(copy and paste
into an email)
For Reasons disclosed
below, the Companionship between
Name of Freeman
and
Name of Freewoman
is considered null and void.
Grounds for
Dissolution
| Signature of Petitioner |
Date: |
| Witness: |
Date: |
| Approved by:
|
Date: |
| Recording
Scribe: |
Date: |
affix seal
Seal