TH IN THE CIRCUIT COURT OF THE 14 JUDICIAL CIRCUIT ROCK ISLAND COUNTY, ILLINOIS IN RE THE MARRIAGE OF: _________________________________ (Type or Print Plaintiffs Name) PLAINTIFF; V S. N O. __________________________________________ (Type or Print Defendants Name) DEFENDANT; AGREEMENT AS TO ASSETS AND DEBTS Now come ____________________________, Plaintiff, and __________________________ _, (Type or Print Plaintiffs Name) (Type or Print Defendants Name) Defendant, and hereby agree to the following distribution of all marital assets in excess of One Hundred Dollars ($100.00) in value and the following division of a ll marital debts and liabilities. MARITAL ASSETS Description of Asset and Estimated Value Party to Receive Asset (List all marital assets in excess of One Hundred Dollars (Enter name of PaHusband or Wife rty ($100.00 in value-assets of lower value may be listed). who will receive the asset). 1.________________________________________________ ____________________________________ 2.________________________________________________ ____________________________________ 3.________________________________________________ ____________________________________ 4.________________________________________________ ____________________________________ 5.________________________________________________ ____________________________________ 6.________________________________________________ ____________________________________ 7.________________________________________________ ____________________________________ 8.________________________________________________ ____________________________________ 9.________________________________________________ ____________________________________ 10._______________________________________________ ____________________________________ 11._______________________________________________ ____________________________________ 12._______________________________________________ ____________________________________ 13._______________________________________________ ____________________________________ 14._______________________________________________ ____________________________________ 15._______________________________________________ ____________________________________ American LegalNet, Inc. www.USCourtForms.com>>>> 2 MARITAL DEBTS AND LIABILITIES Description of Debt or Liability Amount Account Number Party to Pay Debt (List all Marital Debts and Liabilities) (List total balance due) ( List Account Number (Enter nam Pae ofrty wicable) here appl husband or wife who will be responsible for paying the Debt or liability) 1._______________________ $_____________ __ ____________ _____________ 2._______________________ $_____________ ______________ _____________ 3._______________________ $_____________ _______________ _____________ 4._______________________ $_____________ _______________ _____________ 5._______________________ $_____________ ________________ _____________ 6._______________________ $_____________ ________________ _____________ 7._______________________ $_____________ ________________ _____________ 8._______________________ $_____________ ________________ _____________ 9._______________________ $_____________ ________________ _____________ 10.______________________ $_____________ ________________ _____________ 11.______________________ $_____________ _________________ _____________ 12.______________________ $_____________ _________________ _____________ 13.______________________ $_____________ __________________ _____________ 14.______________________ $_____________ __________________ _____________ 15.______________________ $_____________ __________________ _____________ ________________________________ _____________________________ PLAINTIFFS SIGNATURE DEFENDANTS SIGNATURE Subscribed and Sworn to before me this_____ Subscribed and Sworn to before me this _____ Day of _________________________, 20_____. Day of _________________________, 20_____. _______________________________________ _______________________________________ Notary Public Notary Public American LegalNet, Inc. www.USCourtForms.com