Ñòàòóñ: ïðîâîâàÿ ïîìîùü
Ïîçîâíà çàÿâà ïðî ðîç³ðâàííÿ øëþáó



Äî ________________________________
(íàéìåíóâàííÿ ì³ñöåâîãî ñóäó)
Ïîçèâà÷ ___________________________
(Ï. ². Á.)
ùî ïðîæèâຠçà àäðåñîþ: ____________
(ì³ñöå ïðîæèâàííÿ)
Íîìåð çàñîáó çâ'ÿçêó_________________

³äïîâ³äà÷ _________________________
(Ï. ². Á.)
ùî ïðîæèâຠçà àäðåñîþ: ____________
(ì³ñöå ïðîæèâàííÿ)

Íîìåð çàñîáó çâ'ÿçêó_________________


ÏÎÇÎÂÍÀ ÇÀßÂÀ
ÏÐÎ ÐÎDzÐÂÀÍÍß ØËÞÁÓ



"___" ____________ ____ ðîêó ÿ çàðåºñòðóâàâ(ëà) øëþá ç ³äïîâ³äà÷åì (÷èñëî, ì³ñÿöü, ð³ê) _______________________________________ ³ ïðîæèâàâ(ëà) ç íèì îäí³ºþ ñ³ì'ºþ
(Ï. ². Á.)
äî ___________________________________________________________________, (ì³ñÿöü, ð³ê) ï³ñëÿ ÷îãî ìîº ïðîæèâàííÿ îäí³ºþ ñ³ì'ºþ ³ç ³äïîâ³äà÷åì áóëî ôàêòè÷íî ïðèïèíåíî.

³ä öüîãî øëþáó ó íàñ º äèòèíà (ä³òè) _____________________________________________________ _________________________________________________________________________________________
(ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, ÷èñëî, ì³ñÿöü, ð³ê íàðîäæåííÿ äèòèíè (ä³òåé)
________________________________________________________________________, ùî íà äàíèé ìîìåíò ïðîæèâຠ(ïðîæèâàþòü) ðàçîì ç ______________________________________________________________.
Ñï³ëüíå æèòòÿ ç ³äïîâ³äà÷åì íå ñêëàëîñÿ ________________________________________________________________________
(âêàçàòè ïðè÷èíè)
_____________________________________________________________________________.

Ñï³ëüíå ãîñïîäàðñòâî íàìè ðàçîì íå âåäåòüñÿ.
Ïåðåêîíàíà, ùî ïîäàëüøå ñï³ëüíå æèòòÿ ³ çáåðåæåííÿ øëþáó íåìîæëèâå ³ ñóïåðå÷èòèìå ìî¿ì ³íòåðåñàì, ÿê³ ìàþòü ³ñòîòíå çíà÷åííÿ, à ñàìå: ________________________. Ñïîðó ïðî ïîä³ë ìàéíà, ùî º íàøîþ ñï³ëüíîþ âëàñí³ñòþ, íåìàº. ̳æ íàìè äîñÿãíóòî óãîäè ïðî óòðèìàííÿ íàøî¿ äèòèíè (íàøèõ ä³òåé).

Ç ïèòàííÿ ùîäî óòðèìàííÿ òà âèõîâàííÿ ä³òåé (äèòèíè) ñïîðó íåìàº, îñê³ëüêè ____________ ________________________________________________________________________________
(âêàçàòè ç êèì ³ç ïîäðóææÿ áóäå ïðîæèâàòè äèòèíà, àáî õòî ç ä³òåé; ÷è áóäóòü
________________________________________________________________________________.
âèïëà÷óâàòèñÿ êîøòè íà óòðèìàííÿ äèòèíè (ä³òåé) äîáðîâ³ëüíî àáî çà ð³øåííÿì ñóäó)

Îäíàê, ³äïîâ³äà÷ íå ïîãîäæóºòüñÿ ðîç³ðâàòè øëþá â ïîðÿäêó ñò. 109 ѳìåéíîãî êîäåêñó Óêðà¿íè.Çâàæàþ÷è íà âèùåâèêëàäåíå, êåðóþ÷èñü ñò. ñò. 105, 109, 110, 112 ѳìåéíîãî êîäåêñó Óêðà¿íè,


ÏÐÎØÓ:


1. Ðîç³ðâàòè øëþá ì³æ ìíîþ ³ ³äïîâ³äà÷åì, _________________________, çàðåºñòðîâàíèé "___" ____________ ____ ð. â îðãàí³ ðåºñòðàö³¿ àêò³â öèâ³ëüíîãî ñòàíó __________________________.


Äîäàòêè:


1. Ñâ³äîöòâî ïðî øëþá.
2. ______________________________________________________________.
3. Êîï³ÿ ñâ³äîöòâà ïðî íàðîäæåííÿ _________________________________.
4. Êîï³ÿ ïîçîâíî¿ çàÿâè.
5. Êâèòàíö³ÿ ïðî ñïëàòó äåðæàâíîãî ìèòà.
6. Êâèòàíö³ÿ ïðî ñïëàòó âèòðàò íà ³íôîðìàö³éíå çàáåçïå÷åííÿ ðîçãëÿäó ñïðàâè
7. ______________________________________________________________.



____________
(Äàòà) (ï³äïèñ) (Ï.².Á.)