IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOIS Case No. Plaintiff/Petitioner Defendant/Respondent File Stamp AGREEMENT AS TO ASSETS AND DEBTS Now come (Type or Print Plaintiff's Name) , Plaintiff, and (Type or Print Defendant's 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 all martial debts and liabilities. Marital Assets Description of Asset and Estimated Value (list all marital assets in excess of One Hundred Dollars [$100.00] in value, including any retirement accounts or IRA's - assets of lower value may be listed) Party to Receive Asset (Enter name of Party [Husband or Wife] who will receive the asset) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. P1-JS-002 (03/16) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com AGREEMENT AS TO ASSETS AND DEBTS continued Case No. Marital Debts and Liabilities Amount (List total balance due) Description of Debt or Liability (list all marital Debts and Liabilities) Account Number (list Account Number where applicable) Party to pay Debt (Enter name of party [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. Plaintiff's Signature Defendant's Signature SUBSCRIBED AND SWORN TO before me this (Date) SUBSCRIBED AND SWORN TO before me this (Date) NOTARY PUBLIC NOTARY PUBLIC P1-JS-002 (03/16) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com