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 of the marriage (see the definition on page 7). List the names, dates of birth and addresses for each.
Field 10: List the Plaintiff's and Defendant's addresses.
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 requires no response on your part. 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:“Ancillary” or Other Relief: If you are asking for other relief in addition to your request for a divorce, this other relief must be listed in this section as “ancillary relief.” Examples include but are not limited to custody, visitation, child support, equitable distribution of specific property from the marriage, maintenance, counsel and/or experts fees, orders of protection, pension benefits, use of a former last name, and exclusive occupancy of the marital residence. If there are unemancipated children of the marriage (see the definition on page 7), child support must be listed in this section. You should also list any presently existing court orders (including the docket /case/index number) that you wish to be continued. (Note: when minor children of the marriage reside in New York State, custody must be determined). You should also list any stipulations or agreements that you have made in writing with the Defendant that you wish to become a part of the judgment. 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. If you are not seeking maintenance as described in the Notice of Guideline Maintenance other than what was already agreed to in a written agreement/stipulation, or if you seek maintenance as described in the Notice of Guideline Maintenance, check the appropriate box. If you would be the party with greater income, you should leave both boxes blank.
Note: do not check these boxes if your action was commenced before January 25, 2016 because the Maintenance Guidelines Law will not apply. If your action was commenced before that date, and if you seek maintenance, instead include your request on the Lines for “Ancillary” or Other Relief at Field 14 together with your reasons. The court will decide your request in its discretion after considering certain factors. If you are not requesting “Ancillary” or Other Relief, check the appropriate box.

Important Note: If you do not ask for a type of “Ancillary” or Other Relief in this section, you may be giving up your rights to things you may be entitled to.

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.