Jason M. Busch, the plaintiff, is seeking a dissolution of marriage from defendant Sabila Rana, with whom he has been married since October 25, 2010, asserting that their relationship has irretrievably broken down for at least six months. There are no children from the marriage, and both parties are not covered by health insurance or receiving public assistance. Busch requests the court to grant the divorce and any relief deemed appropriate, waiving rights to equitable distribution of marital property.

1. SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF QUEENS
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JASON M. BUSCH,
Index No:
Plaintiff,
-against
AFFIDAVIT OF PLAINTIFF
SABILA RANA,
Defendant
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STATE OF NEW YORK }
ss:
COUNTY OF QUEENS }
I, JASON M. BUSCH, being duly sworn, deposes and says:
1. I, the Plaintiff in this action, presently reside at123-25 82nd
Av., Apt. 5, Kew Gardens,
New York 11415, and my Social Security Number is 111-82-3543. The Defendant,
SABILA RANA, presently resides at 48-36 47th
St., Apt. 3G, Woodside, New York
11377 and her Social Security Number is 087-65-2029.
1. I have resided in New York State for a continuous period of five (5) years immediately
preceding the commencement of this action.
2. I married the Defendant on October 25, 2010 in Kew Gardens, New York. The marriage
was not performed by a clergyman, minister or by a leader of the Society for Ethical
Culture.
3. There are no children of this marriage.
4. I am not covered under any health insurance plan and upon information and belief, the
defendant is also not covered under an health insurance plan.
5. I respectfully request the court to enter a judgment for dissolution of marriage and any
and all relief the court deems just and proper, but I waive any right to equitable
distribution of marital property.

2. GROUNDS FOR DIVORCE
6. The ground for dissolution of this marriage is that the relationship between husband and
wife has broken down irretrievably for a period of at least six months based on the
Domestic Relations Law §170(7).
7. On or about ___________________ and continuing to this day, which is within the
period contemplated by law, the relationship between the plaintiff and defendant has
become irretrievably broken down.
8. I am not receiving any form of public assistance and upon information and belief,
defendant is not receiving any form of public assistance.
9. No other matrimonial action is pending in this court or in any other court, and the
marriage has not been terminated by any decree of any court of competent jurisdiction.
10. A photograph of the defendant has been annexed to the Affidavit of Service for the
Summons and Complaint. It is a fair and accurate representation of the defendant.
WHEREFORE, I, JASON M. BUSCH, respectfully request that judgment be entered for the
relief sought and for any other such relief that the court deems just and proper.
Subscribed and Sworn to
before me on _______________________________
December _______, 2011 JASON M. BUSCH
____________________
NOTARY PUBLIC