FORM 68-G CIRCUIT COURT OF __________ COUNTY, MISSOURI ____________________________________ SSN: ___________________________ Petitioner, vs. ____________________________________ SSN: ___________________________ Respondent. ) ) ) ) ) ) ) ) ) ) ) Case No. ___________________ STATEMENT OF MARITAL AND NON-MARITAL ASSETS AND DEBTS OF ______________________________ SSN: __________________________ Instructions: This form must be completed in full. If additional space is required, add a page indicating the section number and supply all information requested. Show only dollar amounts, rounding to the nearest dollar. STATEMENT IS TO BE CURRENT WITHIN 15 DAYS OF HEARING. Failure to submit this form may result in the prohibition of the presentation of affirmative evidence of the information recited herein. This Statement requests that you list all Marital and Non-Marital Property owned by you and/or your spouse, whether in your possession, the possession of your spouse or in the possession of a third party. Definition - Marital and Non-Marital Property As used in this document, Marital Property means all property acquired by either spouse after the date of the marriage regardless of how it is titled, except: 1. 2. 3. 4. 5. Property acquired by gift, bequest, devise or descent; Property acquired by exchange for property acquired prior to the marriage or in exchange for property acquired by gift, bequest, devise or descent; Property acquired by a spouse after a decree of legal separation; Property acquired by valid agreement of the parties; and The increase in value of property acquired prior to the marriage. Note: Excepted property is Non-Marital Property. All other property is Marital Property. _____________________________________________________________________ MARITAL PROPERTY _____________________________________________________________________ 1 American LegalNet, Inc. www.FormsWorkflow.com A. Real Estate. List interest in real estate owned by you, including leaseholds Include street address for each parcel. Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W _____________________________________________________________________ B. Motor Vehicles. Include all automobiles, boats, trailers, aircraft, recreational vehicles and campers in which you have an interest. List year, make, model, and vehicle identification number. Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W ___________________________________________________________________ C. Bank Accounts. List all checking and savings accounts, time deposits, money market certificates, etc., held in your name, alone or with another person. Give the name of the institution, the names on the account and the account numbers. Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W 2 American LegalNet, Inc. www.FormsWorkflow.com ________________________________________________________________ D. Cash on Hand held by you or under your control, directly or indirectly. Present amount Amount Owed Requested Award H or W Who Presently Possesses H or W _____________________________________________________________________ E. Securities. List all stocks, including both public and closely held corporations, bonds, promissory notes, mortgages, money market funds and all other such property in which you have an interest. Give the names in which the securities are held and identification number, if any. Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W _____________________________________________________________________ F. Life Insurance. List the type of policy, name of issuing company insured, beneficiaries, face value and cash value of any policy in which you have an interest other than term insurance. Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W _____________________________________________________________________ 3 American LegalNet, Inc. www.FormsWorkflow.com G. Retirement Pension and/or Profit Sharing. List name of the company, the name and the address of the plan administrator, and the present total value of any plan in which you hold. Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W _____________________________________________________________________ H. Interest in trust. List any Interest which you hold in a trust. Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W _____________________________________________________________________ I. Interest in contracts made and not performed held by you. List the parties to the contract, your interest to the contract and the expected date of performance. Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W _____________________________________________________________________ J. Interest in pending litigation or suit not yet filed held by you. Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W ____________________________________________________________________ K. Interest in farm equipment, crops, animals. List the nature Present Fair Amount Owed Requested Award Who Presently 4 American LegalNet, Inc. www.FormsWorkflow.com of the property and location held by you. Market Value H or W Possesses H or W _____________________________________________________________________ L. Debts owed to you by others. List the name of the debtor, any security, date of loan and due date, if any, of any debts owed to you. Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W _____________________________________________________________________ M. Interests in sole proprietorships, partnerships or joint ventures. List the names of all other business with you and the percent interest you hold. Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W 5 American LegalNet, Inc. www.FormsWorkflow.com _____________________________________________________________________ N. Household and personal goods. List all household goods and personal goods, including all appliances, furniture, silver, antiques, televisions, stereos, clothing, jewelry, furs, cameras, coin and stamp collections, tools, etc. having a value in excess of $100.00 Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W _____________________________________________________________________ O. Other Assets. List all assets below not already listed herein in which you hold any interest. Present Fair Market Value Amount Owed Requested Award H or W Who Presently Possesses H or W 6 American LegalNet, Inc. www.FormsWorkflow.com _____________________________________________________________________ MARITAL LIABILITIES _____________________________________________________________________ List all loans from any bank, credit union, savings and loan association or other lending institution for which you have any liability. Indicate who signed the loan, the date of the loan, purpose of the loan, actual disposition of the proceeds and state the name and address of the lender. Also, list all credit card balances and store charges. State whose name is on the credit card. Also, list all other indebtedness and give the name and address of the creditor. Name of Creditor Current Balance Secured? By what? Required Monthly Payment Liability Incurred by H/W/Joint 7 American LegalNet, Inc. www.FormsWorkflow.com ____________________________________________________________________ NON-MARITAL PROPERTY AND LIABILITIES OF HUSBAND ____________________________________________________________________ Separately list all Non-Marital Property and debt. See definition of Marital and Non-Marital Property on Page 1. _____________________________________________________________________ List all items you claim are the Non-Marital property and debt of the HUSBAND. List all loans from any bank, credit union, savings and loan association or other lending institution for which there is any liability on non-marital property. Indicate who signed the loan, the date of the loan, purpose of the loan, actual disposition of the proceeds and state the name and address of the lender. Also, list all credit card balances and store charges. State whose name is on the credit card. Also, list all other indebtedness and give the name and address of the creditor. Use additional sheets if necessary. Item Description Present Amount Owed To whom owed Fair Market Value How & When Acquired 8 American LegalNet, Inc. www.FormsWorkflow.com ____________________________________________________________________ NON-MARITAL PROPERTY AND LIABILITIES OF WIFE ____________________________________________________________________ List all items you claim are the Non-Marital property and debt of the WIFE. List all loans from any bank, credit union, savings and loan association or other lending institution for which there is any liability on nonmarital property. Indicate who signed the loan, the date of the loan, purpose of the loan, actual disposition of the proceeds and state the name and address of the lender. Also, list all credit card balances and store charges. State whose name is on the credit card. Also, list all other indebtedness and give the name and address of the creditor. Use additional sheets if necessary. Item Description Present Amount Owed To whom owed Fair Market Value How & When Acquired STATE OF MISSOURI ) ) ss. County of _______________________ ) Comes now ___________________________________________ (Affiant) being duly sworn on oath states that Affiant has read the foregoing Statement of Income and Expenses, and the answers given therein are true to the best of Affiant=s knowledge and belief. _____________________________________ Affiant Subscribed and sworn to before me on this _________________________. My term expires: ________________ ___________________________________ Notary Public 9 American LegalNet, Inc. www.FormsWorkflow.com