Page 1 of 4 Revised April 2019 251 201 9 Coconino County Law Library Do not file any of the enclosures or attachments w hen you file this form with t he C ourt . 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 Cases With out Children My Name: Date: Witnesses: I plan to bring the s e Name: Phone Number: Address: Name: Phone Number: Address: American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 4 Revised April 2019 251 201 9 Coconino County Law Library Expert Witnesses: I plan to bring the se Name: Phone Number: Address: What Makes Them an Expert : Have they prepared a report abou [ ] 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 : Have they prep [ ] Yes [ ] No Name of Person Who Has the Report: Address of Person Who Has the Report: Spousal Support : Did you or your spouse ask for spousal support? [ ] Yes [ ] No the following: 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, American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 4 Revised April 2019 251 201 9 Coconino County Law Library social security benefits , worker's compensation benefits, unemployment insurance benefits, disability insurance benefits, recurring gifts, prizes, and spousal maintenance . P roof of court - ordered child support and spousal maintenance from other relationships that I am actually pa ying . Property: 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 pro perty? [ ] Yes [ ] No 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. American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 4 Revised April 2019 251 201 9 Coconino County Law Library 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 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 debts, skip this section. Have you and your spouse agreed in writing about how to divide y our debts? [ ] Yes [ ] No llowing: 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 which 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 elec tronically 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 . Future Information and Documents : If I learn about new or d ifferent information or documents about these topics in the future, I will mail or hand - deliver a copy of it to the other party by 30 days after I learn about it. My Signature: American LegalNet, Inc. www.FormsWorkFlow.com