IN THE CIRCUIT COURT OF THE TWENTY-SECOND JUDICIAL CIRCUIT McHENRY COUNTY, ILLINOIS IN RE THE MARRIAGE OF: _________________________________________ (Type or Print Plaintiff’s Name) Plaintiff vs. ______________________________________ (Type or Print Defendant’s Name) Case Number__________________________________ Defendant AGREEMENT AS TO ASSETS AND DEBTS Now come ____________________________, Plaintiff, and ____________________________________, (Type or Print Plaintiff’s Name) (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 marital debts and liabilities. Marital Assets Description of Asset and Estimated Value Party to Receive Asset (List all marital assets in excess of one hundred dollars [$100.00] in value - assets of lower value may also be listed) (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. ______________________________________________________ ______________________________ DV-AGR1: Revised 12/01/06 Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Marital Debts and Liabilities Description of Debt or Liability (List all Marital Debts and Liabilities) Amount Account Number (List total balance due) (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 _________ Subscribed and Sworn to before me this _________ day of __________________________, 20______. day of __________________________, 20______. _________________________________________ Notary Public _________________________________________ Notary Public (Notary) DV-AGR1: Revised 12/01/06 (Notary) Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com