To ____________ Court, next to be holden at___________, within the County of ___________, on the ___________M,D,Y.
Respectfully Represents, in the County of___________that she resides in said County, and has been a domiciled inhabitant of said State and has resided therein for more than two years next before the preferring of this petition and is now a domiciled inhabitant of said State; that she was married to___________. Her present husband on the twenty-fifth say of ___________，and hath ever since on her part demeaned her self as a faithful wife and performed all the obligations of the marriage covenant; but that the said___________hath violated the same on this; that
There are irreconcilable differences, which have caused the irremediable breakdown of the marriage.
Wherefore your petitioner prays that a decree of this Court may be made divorcing her from the bond of Marriage, and from the said___________.
In front of myself signed in the state county and really take an oath the guarantee on___________M,D,Y.
（Signature）：_____
DATE：______________
