Page 1 of 6 Revised March 2019 251 201 9 Coconino County Law Library D o not file any of the enclosures or attachments when you file this form with the Court. Those just go to the other party. Person Filing: Mailing Address: City, State, Zip: Phone Number: Representing Self COCONINO COUNTY SUPERIOR COURT legal separation, or parenting time: Case Number: DO DISCLOSURE STATEMENT For Divorce Or Legal Separation With Children My Name: Date: W i tnesses: I plan to bring the se Name: Phone Number: Address: Detailed Summary of What American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 6 Revised March 2019 251 201 9 Coconino County Law Library Name: Phone Number: Address: Detailed Summa ry Expert Witnesses: I plan to bring the se Name: Phone Number: Address: What Makes Them an Expert : l Sa y in Court: [ ] Yes [ ] No Name of Person Who Has the Report: Address of Person Who Has the Report: Name: Phone Number: Address: What Makes Them an Expert : Det ailed [ ] Yes [ ] No Name of Person Who Has the Report: Address of Person Who Has the Report: American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 6 Revised March 2019 251 201 9 Coconino County Law Library Treatment Providers: Fill out this section only if you and your spouse disagree about decision - making about the children . Otherwise, skip this section . My Treatment: During the five years before the Petition was filed, I was treated for psychiatric or psychologic al is sues, anger management, substance abuse , or domestic violence by: Start Date of Treatment: End Date of Treatment: Sta rt Date of Treatment: End Date of Treatment: During the five years before the Petition was filed, my spouse was treated for psychiatric or psychological issues, anger management, substance abuse , or domestic violence by: T Start Date of Treatment: End Date of Treatment: Start Date of Treatment: End Date of Treatment: Affi davit of Financial Information: Did you or your spouse ask for spousal support? [ ] Yes [ ] No Do you and your spouse disagree about child support? [ ] Yes [ ] No If either answer is Proper ty: If you and your spouse do not have any property, skip this section. Have you and your spouse agreed in writing about how to divide y our property? [ ] Yes [ ] No American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 6 Revised March 2019 251 201 9 Coconino County Law Library Copies of deeds, deeds of trust, purchas e agreements, escrow documents, settlement sheets, and all other documents that disclose the ownersh ip, legal description, purchase price and encumbrances of all real property owned by any party. Copies of all monthly or periodic bank, checking, savings, brokerage, and security account statements and all electronically stored information concerning such accounts in which any party has or had an interest for a period beginning 6 months before the Petition's filing and through the disclosure date. Copies of all monthly or periodic statements and documents showing the value of all pension, retirement, stoc k option (reflecting grant date, vesting, exercise price and prior exercises), and annuity balances, including Individual Retirement Accounts, 401(k) accoun ts, and all other retirement and employee benefits and accounts in which any party has or had an int erest for a period beginning 6 months before the Petition's filing and through the disclosure date, and, if a claim for premarital accumulation is made as t o a defined contribution plan, copies of all monthly or periodic statements and documents showing va lues, contributions, withdrawals, loans, earnings, and losses from the date of marriage to the disclosure date, or if no monthly or quarterly statements are available during these time periods, the most recent statements or documents that disclose the info rmation. Copies of all monthly or periodic statements and documents showing the cash surrender value, face value, and premiums charged for all life insuran ce policies in which any party has an interest for a period beginning 6 months before the Petition's filing and through the disclosure date, or, if no monthly or quarterly statements are available for this time period, the most recent statements or documen ts that disclose the information. Copies of all documents and all electronically stored information that may assist in identifying or valuing any item of real or personal property in which any party has or had an interest for a period beginning 6 months b efore the petition's filing and through the disclosure date, including any documents that the party may rely on in placing a value on any item of real or personal property. Copies of all business tax returns, balance sheets, profit and loss statements, an d all documents and all electronically stored information that may assist in identifying or valuing any business or business interest for the last 5 completed calendar or fiscal years and through the latest available date before the disclosure statement wi th respect to any business or entity in which any party has an interest or had an interest for a per iod beginning 5 years before the Petition's filing through the disclosure date. Copies of all documents related to any trust in which the party has a benef icial interest. A list of all items of personal property, including, but not limited to, household furniture, furnishings, antiques, artwork, vehicles, jewelry, and similar items in which any party has an American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 6 Revised March 2019 251 201 9 Coconino County Law Library interest, together with the party's estimate of cu rrent fair market value (not replacement value) for each item. Debts : If you and your spouse do not have any de bts, skip this section. Have you and your spouse agreed in writing about how to divide y our debts? [ ] Yes [ ] No following: Copies of all monthly or periodic statements and documents and all electronically stored information showing the balances owing on all mortgages, notes, liens, and encumbrances outstanding against all real property and personal property in whic h I have or had an interest during the 11 months before the Petition was filed and up to today. I f no monthly or quarterly statements or electronically stored information are available during this time period : T he most recent statements or documents or ele ctronically stored information that list the information . C opies of credit card statements and debt statements for all months during the 11 months before the Petition was filed and up to today . - Making Abou t the Children: - ma king about the children? [ ] Yes [ ] No If No A copy of any past or current protective order , and the petition that asked for it, involving me or my spouse or a member of one of our household s . The date, description, loca tion , and documentation of any criminal charge against or conviction of me or my spouse or a member of one of our households during the ten years before the Petition was filed. The date, description, location , and documentation of any Department of Child Safety investigation or proceeding involving me or my spouse or a member of one of our households during the ten years before the Petition was fi led . Proof of Income: Did you or your spouse ask for spousal support? [ ] Yes [ ] No Do you and your spouse disagree about child support? [ ] Yes [ ] No American LegalNet, Inc. www.FormsWorkFlow.com Page 6 of 6 Revised March 2019 251 201 9 Coconino County Law Library P roof of my income from all sources, inc luding complete tax returns, W - 2 forms, 1099 forms, and K - 1 forms, for the past 3 completed calendar years, and year - end information for the most recent calendar year if tax returns are not yet due . I nformation for the current calendar year for all income sources, including year - to - date pay stubs, salaries, wages, commissions, bonuses, self - employment income, dividends, severance pay, pensions, interest, trust income, income from businesses and properties, annuities, capital gains, social security benefits , worker's compensation benefits, unemployment insurance benefits, disability insurance benefits, recurring gifts, prizes, and spousal maintenance . P roof of c