PURPOSE: This rule establishes the content of the certificate of dissolution of marriage for dissolutions granted by any court in this state to be filed with the Department of Health.

1. (1) The certificate of dissolution of marriage shall include the following items: case number; husband’s name, residence (city, town or location), state, zip code, county, date of birth, birthplace; wife’s name, maiden surname, residence (city, town or location), state, zip code, county, date of birth, birthplace, place of marriage (city, town or location), county, state or foreign country; date of this marriage; date couple last resided in same household; number of children under eighteen (18) in this household as of the date the couple last resided in same household; petitioner (check appropriate box); name of petitioner’s attorney; address of attorney; date of dissolution (month, day, year); type of decree (check appropriate box); date recorded; number of children under eighteen (18) whose physical custody was awarded to (designate in appropriate spaces); child support was awarded to (check appropriate box); county of decree; title of court; signature of certifying official; title of certifying official; number of this marriage— husband; number of this marriage—wife; husband—if previously married, last marriage ended by (check box) and date; wife—if previously married, last marriage ended by (check box) and date; husband’s race; wife’s race; husband’s education; wife’s education.

AUTHORITY: section 193.205, RSMo 1986. This rule was previously filed as 19 CSR 30- 10.070. Original rule filed Sept. 12, 1988, effective Jan. 1, 1989. Changed to 19 CSR 10-10.070 July 30, 1998.