IN THE DISTRICT COURT OF SEBASTIAN COUNTY, ARKANSAS FORT SMITH DIVISION ___________________________ PLAINTIFF CASE NO. _____________ ___________________________ DEFENDANT SCHEDULE OF PROPERTY ACT 610 OF 1991 REQUIRES THAT YOU PREPARE A SCHEDULE VERIFIED BY AFFIDAVIT, OF ALL YOUR PROPERTY, BOTH REAL AND PERSONAL, INCLUDING MONEYS, BANK ACCOUNTS, RIGHTS, CREDITS AND CHOSES IN ACTION HELD BY YOURSELF OR OTHERS FOR YOU, AND THAT YOU SPECIFY WHAT PROPERTY YOU CLAIM EXEMPT UNDER THE PROVISIONS OF THE LAW. LIST ALL ASSETS IN YOUR NAME HELD SOLELY OR WITH ANOTHER PERSON: (If more space is required, please attach a separate sheet.) 1. Bank(s)/Credit Union(s) Name of Institution: Address: Type of Account: Account Number: Current Balance: 2. Savings Name of Institution: Address: Type of Account: Current Balance: 3. Real estate Street Address: City/State: 4. Vehicles (Include automobiles, trucks, boats, airplanes, and other vehicles) Make: _______________________________________ Year: ________ License Number: _________________ Liens against vehicle: Make: ______________________________________ Year: ________ License Number: _________________ Liens against vehicle: Mileage: Mileage: American LegalNet, Inc. www.FormsWorkFlow.com 5. Stocks, bonds, gold, silver, gems, jewelry (List number of shares or description, value, and where located.) 6. Employer or other source of income Name: Address: Phone Number: 7. Value of household furniture, furnishings or effects 8. Other personal property not scheduled 9. Debtors owing you money Name: Address: Phone Number: 10. Property which you claim as exempt Current Mailing Address Street: City/State/Zip: Phone: I swear or affirm the above is whole, true and correct. _____________________________ DEFENDANT VERIFICATION State of County of Subscribed and sworn to before me this ____ day of ____________________, 20____. (Notary Seal) Notary Public ____________________________ DATE American LegalNet, Inc. www.FormsWorkFlow.com