The 18th Judicial District, Iberville, Pointe Coupee & West Baton Rouge Parishes
State of Louisiana
Form 1
Divorce-Default Confirmation LA. C.C. Art. 103
Pursuant to LA. C.C.P. Art. 1702(E)
________________________________
NO:___________________ DIV.__________
(PETITIONER)
VERSUS
THE 18TH JUDICIAL DISTRICT COURT
________________________________
PARISH OF __________________________
(DEFENDANT)
STATE OF LOUISIANA
•
Date the parties were married:
Date
•
Physical separation date:
________________________
Date
•
The requisite period of time to live separate and apart (select one):
____ 180 days- there are no minor children of the marriage
____ 365 days- there are no minor children of the marriage
•
Petition for divorce was filed:
________________________
Date
•
Service/waiver (select one):
____ Personal/domiciliary service on: _________________________
____ Waiver was executed on: _____________________ and filed on:
____ Long arm service delivery on: ________________and affidavit filed:
•
Date preliminary default was entered:
•
Affidavit of petitioner specifically testifying as to facts
sufficient to obtain a divorce?
_______________________
Date
__________
__________
YES
NO
CERTIFICATION OF ATTORNEY
I certify that the information I have provided above is correct after an examination of the record.
___________________________________________
_________________________________________
ATTORNEY SIGNATURE
DATE
COURT USE ONLY
CERTIFICATION OF MINUTE CLERK
I certify that after examining the record, no answer or opposition has been filed in the proceeding.
________________________________________
______________________________________
MINUTE CLERK SINGATURE
DATE
Form 1 – Default Divorce Confirmation Checklist
18JDC Revised: May 2015