IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT MCLEAN COUNTY, ILLINOIS In Re The Marriage Of: __________________________________ (Type or Print) Plaintiff And __________________________________ (Type or Print) Defendant ) ) ) ) ) ) ) ) ) ) ) Case # ______________________________ 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 be listed) (Enter name of Party [Husband or Wife] who will receive asset) 1. ____________________________________________________ ____________________________________ 2. ____________________________________________________ ____________________________________ 3. ____________________________________________________ ____________________________________ 4. ____________________________________________________ ____________________________________ 5. ____________________________________________________ ____________________________________ 6. ____________________________________________________ ____________________________________ 7. ____________________________________________________ ____________________________________ 8. ____________________________________________________ ____________________________________ 9. ____________________________________________________ ____________________________________ 10. ____________________________________________________ ____________________________________ 11. ____________________________________________________ ____________________________________ 12. ____________________________________________________ ____________________________________ American LegalNet, Inc. www.USCourtForms.com MARITAL DEBTS AND LIABILITIES Description of Debt or Liability Amount Account Number Party to Pay Debt (List all marital Debts and Liabilities) (Total balance) (List account number) (Enter name of party [husband or wife] who will be responsible for paying the debt) 1. _________________________________ $__________ __________________________ _____________________ 2. _________________________________ $__________ __________________________ _____________________ 3. _________________________________ $__________ __________________________ _____________________ 4. _________________________________ $__________ __________________________ _____________________ 5. _________________________________ $__________ __________________________ _____________________ 6. _________________________________ $__________ __________________________ _____________________ 7. _________________________________ $__________ __________________________ _____________________ 8. _________________________________ $__________ __________________________ _____________________ 9. _________________________________ $__________ __________________________ _____________________ 10. _________________________________ $__________ __________________________ _____________________ ____________________________________________________________________________________________________________ ___________________________________________ Plaintiff's Signature ___________________________________________ Defendant's Signature Subscribed and sworn before me this ____________ Subscribed and sworn before me this _____________ day of ________________________, ____________ day of _________________________, ___________ ___________________________________________ Notary Public ___________________________________________ Notary Public American LegalNet, Inc. www.USCourtForms.com