall, 235 Wellesley St., (508) 358-7688, Contact: Michele Diamond, www.divorcestep.com WORCESTER Parents Apart, University of Mass. Medical Center, 55 Lake Avenue North, (508) 793-6336, Contact: Michele Eberhart Children Cope with Divorce, Jewish Family Service of Worcester, 646 Salisbury St., (508) 755-3101, Contact: Kristy Fiorillo , Website: www.jfsworcester.org [2 sessions of 2.5 hours each] Parents Apart, Family Services of Central Massachusetts, 31 Harvard St., (508) 756-4646, Contact: Intake Department, Website: www.fscm.org Consider the Children, Divorce Education, Inc., Relationship Institute @ 6 Melville Street, (508) 4354745 or (508) 853-7373, Contact: Diane Ferkler or Samuel Chiancola STANDING ORDER 4-08 PARENT EDUCATION PROGRAM ATTENDANCE This court finds that the interests of the minor children of parties appearing before it would be well served by educating their parents about children’s emotional needs and the effects of divorce on child behavior and development. IT IS HEREBY ORDERED THAT: 1. All parties to a divorce action in which there are minor children, are ordered to attend and participate in an approved Parent Education Program (hereinafter, program) except as herein provided. This requirement applies to divorces brought under Ch. 208 sec. 1 (fault divorces); and Ch. 208 secs. 1A and 1B (irretrievable breakdown) and as ordered by a judge of this court in an action to establish paternity, complaints for modification or contempt or in any case involving visitation, custody, or support of minor children. 2. Attendance at an approved program is mandatory for parties to such actions unless waived by the court. Parties must register with an approved provider within sixty days (60) days of service of the original complaint upon the original defendant and attend the next available session. 3. No Pre-trial Conference or Trial will be held by the court until the court receives a certificate of attendance from an approved program for each party, or waives the requirement. An uncontested divorce hearing may be scheduled pending attendance if the parties file confirmations of registration with the court and so long as both parties complete the program prior to the hearing. A Pre-Trial Conference in a contested case may be similarly scheduled so long as the parties complete the program prior to the Pre-Trial Conference. PARENT EDUCATION PROGRAMS Understanding the Effect of Divorce on Children 4. The court may waive the attendance requirement upon motion, with notice, for one or both parties. Waivers will only be granted upon a demonstrable showing of chronic and severe violence which negates safe parental communication; language barriers; institutionalization or other unavailability of a party; failure of the other party to complete a program; unavailability of an approved program in the county in which the original divorce brought under Ch. 208 sec. 1 and Ch. 208 secs. 1A and 1B was filed; or where justice otherwise indicates. 5. Sanctions for failure to register with an approved program within sixty (60) days of service of the original complaint upon the original defendant may be imposed by the court. ***Programs Offered in Spanish BEVERLY Parent Education and Custody Effectiveness-PEACE, North Shore Counseling Center, 23 Broadway, (978) 922-2280, Contact: Linda Migdole, Website: www.nsccpsyc.org FITCHBURG Reducing the Effects of Divorce, Children’s Aid & Family Service, Fitchburg Fire Dept. 33 North Street, (978) 534-5218, Contact: Family Counseling Center, Website: www.sevenhills.org LAWRENCE Divorce & Its Impact on Children’s Development, Northern Essex Community College, 45 Franklin Street, (978) 745-7808, Contact: Madeline Segal 6. The parties must attend programs approved by the Chief Justice of the Probate and Family Court. Attendance at an approved program, wherever held within the Commonwealth, is permissible. Programs which are not approved by the Chief Justice will not satisfy the attendance requirement. Program vendors will ensure that parties to an action do not attend the same session of any program. Lists of approved programs shall be available at all Registries of Probate and at http://www.state.ma.us/courts/courtsandjudges/courts/probateandfamilycourt/selfhelp.html 7. A pamphlet entitled Parent Education Programs: Understanding the Effect of Divorce on Children, which lists the approved program providers shall be given to the plaintiff or his/her attorney upon the filing of a complaint for divorce involving minor children. The plaintiff or his/her attorney shall serve a copy of said pamphlet along with the complaint and summons to the person authorized to make service pursuant to Mass.R.Dom.Rel.P. 4(c). 8. The parties shall each pay $80.00 to the provider in advance of the program to offset the cost of materials and facilitators. 9. A party may pay a reduced fee of $5.00 to the provider if that party has submitted and had allowed an “Affidavit of Indigency and Request for Waiver, Substitution or State Payment of Fees and Costs.” This form is prescribed by the Chief Justice of the Supreme Judicial Court pursuant to G.L. c. 261, § 27B, promulgated March, 2003 and is available at the Registry of the Probate and Family Court. The party must submit a copy of this form to the provider when registering for a program at a reduced fee of $5.00. 10. Nothing herein shall be construed to limit the authority of any Probate and Family Court justice to order parties to attend an approved program in any case involving visitation, custody, or support of minor children. 11. All information submitted in compliance with the research component of the program shall be the work product of the Probate and Family Court Administrative Office. The material is for research purposes only and shall not be discoverable. April 2008 PROBATE AND FAMILY COURT ADMINISTRATIVE OFFICE John Adams Courthouse One Pemberton Square Boston, MA 02108 http://www.mass.gov/courts Paula M. Carey Chief Justice R E V IS E D A P R IL 2011 A pproved P rogram P roviders A ll program s are 2 sessions of 2 ½ hrs each unless noted otherw ise ACTON Changing Families, Changing Times, Boundaries Therapy Center, Clubhouse at Nagog Condominiums, (978) 263-4878 extension 230, Contact: Helen Frey AGAWAM Parent Education Program, Behavioral Health Network, Agawam Counseling Center, 30 Southwick St., Feeding Hills (413) 786-6410, Contact: Coordinator ATTLEBORO Parents Forever, Family Service Assoc., Arbour Fuller Hospital, 200 May St., (508) 677-3822, Contact: Sue Roque, Website: www.frfsa.org [2 sessions of 3 hours each] AUBURN Parents Forever, Pakachoag Church, 203 Pakachoag Street, (508) 798-6699, Contact: Karen Feeney, Website: www.eastpointservices.com BEVERLY **Parent Education and Custody Effectiveness-PEACE, North Shore Counseling Center, 23 Broadway, (978) 922-2280, Contact: Linda Migdole, Website: www.nsccpsyc.org BILLERICA Divorce and Its Impact on Children’s Development, First Parish Church, 7 Concord Road, (978) 745-7808, Contact: Madeline Segal BOSTON Parents Apart, Family Healthy Choices, Massachusetts General Hospital, Yawkey Bldg. Suite 10-660, Conference Room E, (978) 887-6342, Contact: Steven Nisenbaum, Website: www.familyhealthychoices.org BRAINTREE Parents Apart, Divorce Center, Inc., Braintree Health South Hospital, 250 Pond Street, (888) 434-8787, Contact: Coordinator, Website: www.divorcecenter.org FALL RIVER Parents Forever, Family Service Association, 101 Rock Street, (508) 677-3822, Contact: Sue Roque, Website: www.frfsa.org [2 sessions of 3 hours each] FITCHBURG Reducing the Effects of Divorce, Children’s Aid & Family Service, Fitchburg Fire Dept. 33 North Street, (978) 345-4147, Contact: Family Counseling Center, Website: www.sevenhills.org Reducing the Effects of Divorce, Children’s Aid and Family Service, Fitchburg Chamber of Commerce, 1460 John Fitch. Highway, (978) 345-4147, Contact: Family Counseling Center, Website: www.sevenhills.org FRAMINGHAM Consider the Children, Divorce Education, Inc., Mass Bay Community College, 19 Flagg Drive, (508) 435-4745, Contact: Diane Ferkler or Samuel Chiancola GARDNER Reducing the Effects of Divorce, Children’s Aid & Family Service, 7th Day Adventist Church, 100 Colony Road, (978) 345-4147, Contact: Family Counseling Center, Website: www.sevenhills.org G R E E N FIE LD Families in Transition (FIT), Franklin County Bar Association, Franklin Medical Center,164 High St., (413) 773-9839, Contact: Katie Schendel, Website: www.franklincountybar.org HANOVER Parents Apart, Marvista Psychological Associates, PC, South Shore Vocational High School, (781) 383-0860, Contact: Selma Ingber or Charles Mundhenk, Website: www.marvistapsych.com HAVERHILL Positive Co-Parenting in Difficult Times, Psychotherapy Associates of North Reading, Northern Essex Community College,100 Elliot St., (978) 664-2566, ext. 5 Contact: Dr. Donna Whipple, Website: www.panr.net HYANNIS *Set A Good Example (SAGE), MSPCC, 206 Breeds Hill Road, (508) 775-0275, Contact: Kirsten Abrahamson, [2 sessions 5:30 - 8 each BROCKTON Parents Apart, Mass Bay Counseling, Massasoit Community College, 1 Massasoit Avenue, (617) 786-3027, Contact: Amy Crissinger Parents Apart Mass. Bay Counseling,455 Iyanough Rd. ,VFW Post 2578, (617) 786-3027, Contact: Amy Crossinger “Set a Good Example” (SAGE) Northeast Health Services, 231 Main Street, (800) 339-2204, Contact: Jean Adams or Nelson Cardona (2 sessions, First session 2 hours, Second 3 hours) LAWRENCE Divorce & Its Impact on Children’s Development, Northern Essex Community College, 45 Franklin Street, (978) 745-7808, Contact: Madeline Segal BROOKLINE For the Sake of the Children, Center for Families in Transition, Brookline PDHQ, 350 Washington Street, (617) 492-7245 or 857-373-9011, Contact: Robin Zucker, Website: www.cftclass.org. or Email: [email protected] Putting Children First, Family Service, Inc., Merrimack College, (978) 683-9505, Contact: Intake Worker, Website: www.familyserviceinc.com Parenting Through Divorce: Supporting the Child, Boston Graduate School of Psychoanalysis, 1581 Beacon Street, (617) 277-3915, Contact: William Sharp, Website: www.bgsp.edu CAMBRIDGE For the Sake of the Children, Center for Families in Transition, Cambridge College, 1000 Mass. Ave., (617) 492-7245 or 857-373-9011, Contact: Robin Zucker, Website: www.cftclass.org or Email: [email protected] CHELMSFORD Moving Forward, Life Transitions, Inc. 10 Billerica Road, (978) 649-6255, Contact: Robert DiMeo, Website: www.lifetransitionsinc.net CHICOPEE Parents Apart, Elm’s College, Berchmans Hall, 291 Springfield Street, (413) 783-2202, Contact: Judith Haggerty DANVERS Parents Apart, Family Healthy Choices, Peabody Inst. Library, 15 Sylvan Street, (978) 887-6342, Contact: Steven Nisenbaum, Website: www.familyhealthychoices.org DARTMOUTH Parents Forever, UMASS Dartmouth, McLean Center, 285 Old Westport Road, No. Dartmouth, (508) 6773822, Contact: Sue Roque, Website: www.frfsa.org DEDHAM Parents Apart, Child & Family Psychological Services, Inc., Dedham Community Asssociation, 671 High Street, (781) 551-0999 ext. 503, Contact: Coordinator, Website: www.cfpsych.org Focusing on Our Children Divorce Education Services, Dedham Community House, 671 High Street, (781) 237-5064, Contact: Ann Steele LEXINGTON Parents Apart, Lexington Institute, Inc., 3 Militia Drive, (781) 860-0600, Contact Dr. Paul Bombara LITTLETON Moving Forward, Life Transitions, Inc., 461 King St., (978) 649-6255 , Contact: Robert DiMeo, Website: www.lifetransitionsinc.net LOWELL Divorce & Its Impact on Children’s Development, Pawtucket Congregational Church, 15 Mammoth Road (978) 745-7808, Contact: Madeline Segal LYNN Divorce and Its Impact on Children’s Development, Lynn Housing Authority and Neighborhood Community Room, 10 Church Street, (978) 745-7808, Contact: Madeline Segal MARLBOROUGH Consider the Children, Divorce Education Inc., Marlborough High School, 431 Bolton Street, (508) 435-4745, Contact: Diane Ferkler or Samuel Chiancola MEDFORD Positive Co-Parenting in Difficult Times, Psychotherapy Associates of North Reading, Medford High School, 489 Winthrop St., (978) 664-2566, ext. 5 Contact: Dr. Donna Whipple, Website: www.panr.net MELROSE Divorce and Its Impact on Children’s Development, Melrose Highlands, Congregational Church, 355 Franklin St., (978) 745-7808, Contact: Madeline Segal MILFORD Consider the Children, Divorce Education, Inc., Milford High School, 31 West Fountain St., (508) 435-4745 or (508) 473-4674, Contact: Diane Ferkler or Samuel Chiancola NEEDHAM Focusing on Our Children, Divorce Education Services, Deaconess-Glover Hospital, 148 Chestnut St., (781) 237-5064, Contact: Ann Steele NEWBURYPORT Parents Apart,.Family Healthy Choices, Nock Middle School, 70 Low Street, (978) 887-6342, Contact: Steven Nisenbaum, Website: www.familyhealthychoices.org NORTH READING Positive Co-Parenting in Difficult Times, Psychotherapy Assoc. of North Reading, E. Little School, 7 Barberry Lane , (978) 664-2566, ext. 5 Contact: Dr. Donna Whipple, Website: www.panr.net NORTHAMPTON Parents and Children in Transition (PACT), Hampshire County Bar Association, Hall of Records Community Room, 33 King St., (413) 586-4597, Contact: Rebecca Ryan NORTHBRIDGE Parents Forever, Whitinsville Community Center, 60 Main Street, (508) 798-6699, Contact: Karen Feeney, Website:www.eastpointservices.com NORWOOD Parents Apart, Child & Family Psychological Services, Inc.,Dr. Philip Coakley Middle School in library, 1315 Washington Street,, or Norwood Education Center/Savage Center, 275 Prospect Street, Room 218/219, (781) 551-0999, Contact: Coordinator, Website: www.cfpsych.org OAK BLUFFS Parents Apart, 111 Edgartown Road,, (508) 693-7900 ext. 225, Contact: Joanne DeBettencourt, Website: www.mvcommunityservices.com PITTSFIELD Families in Transition, Brien Center for Mental Health and Substance Abuse Services, 333 East Street , (413) 629-1061, Contact: Intake Coordinator, Karen Wasileski PLYMOUTH Parents Apart, Marvista Psychological Associates, PC, Plymouth North High School, 41 Obery Street, (781) 383-0860, Contact: Selma Ingber or Charles Mundhenk Website: www.marvistapsych.com QUINCY Parents Apart, Mass Bay Counseling, Quincy High School, 52 Coddington St., (617) 786-3027, Contact: Amy Crissinger SALEM Divorce & Its Impact on Children’s Development, St. Peters Church, 24 St. Peter St., (978) 745-7808, Contact: Madeline Segal SANDWICH For the Sake of the Children, Center for Families in Transition, Sandwich Library, 142 Main Street, (617) 492-7245 or 857-373-9011 Contact: Robin Zucker, www.cftclass.org or Email: [email protected] SOUTHBRIDGE Parents Apart, George B. Wells Human Service Center, Harrington Memorial Hospital, 29 Pine St.,(508) 765-9167, Contact: Coordinator SPRINGFIELD Parent Education Program, Behavioral Health Network, Child Guidance Clinic, 110 Maple St., (413) 732-7419, Contact: Coordinator Parents & Children in Divorce, Child and Family Service of Pioneer Valley, Inc., Baystate Health, 3300 Main Street, (413) 737-4718, Contact: John Maloney Parents in Cooperation, Square One, 947 Main Street, (413)-735-1719, Contact: Barry Krimsky TAUNTON *Family Service Association, Taunton Galleria Mall Silver City, Community Room, 2 Galleria Mall Drive, (508) 677-3822, Contact: Sue Roque, Website: www.frfsa.com [2 sessions of 3 hours each] WAKEFIELD Partners for Positive Co-Parenting, Riverside Community Care, 328 Main Street, Suite 304 (781) 246-2010, Contact: Coordinator WALTHAM Parents Apart, Divorce Center, Inc., West Suburban Chamber of Commerce, 84 South St., (888) 434-8787, Contact: Coordinator, Website: www.divorcecenter.org