Form A1 - Auckland Justices of the Peace Association

rr 337(2)(b), 355(1)(a)(ii)

Form FP 14

Affidavit to accompany joint application for order dissolving marriage or civil union Section 38(2)(d), Family Proceedings Act 1980 FAM No: …………………….

In the Family Court at …………………………………… [place]

…………………

Svenja Katharina ZIELINSKI …………….. [full name]

……98 Holy Links Pde, Wattle Downs, Auckland 1234. [address]

……………

Primary School Teacher ………………………….. [occupation]

Applicant …………………

Marc Franc PANZER ………………………….. [full name]

…3

Lucky St, Frankton, Hamilton …………………….. [address]

……………………………

Insurance Broker ………………….. [occupation]

Applicant [Set out full description of document (including whether it is made with or without notice), its date, the Act under which the document is filed, and, in the case of an affidavit or affirmation, the name of the deponent in whose support it is filed.]

Affidavit of

………….Svenja Katharina ZIELINSKI …… [name] and

……………..Marc Franc PANZER ..……………[name] in support of Joint Application for Order Dissolving Marriage or Civil Union (Family Proceedings Act 1980) dated………………………………………………………………………… This document is filed by [name and address for service, and, if filed by lawyers, the name and telephone number of the acting lawyer.]

Svenja Katharina Zielinski 98 Holy Links Parade, Wattle Downs Auckland 1234

P1/4 SKZ MFP JE B

2

I, ...………

Svenja Katharina ZIELINSKI……………….. [full name]

of 98 Holy Links Pde, Wattle Downs, Auckland 1234. [address]

……………

affirm

Primary School Teacher …………………… [occupation]

and I, ...………

Marc Franc PANZER …………………….………... [full name]

of ...……

3 Lucky St, Frankton, Hamilton .………………. [address]

………………………Insurance

Broker……………………………..

[occupation]

swear (or affirm) that: 1. We are the applicants for an order dissolving a marriage or civil union. [select and complete the option that applies]

2. ………………………………………..............………………………… [full name of one of the marriage (or civil union) partners]

is domiciled in New Zealand. or 2. We are both domiciled in New Zealand. 3. We were married or entered into a civil union on …1 at …Parnell ………………

st

December 2007[date]

Rose Gardens, Parnell…….……….……….

[place]

Auckland……………………………………...………. [name of city or town etc]

4. A copy of our marriage or civil union certificate is annexed to this affidavit and marked with the letter A. 5. We are living apart. 6. We will, at the filing of the application, have been living apart for the period of 2 years immediately preceding the filing of this application. 7. We ceased living together on ………1st

May 2012...………….

[date]

P2/4 SKZ MFP JE B

3

[select and complete the option 8 that applies]

8. (a) A separation order was made on ………………………..… [date] (b) A copy of the separation order is annexed to this affidavit and marked with the letter B. or 8. (a) A written separation agreement was made on ……….……. [date] (b) A copy of the written separation agreement is annexed to this affidavit and marked with the letter B. or 8. We made an oral agreement to separate on

1st May 2012.

[date]

or 8. No separation order was made and we did not agree to separate. 9. Our marriage or civil union has broken down irreconcilably. [Note: Select and complete paragraphs 10 and 11 if there are children of the marriage or civil union.] 10. Satisfactory arrangements, or arrangements that are the best that may be devised in the circumstances, have been made for the day-to-day care, maintenance, and other aspects of the welfare of every child of the marriage or civil union. The arrangements relate to every child who is under 16 years. They also relate to every child who is 16 years or over and who, because of special circumstances, requires arrangements to be made. 11. The arrangements referred to in paragraph 10 of this affidavit are as follows: Day-to-day care: [give details]

N/A

Maintenance: [give details]

N/A

P3/4 SKZ MFP JE B

4

Other aspects of welfare, such as schooling or any special needs: [give details]

Include if there are children of the marriage or civil union.

N/A

SKZielinski ……………………………….... Signature of deponent

MFPanzer ……………………………….... Signature of deponent

Severally Sworn (or affirmed) at …………AUCKLAND……….... [place]

this …23

rd

day of January 2015 ..

Joe Bloggs JP Registration No 22929 Auckland Justice of the Peace for New Zealand

[date] before me:

JE BLOGGS ZJP Registrar (or Justice of the Peace or Solicitor of the High Court)

……………………………….... Signature of deponent

Sworn (or affirmed) at ………………………………………...…………. [place], this ………………………..………….. [date] before me:

……………………………….... Registrar (or Justice of the Peace or Solicitor of the High Court)

P4/4

“A”

5

BDM 109

New Zealand Marriage Certificate Particulars of Parties to Marriage BRIDEGROOM Marc Frank Panzer

Svenja Katharina Zielinski

First/given name(s) Surname/family name (If different First/given name(s) at birth__ from above) Surname/family name at birth__ Date and year of birth Place of birth Usual occupation, profession or job Relationship status

Usual residential address

MOTHER: First or given name(s)

Surname or family name Surname or family name at birth (If different from above)

FATHER: First or given name(sJ

Surname or family name

__ __

25 April 1981 Hamburg Germany

23 January 1968 Hamburg Germany

Primary School Teacher Never Married

Insurance Broker Never Married

Bei der Reitbahn 3 Hamburg Germany

Achtern Sand 39 Hamburg Germany

Brigitte Zielinski Wahn

Helga Panzer Hardt

Frank Gerd Panzer __

Jorg Uwe Zielinski

Surname or family name at birth__ (If different from above)

_

Date of marriage

01 December 2007

This is the document marked “A” referred to in the attached declaration/affidavit of ___ Svenja Katharina ZIELINSKI and Marc Franc PANZER declared / sworn / affirmed at __ Auckland __

Place of marriage

Other information pursuant to sections__

Parnell Rose Gardens Gladstone Road Parnell on, __23rd of January of 20_15 Auckland before me ___ JE BLOGGS ZJP

59. 60. 62 or 62D of the Births, Death s, and Marriages Registration Act 1995

by he sea

egis

r

Joe Bloggs JP Registration No 22929 Auckland Justice of the Peace For New Zealand

egis

(1) falsifies any of the particulars on

certificate

(

is liable to prosecution under