Your County:
Choose...
Suffolk County
Nassau County
Queens County
Brooklyn (Kings County)
Bronx County
Manhattan (NY County)
Staten Island
Party Completing This Form
Choose...
Wife
Husband
Your First Name
Your Middle Name / Initial
Your Last Name
Your Street (with Apt. Number, if any)
Your City / Town
Your Zip Code
Your Phone Number
Your Social Security Number
Your Birthdate
Month...
January
February
March
April
May
June
July
August
September
October
November
December
Day...
1
2
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5
6
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29
30
31
Year...
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
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1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934 or earlier
What Number Marriage is this for you?
1
2
3
4
5
How many prior marriages ended in divorce?
0 or Not Applicable
1
2
3
4
Ended due to death of your spouse?
0 or Not Applicable
1
2
3
4
Your Race
Choose...
White / Caucasian
African American / Black
Hispanic / Latin American
Asian
Amer. Indian / Nat. Alaskan
Nat. Hawaiian / Pacific
Your Education Level (Highest Grade Completed)
Choose...
0
1
2
3
4
5
6
7
8
9
10
11
12 (End High School)
13 (1 Year of College)
14 (2 Years of College)
15 (3 Years of College)
16 (4 year degree or more)
Information Regarding Your Spouse
Spouse's First Name
Spouse's Middle Name / Initial
Spouse's Lastname
Spouse's Street (with Apt. Number, if any)
Spouse's Town / City
Spouse's State
Spouse's Phone Number
Spouse's Social Security Number
Spouse's County
Spouse's Birthdate
Month...
January
February
March
April
May
June
July
August
September
October
November
December
Day...
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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21
22
23
24
25
26
27
28
29
30
31
Year...
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934 or earlier
What Number Marriage is this for your spouse?
1
2
3
4
5
How many of your spouse's prior marriages ended in divorce?
0 or Not Applicable
1
2
3
4
Ended due to death of your spouse's partner?
0 or Not Applicable
1
2
3
4
Your Spouse's Race
Choose...
White / Caucasian
African American / Black
Hispanic / Latin American
Asian
Amer. Indian / Nat. Alaskan
Nat. Hawaiian / Pacific
Spouse's Education Level
(Highest Grade Completed)
Choose...
0
1
2
3
4
5
6
7
8
9
10
11
12 (End High School)
13 (1 Year of College)
14 (2 Years of College)
15 (3 Years of College)
16 (4 year degree or more)
Will your spouse be representing him/herself?
Yes
No-my spouse has a lawyer
Information Regarding Your Marriage
Marriage Date
Month...
January
February
March
April
May
June
July
August
September
October
November
December
Day...
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year...
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978 or earlier
Marriage Place (City, State)
Was there a religious ceremony?
Choose...
Yes
No
Wife's Maiden Name
Date of Separation (if none, pick today's date)
Month...
January
February
March
April
May
June
July
August
September
October
November
December
Day...
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year...
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978 or earlier
Address Where Parties Last Lived Together
Number of Total Children From This Marriage
Choose...
None
1
2
3
4
5
6 or more
Number of Children Under 18
Choose...
None
1
2
3
4
5
6 or more