┌ In the FAMILY COURT ┐ For File Stamp Only Of St. Louis County, Missouri _____________________________________________ Petitioner _______________________ Case Number vs. _____________________________________________ Respondent _______________________ Division └ ┘ MANDATORY DOCUMENT EXCHANGE COMPLIANCE FORM NOTE: Compliance with the local rule does not require that copies of the actual documents be filed in the court file. The undersigned certifies that I have satisfied the requirements of local rule 68.5 on , ______ I have provided the following documents to the other party: DOCUMENTS REQUIRED IN ALL CASES ___ 1. Federal and state income tax returns including all schedules, W-2, K-1 and 1099 forms, for each of the last three years. ___ 2. My paycheck stubs or evidence of wages, salaries or tips for the last three months if no paycheck stub has been issued. ___ 3. For any children for whom support is being determined, any statements or other documents for the last twelve months related to child care costs, health insurance and premium payments (portion for children only), dental and orthodontic expenses. ADDITIONAL DOCUMENTS REQUIRED FOR ALL CASES IN WHICH THERE ARE ISSUES CONCERNING AN AWARD OF MAINTENANCE, OR AN AWARD OF PROPERTY OR DIVISION OF DEBT ___ 4. The three most recent statements for any financial accounts held in any bank, brokerage firm or other financial institution. ___ 5. The most recent employee benefit statement for any retirement plan, whether vested or unvested, in which a party has an interest. ___ 6. Any appraisals related to any marital or separate property done within the last twelve months. ___ 7. The last three months of credit card statements and/or store charges. ___ 8. The most recent mortgage statement for any real property owned by a party, and a copy of the deed for any such property. ___ 9. The most recent balance statement for any existing debt owed by either party. CCFC195 03/10 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com The following documents (be specific) have not been exchanged because they are not in my possession or control and are not readily available to me electronically. As to these documents I have provided the other party with my best information concerning the location of such documents and the steps necessary to obtain or notified them that no such document exists. I have not provided the following documents (be specific) because the parties have agreed in writing that these documents will not be relevant to any issues in this case: I am not required to exchange documents because the case has been set for a default or noncontested hearing within 60 days of service of the summons. The case is set for hearing on , ______. I have sent a copy of this compliance form to the opposing attorney or opposing party if not represented by counsel on , ______. ________________________________ Attorney for Respondent, or Respondent, if unrepresented Attorney for Petitioner or Petitioner, if unrepresented Address: Address: Phone No.: Phone No.: Date: Date: THE ORIGINAL OF THIS DOCUMENT SHOULD BE FILED IN THE COURT FILE AND A COPY SENT TO THE OPPOSING PARTY. RETAIN ONE COPY FOR YOUR RECORDS. CCFC195 03/10 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com