INITIALS OF AFFIANT: ___________ (PAGE 1 OF 3)

V I R G I N I A: IN THE CIRCUIT COURT OF THE CITY OF CHESAPEAKE _________________________________________________,

Plaintiff, v. Case No.: ________________ __________________________________________________,

Defendant.

AFFIDAVIT OF PARTY IN SUPPORT OF DIVORCE VIRGINIA CODE § 20-106

COMES NOW, ______________________________________________________, and after being duly sworn, affirms under oath and based upon personal knowledge, the following factual support for the allegations and grounds of divorce stated in the __ Complaint {or} __ Counterclaim:

1. __ My current address is: _______________________________________________________

_________________________________________________________________________.

2. __ The opposing party and I were married on the _____ day of _________________________,

_________, in the City/County of_____________________________, ____________________.

3. __ Both parties are over the age of eighteen (18).

4. __ Both parties are sui juris and neither party is suffering from any condition that renders either

party legally incompetent.

5. __ Neither party is currently incarcerated in a mental or penal institution; {or}

__ The __ Plaintiff / __ Defendant is currently incarcerated in a __ mental or __ penal institution.

6. __ The opposing party is not an active duty member of the armed forces of the United States of

America; {or}

__ The opposing party is an active duty member armed forces of the United States of America, and

has __ filed an Answer; {or} __ filed a waiver of rights under the federal Servicemembers Civil

Relief Act (50 U.S.C. app. § 501 et seq.)

INITIALS OF AFFIANT: ___________ (PAGE 2 OF 3)

7. __ At least one of the parties to this suit is, and has been for a period in excess of six months

immediately preceding the commencement of the suit, a bona fide resident and domiciliary of

the Commonwealth of Virginia, to wit: __ Plaintiff {and/or} __ Defendant.

8. __ The opposing party and I last cohabitated in the City/County of:

_______________________________________________, ____________________________.

9. __ There were no children born or adopted of the marriage and the wife is not known to be pregnant

from the marriage; {or}

__ I affirm that there were ____ children born or adopted of the marriage and that the wife is not

known to be pregnant from the marriage. The names and dates of birth of the children are as

follows:

___________________________________________________ ______________________

___________________________________________________ ______________________

___________________________________________________ ______________________

___________________________________________________ ______________________

___________________________________________________ ______________________

___________________________________________________ ______________________

___________________________________________________ ______________________

10. __ My spouse and I have not entered into a written and signed settlement agreement; {or}

__ The parties have entered into a written and signed settlement agreement, dated the _____ day of

____________________________, __________, and I request that the Court affirm, ratify and

incorporate, but not merge, the settlement agreement into the Final Decree of Divorce; {and/or}

__ The parties have entered into a written and signed addendum to the settlement agreement, dated

the ______ day of ______________________________, __________, and I request that the

Court affirm, ratify and incorporate, but not merge, the addendum to the settlement agreement

into the Final Decree of Divorce.

11. __ The parties separated on the ______ day of ______________________________, __________

and have lived separate and apart, continuously, without interruption and without cohabitation,

and with the intent to remain separate and apart permanently, for the statutory period required by

subdivision A(9) of Virginia Code § 20-91.

INITIALS OF AFFIANT: ___________ (PAGE 3 OF 3)

I declare and verify under penalty of perjury that the foregoing is true and correct. ___________________ __________________________________________

Date __ Plaintiff / __ Defendant Commonwealth/State of _______________________________ [ ] City [ ] County of _______________________________ Subscribed and Sworn/Affirmed before me this _______ day of ________________________, 20______ By: ___________________________________________________________________ ___________________ _______________________________________________________ Date [ ] Clerk [ ] Deputy Clerk

[ ] Notary Public: My Commission Expires: _____________________

Registration No: __________________________

12. __ I desire to be awarded a divorce pursuant to subdivision A(9) of Virginia Code § 20-91 and

Virginia Code § 20-121.02, and I affirm that there is no reasonable chance of reconciliation.

13. __ Any additional information (optional): _____________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________