Field 1: Fill in the county in which the action is brought. Be consistent with other forms.

Field 2: Print the Plaintiff's name.

Field 3: Write in the index number assigned to this matter.

Field 4: Print the Defendant's name.

Field 5: Write the name of Plaintiff's attorney in the blank space or, if Plaintiff is representing himself or herself, strike the word "by" and leave the space blank.

Field 6: This section informs the court of whether it has the jurisdiction (authority) to hear your case. Check the appropriate box or boxes.

Field 7: Insert the date that you and your spouse were married as listed on a marriage license and the city, town or village; and the state or country of the marriage.

Field 8: Check the appropriate box. If you had a religious ceremony, you must strike the word "not" in the first line and you must check one of the three options below as to your removing barriers to remarriage. If you had a civil ceremony, leave the word "not" in place and do not check any of the three options below. A Barriers to Remarriage Affidavit (Forms UD-4 and UD-4a) must be filed with proof of service unless the Defendant waives the filing of the Affidavit.

Field 9: Check the appropriate box. List the number of children either born or adopted during the marriage. List the names, dates of birth and addresses for each.

Field 10: List the Plaintiff's and Defendant's addresses. If child support is not an issue leave this section blank.

Field 11: Fill in the required information about Plaintiff's and Defendant's insurance coverage. Make sure to include the type of coverage. Examples include, but are not limited to, medical, dental and optical coverage. If either party has more than one insurance plan, you must list the additional coverage. Strike this section if child support is not an issue.

Field 12: You must state and describe the grounds for divorce. In addition to selecting the section (be specific as possible) of the Domestic Relations Law that applies, you should fill in the date where appropriate and also give a brief description as to how you meet New York State's grounds requirements. (Refer to Grounds for Divorce on pages 2 through 5 of these instructions).

Field 13: This section remains unchanged. If a judgment of divorce was already entered in this state or another state between you and your spouse and/or there is another action for divorce pending between you and your spouse, you may not be permitted to maintain this action. You should seek legal assistance as noted in the Foreword.

Field 14: If you are asking for other relief in addition to your request for a divorce, this relief must be listed in this section. Examples include but are not limited to custody, visitation, equitable distribution, maintenance and exclusive occupancy of the marital home. If there are minor children of the marriage, child support must be listed in this section. You should also list any presently existing Family Court orders (with the docket number) that you wish to be continued. (Note: when children reside in New York, custody must be determined).

* If you are requesting that an equitable distribution of marital property be made, you must check the appropriate box. Be aware that requests to distribute marital property may require a hearing before a judge or special referee. If you are waiving the distribution of marital property or if marital property is being distributed pursuant to an agreement/stipulation, check the appropriate box.

Field 15: Insert the date that you prepared the document.

Field 16: Check the appropriate box. The attorney for the Plaintiff must sign this line and print his or her name, address and telephone number. If the Plaintiff does not have an attorney, the Plaintiff must sign at that line and put in his or her address and telephone number.

Field 17: The Plaintiff must sign this section in the presence of a notary public, who then must notarize the document. That individual will fill in the remaining information on this page.