Name: Mailing Address: Daytime Telephone Number: Representing [ ] Self [ ] Petitioner [ ] Respondent For Clerk's Use Only IN THE SUPERIOR COURT OF THE STATE OF ARIZONA IN AND FOR THE COUNTY OF YAVAPAI In the Marriage of: 1300DO Petitioner Div. v. DISCLOSURE STATEMENT Respondent THE [ ] PETITIONER OR [ ] RESPONDENT, PURSUANT TO RULE 49 OF THE ARIZONA RULES OF FAMILY LAW PROCEDURE (ARFLP), PROVIDES THIS DISCLOSURE STATEMENT. A. RESOLUTION STATEMENT: Form 4 or 5, of Rule 97 ARFLP accompanies this Disclosure Statement. CHILD SUPPORT (If applicable): The following have been previously provided or accompany this Disclosure Statement: 1. A current Affidavit of Financial Information on a form substantially in compliance with Form 2, Rule 97 ARFLP. Proof of income from all sources, specifically including complete tax returns, W-2 forms, 1099 forms, for the past two (2) completed calendar years, and other proof. Rule 49.B.2., ARFLP. Proof of court-ordered child support and spousal maintenance actually paid in any case other than this one, if any. Proof of all medical, dental, and vision insurance premiums paid by me for the children listed or referenced in the Petition/Response. Proof of any child care expenses paid by me for any child listed or referenced in the Petition/Response. Page 1 of 4 GTDS12f American LegalNet, Inc. www.FormsWorkFlow.com B. 2. 3. 4. 5. Superior Court of Arizona in Yavapai County June 2012 6. Proof of any expenses paid by me for private or special schools or other particular education needs of a child listed or referenced in the Petition/Response. Proof of any expenses paid by me for the special needs of a gifted or handicapped child listed or referenced in the Petition/Response. 7. C. SPOUSAL MAINTENANCE AND ATTORNEYS' FEES AND COSTS: If either party has requested an award of spousal maintenance or an award of attorneys' fees and costs, the following have been previously provided or accompany this Disclosure Statement: 1. A current Affidavit of Financial Information on a form substantially in compliance with Form 2, Rule 97 ARFLP. Proof of income from all sources, specifically including complete tax returns, W-2 forms, 1099 forms, for the past two (2) completed calendar years, and other proof. 2. D. PROPERTY: Unless the parties have entered into a written agreement disposing of all property issues in the case, or no property is at issue in the case, the following have been previously provided or accompany this Disclosure Statement: 1. Copies of all deeds, deeds of trust, purchase agreements, escrow documents, settlement sheets, and all other documents that disclose the ownership, legal description, purchase price and encumbrances of all real property owned by me. Copies of all monthly or periodic bank, checking, savings, brokerage and security account statements in which I have or had for a period commencing six (6) months prior to the filing of the petition and through the date of this discover. Copies of all monthly or periodic statements and documents showing the value of all pension, retirement, stock option, and annuity balances, including Individual Retirement Accounts, 401(k) accounts, and all other retirement and employee benefits and accounts in which I have or had an interest for the period commencing six (6) months prior to the filing of the petition and through the date of the disclosure, or if no monthly or quarterly statements are available during this time period, the most recent statements or documents that disclose the information; Copies of all monthly or periodic statements and documents showing the cash surrender value, face value, and premiums charged for ail life insurance policies in which I have or had an interest for the period commencing six (6) months prior to the filing of the petition and through the date of the disclosure, or if no monthly or quarterly statements are available for this time period, the most recent statements or documents that disclose the information; Copies of all documents that may assist in identifying or valuing any item of real or personal property in which I have or had an interest for the period commencing six (6) months prior to the filing of the petition, including any documents that the party may rely upon in placing a value on any item of real or personal property; 2. 3. 4. 5. Superior Court of Arizona in Yavapai County June 2012 Page 2 of 4 GTDS12f American LegalNet, Inc. www.FormsWorkFlow.com 6. Copies of all business tax returns, balance sheets, profit and loss statements, and all documents that may assist in identifying or valuing any business or business interest for the last two (2) completed calendar or fiscal years with respect to any business or entity in which I have or had an interest; and 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 I have an interest, together with my estimate of current fair market value (not replacement value) for each item. 7. E. DEBTS: Unless the parties have entered into a written agreement disposing of all debt issues, the following have been previously provided or accompany this Disclosure Statement: 1. Copies of all monthly or periodic statements and documents showing the balances owing on all mortgages, notes, liens, and encumbrances outstanding against all real property and personal property in I have or had an interest for the period commencing six (6) months prior to the filing of the petition and through the date of this disclosure, or if no monthly or quarterly statements are available during this time period, the most recent statements or documents that disclose the information; and Copies of credit card statements and debt statements for all months for the period commencing six (6) months prior to the filing of the petition and through the date of the disclosure. 2. F. DISCLOSURE OF WITNESSES: The names, addresses, telephone numbers, and a statement fairly describing the substance of each witness's expected testimony is as follows (NOTE You will not be allowed to call a witness who has not been disclosed at least sixty (60) days before trial, or such time as may be ordered by the court): (Use additional sheets for more witnesses.) 1. Name: Address: Telephone Nos. Expected testimony: 2. Name: Address: Telephone Nos. Expected testimony: Superior Court of Arizona in Yavapai County June 2012 Page 3 of 4 GTDS12f American LegalNet, Inc. www