EXPRESS DIVORCE APPLICATION FORM
* required

Date:
Wife Information:		Husband Information:
Name:	Last name:	Name:	Last name:
DOB:mo day year		DOB:mo day year
Address:		Address:
Tel:		Tel:
E-mail:		E-mail:
Community Property : Yes no
Community Debts : Yes no
Marriage date: modayyear; Marriage city/State: ,
Minor children’s name (under 18 years old)
1. Name: DOB: mo day year, reside in(state), sex:
2. Name: DOB: moday year, reside in(state), sex:
Child Support:
Divorce Category:
Both parties agree to sign.(Signature must be verified and notarized)
Complaint for divorce (One side divorce), must have correct address to serve Summons.
Publication Divorce: disappear in US or in Overseas or can not serve or can not located.
Last disappear date:	modayyear
Last known address:
Mail check: $
Payable to: Las Vegas Legal Service, Inc. Mailing Address : 41-25 Kissena Blvd, Room 107 Flushing, NY 11355 Tel: 718-475-6111 Fax: 718-888-0922
Please input OKto confirm and click Submit: