Form VS243 "Worksheet for Divorce or Annulment Registration" - Kansas

What Is Form VS243?

This is a legal form that was released by the Kansas Department of Health & Environment - a government authority operating within Kansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2019;
  • The latest edition provided by the Kansas Department of Health & Environment;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form VS243 by clicking the link below or browse more documents and templates provided by the Kansas Department of Health & Environment.

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Download Form VS243 "Worksheet for Divorce or Annulment Registration" - Kansas

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KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT
Office of Vital Statistics
WORKSHEET FOR DIVORCE OR ANNULMENT REGISTRATION
This worksheet may be used to collect the information to be reported on the Certificate of Divorce or Annulment or through the electronic filing process. It may
also be used to provide the District Court information if the court is filing the official record for the parties.
This worksheet is not to be forwarded to the Office of Vital Statistics.
1. HUSBAND/SPOUSE NAME (First, Middle, Last)
2. HUSBAND/SPOUSE LAST NAME PRIOR TO FIRST MARRIAGE
4 RESIDENCE-STATE
5
COUNTY
3. DATE OF BIRTH (Month, Day, Year)
6. WIFE/SPOUSE NAME (First, Middle, Last)
7. WIFE/SPOUSE LAST NAME PRIOR TO FIRST MARRIAGE
8. DATE OF BIRTH (Month, Day, Year)
9. RESIDENCE-STATE
10. COUNTY
11. PLACE OF THIS MARRIAGE - STATE OR
12. COUNTY
13. DATE OF THIS MARRIAGE
14. NUMBER OF CHILDREN UNDER 18 IN THIS
FOREIGN COUNTRY
(Month, Day, Year)
HOUSEHOLD AS OF DATE IN ITEM 18
16 NAME OF PETITIONER’S ATTORNEY (Type)
15 PETITIONER
Husband/Spouse
Wife/Spouse
Both
Other (Specify)
_______
17 ATTORNEY’S ADDRESS (Street and Number or Rural Route, City or Town, State, Zip Code)
18 DATE DECREE FILED (Month, Day, Year)
19 TYPE OF DECREE-(Specify)
20. COUNTY OF DECREE
21. CASE NUMBER
Divorce
Annulment
THE INFORMATION BELOW WILL NOT APPEAR ON CERTIFIED COPIES OF THE RECORD.
K.S.A. 65-2422B, REQUIRES THE DIVORCE REPORT TO INCLUDE THE SOCIAL SECURITY NUMBER OF BOTH PARTIES TO MAKE SUCH INFORMATION AVAILABLE TO THE SECRETARY OF
KANSAS DEPARTMENT OF CHILDREN & FAMILIES FOR THE PURPOSE OF ESTABLISHING, MODIFYING, OR ENFORCING A SUPPORT OBLIGATION.
22. HUSBAND/SPOUSE SOCIAL SECURITY NUMBER & GENDER
23. WIFE/SPOUSE SOCIAL SECURITY NUMBER & GENDER
_____/_____/______
Male
Female
_____/_____/______
Male
Female
24. NUMBER OF THIS MARRIAGE First, Second, etc.
25. IF PREVIOUSLY MARRIED, LAST MARRIAGE ENDED
(Specify below)
By Death, Divorce, or Annulment (Specify below)
Date (Month, Day, Year)
24a. HUSBAND/SPOUSE
25a. HUSBAND/SPOUSE
25b HUSBAND/SPOUSE
24b. WIFE/SPOUSE
25c. WIFE/SPOUSE
25d. WIFE/SPOUSE
26. HISPANIC ORIGIN (Check the box or boxes that best describes
27. RACE (Check one or more boxes to indicate what race(s) you consider yourself to be.)
whether you are Spanish, Hispanic, or Latino. Check the “no” box if
27a. HUSBAND/SPOUSE
27b. WIFE/SPOUSE
you are not Spanish, Hispanic, or Latino.)
26a. HUSBAND/SPOUSE
26b. WIFE/SPOUSE
White
Korean
White
Korean
Black or
Vietnamese
Black or
Vietnamese
No, not Spanish/
No, not Spanish/
African American
African American
Hispanic/Latino
Hispanic/Latina
American Indian or
Other Asian (Specify)
American Indian or
Other Asian (Specify)
Yes, Mexican/Mexican
Yes, Mexican/Mexican
Alaska Native
Alaska Native
American/Chicano
American/Chicana
(Name of the enrolled
(Name of the enrolled
Yes, Puerto Rican
Yes, Puerto Rican
or principal tribes)
or principal tribes)
Yes, Cuban
Yes, Cuban
Yes, Central American
Yes, Central American
Native Hawaiian
Native Hawaiian
Yes, South American
Yes, South American
Asian Indian
Guamanian or
Asian Indian
Guamanian or
Yes, other Spanish/
Yes, other Spanish/
Chamorro
Chamorro
Hispanic/Latino (Specify)
Hispanic/Latina (Specify)
Chinese
Samoan
Chinese
Samoan
Filipino
Other Pacific Islander
Filipino
Other Pacific Islander
(Specify)
(Specify)
Unknown
Unknown
Japanese
Japanese
Other (Specify)
Other (Specify)
Unknown
Unknown
28. EDUCATION (Check the box that best describes the highest degree or level of school completed.)
th
th
th
28a.
8
grade or less
9
- 12
grade; no diploma
High school graduate or GED
HUSBAND/SPOUSE EDUCATION
Bachelor’s degree (e.g., BA, AB, BS)
Some College credit, but no degree
Associate degree (e.g., AA,AS)
Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)
Unknown
Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)
th
th
th
28b. WIFE/SPOUSE EDUCATION
8
grade or less
9
- 12
grade; no diploma
High school graduate or GED
Bachelor’s degree (e.g., BA, AB, BS)
Some College credit, but no degree
Associate degree (e.g., AA,AS)
Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)
Unknown
Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)
VS243 Rev.11/19
KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT
Office of Vital Statistics
WORKSHEET FOR DIVORCE OR ANNULMENT REGISTRATION
This worksheet may be used to collect the information to be reported on the Certificate of Divorce or Annulment or through the electronic filing process. It may
also be used to provide the District Court information if the court is filing the official record for the parties.
This worksheet is not to be forwarded to the Office of Vital Statistics.
1. HUSBAND/SPOUSE NAME (First, Middle, Last)
2. HUSBAND/SPOUSE LAST NAME PRIOR TO FIRST MARRIAGE
4 RESIDENCE-STATE
5
COUNTY
3. DATE OF BIRTH (Month, Day, Year)
6. WIFE/SPOUSE NAME (First, Middle, Last)
7. WIFE/SPOUSE LAST NAME PRIOR TO FIRST MARRIAGE
8. DATE OF BIRTH (Month, Day, Year)
9. RESIDENCE-STATE
10. COUNTY
11. PLACE OF THIS MARRIAGE - STATE OR
12. COUNTY
13. DATE OF THIS MARRIAGE
14. NUMBER OF CHILDREN UNDER 18 IN THIS
FOREIGN COUNTRY
(Month, Day, Year)
HOUSEHOLD AS OF DATE IN ITEM 18
16 NAME OF PETITIONER’S ATTORNEY (Type)
15 PETITIONER
Husband/Spouse
Wife/Spouse
Both
Other (Specify)
_______
17 ATTORNEY’S ADDRESS (Street and Number or Rural Route, City or Town, State, Zip Code)
18 DATE DECREE FILED (Month, Day, Year)
19 TYPE OF DECREE-(Specify)
20. COUNTY OF DECREE
21. CASE NUMBER
Divorce
Annulment
THE INFORMATION BELOW WILL NOT APPEAR ON CERTIFIED COPIES OF THE RECORD.
K.S.A. 65-2422B, REQUIRES THE DIVORCE REPORT TO INCLUDE THE SOCIAL SECURITY NUMBER OF BOTH PARTIES TO MAKE SUCH INFORMATION AVAILABLE TO THE SECRETARY OF
KANSAS DEPARTMENT OF CHILDREN & FAMILIES FOR THE PURPOSE OF ESTABLISHING, MODIFYING, OR ENFORCING A SUPPORT OBLIGATION.
22. HUSBAND/SPOUSE SOCIAL SECURITY NUMBER & GENDER
23. WIFE/SPOUSE SOCIAL SECURITY NUMBER & GENDER
_____/_____/______
Male
Female
_____/_____/______
Male
Female
24. NUMBER OF THIS MARRIAGE First, Second, etc.
25. IF PREVIOUSLY MARRIED, LAST MARRIAGE ENDED
(Specify below)
By Death, Divorce, or Annulment (Specify below)
Date (Month, Day, Year)
24a. HUSBAND/SPOUSE
25a. HUSBAND/SPOUSE
25b HUSBAND/SPOUSE
24b. WIFE/SPOUSE
25c. WIFE/SPOUSE
25d. WIFE/SPOUSE
26. HISPANIC ORIGIN (Check the box or boxes that best describes
27. RACE (Check one or more boxes to indicate what race(s) you consider yourself to be.)
whether you are Spanish, Hispanic, or Latino. Check the “no” box if
27a. HUSBAND/SPOUSE
27b. WIFE/SPOUSE
you are not Spanish, Hispanic, or Latino.)
26a. HUSBAND/SPOUSE
26b. WIFE/SPOUSE
White
Korean
White
Korean
Black or
Vietnamese
Black or
Vietnamese
No, not Spanish/
No, not Spanish/
African American
African American
Hispanic/Latino
Hispanic/Latina
American Indian or
Other Asian (Specify)
American Indian or
Other Asian (Specify)
Yes, Mexican/Mexican
Yes, Mexican/Mexican
Alaska Native
Alaska Native
American/Chicano
American/Chicana
(Name of the enrolled
(Name of the enrolled
Yes, Puerto Rican
Yes, Puerto Rican
or principal tribes)
or principal tribes)
Yes, Cuban
Yes, Cuban
Yes, Central American
Yes, Central American
Native Hawaiian
Native Hawaiian
Yes, South American
Yes, South American
Asian Indian
Guamanian or
Asian Indian
Guamanian or
Yes, other Spanish/
Yes, other Spanish/
Chamorro
Chamorro
Hispanic/Latino (Specify)
Hispanic/Latina (Specify)
Chinese
Samoan
Chinese
Samoan
Filipino
Other Pacific Islander
Filipino
Other Pacific Islander
(Specify)
(Specify)
Unknown
Unknown
Japanese
Japanese
Other (Specify)
Other (Specify)
Unknown
Unknown
28. EDUCATION (Check the box that best describes the highest degree or level of school completed.)
th
th
th
28a.
8
grade or less
9
- 12
grade; no diploma
High school graduate or GED
HUSBAND/SPOUSE EDUCATION
Bachelor’s degree (e.g., BA, AB, BS)
Some College credit, but no degree
Associate degree (e.g., AA,AS)
Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)
Unknown
Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)
th
th
th
28b. WIFE/SPOUSE EDUCATION
8
grade or less
9
- 12
grade; no diploma
High school graduate or GED
Bachelor’s degree (e.g., BA, AB, BS)
Some College credit, but no degree
Associate degree (e.g., AA,AS)
Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)
Unknown
Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)
VS243 Rev.11/19