Form 465 Rev 09/2018 The Family Court of the State of Delaware In and For New Castle County Kent County Sussex County ANCILLARY FINANCIAL DISCLOSURE REPORT PROPERTY DIVISION, ALIMONY, COUNSEL FEES Petitioner v. Respondent NOTE: If additional space is needed for a response, continue the response on the last page of this form. A. List names and dates of birth of minor children of the parties. Indicated with whom the child primarily resides by selecting (P) for Petitioner (R) for Respondent (S) for Shared. Petitioner v. Respondent B. List names and dates of birth of adult children of the parties. Indicate if the child is enrolled in school. Petitioner v. Respondent DATE OF MARRIAGE/CIVIL UNION: CASE NAME: DATE OF SEPARATION: FILE NUMBER: DATE OF DIVORCE: PETITION NUMBER: Name Name Street Address (including Apt) Street Address (including Apt) P.O. Box Number P.O. Box Number City/State/Zip Code City/State/Zip Code Phone Date of Birth Phone Date of Birth Employer Name Work Phone Employer Name Work Phone Employer Street Address Employer Street Address City/State/Zip Code City/State/Zip Code Years Employed Position or Occupation Years Employed Position or Occupation Current Annual Income Current Annual Income $ $ Attorney Attorney Child222s Name (Minor): Resides With: Child222s Name (Minor): Resides With: (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) Child222s Name (Adult): Enrolled in School? Child222s Name (Adult): Enrolled in School? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No American LegalNet, Inc. www.FormsWorkFlow.com Form 465 Rev 09/2018 C. List your employment history for the past five years. Start with your most recent employer. For each employer include: Name and Address Dates of Employment Ending Annual Income (annual income at the time of departure) Reason for Leaving (reason employment ended) Petitioner Employer Name & Address Dates of Employment Ending Annual Income Reason for Leaving Start E nd Respondent Employer Name & Address Dates of Employment Ending Annual Income Reason for Leaving Start End D. Do you have health/dental insurance benefiting you, your spouse and/or children of this marriage? If so, please state the name of your insurance company, the group and member numbers and cost: Petitioner Respondent E. Does your employer offer a qualified and/or non-qualified pension plan? Are you a participant in any pension and/or retirement plan at your current place of employment? Were you a participant in any other pension and/or retirement plan(s) through previous employment? F. Do you have any other deductions from your pay (not including taxes), such as union dues, mandatory pension deductions, or other? If so, please identify the deduction and monthly cost: Petitioner Respondent Petitioner: Yes No Respondent: Yes No Insurance Company Name: Insurance Company Name: Group Number: Member Number: Group Number: Member Number: Monthly Cost: $ Who is Covered: Monthly Cost: $ Who is Covered: Petitioner: Yes No Respondent: Yes No Petitioner: Yes No Respondent: Yes No Petitioner: Yes No Respondent: Yes No Petitioner: Yes No Respondent: Yes No Deduction Monthly Cost Deduction Monthly Cost $ $ $ $ $ $ $ $ American LegalNet, Inc. www.FormsWorkFlow.com Form 465 Rev 09/2018 G. Do you participate in or own any life insurance on your life? If so, please state the following: Petitioner Respondent Name of Plan (1) : Name of Plan (1) : Policy Number: Policy Number: Type : Whole Life Term Life Employer Type : Whole Life Term Life Employer Beneficiary(ies): Beneficiary(ies): Face Value: $ Face Value: $ Cash Surrender Value: $ Cash Surrender Value: $ Monthly Cost : $ Monthly Cost : $ Basis for Non - Marital Claim: Basis for Non - Marital Claim: Name of Plan (2) : Name of Plan (2) : Policy Number: Policy Number: Type : * Type : * Beneficiary(ies): Beneficiary(ies): Face Value: $ Face Value: $ Cash Surrender Value: $ Cash Surrender Value: $ Monthly Cost : $ Monthly Cost : $ Basis for Non - Marital Claim: Basis for Non - Marital Claim: H. Do you claim any inability to pay support due to ill health, disability or extraordinary expenses which results in dependency upon the other party for support and/or impairment of earning capacity? If yes, please provide below and the name and address of all treating physicians and state the nature of the disability: Petitioner Respondent Nature of Disability (1): Nature of Disability (1): Treating Physician Treating Physician Street Address City/State/Zip Code Street Address City/State/Zip Code Telephone Number Telephone Number Nature of Disability (2): Nature of Disability (2): Treating Physician Treating Physician Street Address City/State/Zip Code Street Address City/State/Zip Code Telephone Number Telephone Number I. Are you receiving any income from benefits such as Social Security retirement, Social Security Disability (SSDI), VA benefits, federal pension (CSRS or FERS), private disability or military pension? If so, please indicate from where you receive the benefit(s) and the monthly amount: Petitioner Respondent J. During the last five (5) years, have you given, transferred, or entrusted your property (including cash) in excess of $1000.00 in the aggregate to anyone other than a party to this proceeding? Petitioner: Yes No Respondent: Yes No Petitioner: Yes No Respondent: Yes No Benefit Monthly Cost Benefit Monthly Cost $ $ $ $ $ $ $ $ Petitioner: Yes No Respondent: Yes No American LegalNet, Inc. www.FormsWorkFlow.com Form 465 Rev 09/2018 If so, please name the recipient of each item and describe the item and its value: Petitioner Respondent INCOME INFORMATION K. List annual gross income from all sources for the last 3 years, including estimated gross income for current year: Petitioner Respondent 3 Years Ago $ 3 Years Ago $ 2 Years Ago $ 2 Years Ago $ 1 Year Ago $ 1 Year Ago $ Current $ Current $ ASSETS OF THE PARTIES 223Assets224 include all assets (property) of any kind, including real estate, and tangible and intangible personal property (such as bank accounts, stocks, bonds, etc.). Unless you explain otherwise, it will be presumed that you are the sole legal owner of any asset(s) identified in your answers. If you are not the sole legal owner, please explain the nature and extent of your ownership, including the name of all co-owners. If the space provided is insufficient, please attach additional pages, indicating whether the attachment is supplied by Petitioner or Respondent. All property will be considered marital and subject to division unless a party indicates to the contrary. Such an indication must be made by listing one of the following reasons for claiming the property is non-marital under the 223Basis for Non-Marital Claim224 category: 1. Premarital Property owned by a party before marriage/civil union). 2. Agreement Property excluded by agreement of the parties. 3. Post-Separation Property acquired after separation. 4. Exchange Property acquired in exchange for premarital/pre- union property. 5. Increase The increase in value of property acquired before marriage/civil union. 6. Gift Property acquired by gift from a third person 7. Inheritance Property acquired by inheritance Property Transferred Entrusted Recipient (s) Value Property Transferred Entrusted Recipient (s) Value $ $ $ $ American LegalNet, Inc. www.FormsWorkFlow.com Form 465 Rev 09/2018 REAL PROPERTY L. Interests in Real Estate: Street Address / City, State ZIP In Whose Name Market Value Mortgage Balance Source of Funds for Purchase Petitioner Respondent $ $ Petitioner Respondent Basis for Non-Marital Claim Petitioner: Respondent: Petitioner Respondent $ $ Petitioner Respondent Basis for Non-Marital Claim Petitioner: Respondent: Petitioner Respondent $ $ Petitioner Respondent Basis for Non-Marital Claim Petitioner: Respondent: Petitioner Respondent $ $ Petitioner Respondent Basis for Non-Marital Claim Petitioner: Respondent: MOTOR VEHICLES M. Automobiles, trailers, motorcycles, and other vehicles: Make, Model, Year In Whose Name Value* Balance on Loan Who Drives? Petitioner Respondent Petitioner: $ Respondent: $ $ Petitioner Respon