Case No. _________________________ EXHIBIT A: PROPERTY AND DEBTS 1a. DIVISION OF COMMUNITY PROPERTY: [ ] The following community property is awarded to each party as follows: 1b. LIST OF COMMUNITY PROPERTY. (Be specific) Petitioner AWARDED TO: Respondent Sell/Split [ ] Household furniture/furnishings [ [ [ [ [ ] ] ] ] ] [ [ [ [ [ ] ] ] ] ] [ [ [ [ [ ] ] ] ] ] [ [ [ [ [ ] ] ] ] ] [ [ [ [ [ ] ] ] ] ] [ [ [ [ [ ] ] ] ] ] Appliances [ ] VCR/DVD [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] [ [ [ [ [ ] ] ] ] ] [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] T TV ] ] ] ] ] [ ] [ ] [ ] Personal Computer [ ] Stereo State Income Tax Federal Income Tax [ [ [ [ [ [ [ [ [ [ Motor vehicle [ ] Motor vehicle [ ] [ ] Motor vehicle Cash, bonds of $ [ ] Other: [ ] Other: [ ] [ ] Other: Other: [ ] Award each party the personal property in his or her possession. Continued on attached list. ] ] ] ] ] ] ] ] ] ] 1c. DIVISION OF RETIREMENT, PENSION, DEFERRED COMPENSATION WARNING. You should see an attorney about your retirement, pension, deferred compensation, 401k plans and/or benefits. If you do not see an attorney regarding these assets, you risk losing any interest you have in these plans and/or benefits. There are certain documents the plan administrator must have. Only an attorney can help you prepare these documents. Superior Court of Arizona in Yavapai County March 2008 Page 1 of 5 Exhibit A American LegalNet, Inc. www.FormsWorkFlow.com Case No. _________________________ [ ] OR [ ] OR [ ] Each party is awarded his or her interest in any retirement benefits, pension plans, or other deferred compensation described as: Petitioner’s: Respondent’s: The Plan Administrator and the parties have approved the Qualified Domestic Relations Order (QDRO) attached as Exhibit(s) . Do not check this box without first seeking the help of an attorney. Each party WAIVES AND GIVES UP his or her interest in any retirement benefits, pension plan, or other deferred compensation of the other party: [ ] Signature of Petitioner: [ ] Signature of Respondent: OR [ ] OR [ ] 1d. Neither party has a retirement, pension, deferred compensation, 401K Plan and/or benefits. Other: __________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________. DIVISION OF REAL PROPERTY. Section A is for one piece of property. Section B is for another piece of property. If you own more than 2 pieces of property, check the box below and attach another sheet of paper with the information requested in A and B. [ ] More than 2 pieces of property are involved. See attached sheet listing the same information as in A and B. A. Real property located at (address ) which is legally described as: (You must provide the legal description. The legal description can be found on the deed to the property. If you do not provide the legal description, you may have to come back to court to amend the Decree to include the legal description.) LEGAL DESCRIPTION: The real property as described above is: [ ] Awarded to [ ] Petitioner [ ] Respondent as his or her sole and separate property. OR [ ] Shall be sold and the proceeds divided as follows: % or $ to Petitioner. % or $ to Respondent. [ ] This Decree can be used as a transfer of title and can be recorded. Parties shall sign all documents necessary to complete all transfer of titles ordered in this Decree, such as motor vehicles, houses, and financial institution accounts. Superior Court of Arizona in Yavapai County March 2008 Page 2 of 5 Exhibit A American LegalNet, Inc. www.FormsWorkFlow.com Case No. _________________________ [ ] is appointed real estate commissioner to sell this real property. B. Real property at (address ) which is legally described as: (You must provide the legal description. The legal description can be found on the deed to the property. If you do not provide the legal description, you may have to come back to court to amend the Decree to include the legal description.) LEGAL DESCRIPTION: The real property as described above is: [ ] Awarded to [ ] Petitioner [ ] Respondent as his or her sole and separate property. OR [ ] Shall be sold and the proceeds divided as follows: % or $ to Petitioner. % or $ to Respondent. [ ] This Decree can be used as a transfer of title and can be recorded. Parties shall sign all documents necessary to complete all transfer of titles ordered in this Decree, such as motor vehicles, houses, and financial institution accounts. [ ] is appointed real estate commissioner to sell this real property. 1e. DIVISION OF COMMUNITY DEBTS. [ ] The follows: Creditor Amount To Be Paid By Wife $ following community debts shall be divided as Amount To Be Paid Total Amount By Husband $ $ $ $ $ $ $ $ $ $ $ [ ] [ ] $ $ $ Continued on attached list. Any debts or obligations incurred by either party before the Respondent was served with the Petition for Dissolution, Petition for Legal Separation, or Petition for Annulment that are not identified in the list above or attached shall be paid by the party who incurred the debt or obligation and that party shall indemnify and hold the other party harmless from such debts. Superior Court of Arizona in Yavapai County March 2008 Page 3 of 5 Exhibit A American LegalNet, Inc. www.FormsWorkFlow.com Case No. _________________________ 2a. SEPARATE PROPERTY. The following separate property is awarded as follows: (Be specific) Description of Property. (Be specific) Confirm to Confirm to Petitioner Respondent 2b. SEPARATE DEBT. The parties are each ordered to pay his or her separate debt as follows: Creditor Amount To Be Paid Amount To Be Paid Total Amount By Wife By Husband $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ By signing this Exhibit and subscribing and swearing to same (or affirming to same) before a Notary Public, both parties affirm that the information is true and correct, including the following: 1. NON-COVENANT MARRIAGE. We do not have a covenant marriage. 2. [ ] THIS IS A CONSENT DECREE. MY RIGHT TO TRIAL IS WAIVED. I understand that by signing this Consent Decree, I am waiving my right to a trial before a judge. 3. [ ] THIS IS A CONSENT DECREE. NO DURESS OR COERCION. COMPLETE AGREEMENT. I am not under any force, threats, duress, coercion, or undue influence from anyone, including the other party, to sign this Consent Decree. This Decree with attachments, if any, which I have signed is our full agreement. I have not agreed to something different from what is stated in writing in the Decree. 4. LEGAL ADVICE. I understand that even if I am representing myself without an attorney, I have the right to be represented by an attorney. I have the right to call an attorney and get legal advice before I sign this Decree. 5. LIVE SEPARATE AND APART. I agree that it is my desire to live separate and apart from my spouse. Superior Court of Arizona in Yavapai County March 2008 Page 4 of 5 Exhibit A American LegalNet, Inc. www.FormsWorkFlow.com Case No. _________________________ 6. DIVISION OF PROPERTY. The agreement about division of property and debts is fair and equitable. 7. [ ] THIS IS A CONSENT DECREE. I understand the effect of this Consent Decree on any Protective Orders. SIGNATURE BY PETITIONER: Everything stated by me in this document is true and correct to the best of my knowledge, information and belief. Date State of Arizona County of Petitioner ) )ss. ) Sworn to or affirmed before me on: My Commission Expires: Notary Public or Clerk of the Superior Court SIGNATURE BY RESPONDENT: Everything stated by me in this Stipulation is true and correct to the best of my knowledge, information and belief. Date State of Arizona County of Respondent ) )ss. ) Sworn to or affirmed before me on: My Commission Expires: Notary Public or Clerk of the Superior Court If either party is represented by an attorney, the attorney must sign: Date Approved by Petitioner’s Attorney Date Approved by Respondent’s Attorney If the Attorney General is involved in this case, the Attorney General must approve the child support amount only and sign below or provide a separate form to file: Date Child Support Amount Approved by Attorney General Superior Court of Arizona in Yavapai County March 2008 Page 5 of 5 Exhibit A American LegalNet, Inc. www.FormsWorkFlow.com