FORM 9 IN THE CIRCUIT COURT OF (COUNTY NAME) COUNTY, MISSOURI In Re The Marriage Of: Petitioner, vs. Respondent. ) ) ) ) ) ) ) ) ) Case No. CONSOLIDATED STATEMENT OF MARITAL AND NON-MARITAL ASSETS AND DEBTS OF PETITIONER AND RESPONDENT 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 SUBMITTED TO THE COURT ON THE DATE OF THE HEARING. Failure to submit this form may result in sanctions. 38th Circuit Form 9 (Rev. 1-1-2000) 1 American LegalNet, Inc. www.FormsWorkFlow.com MARITAL PROPERTY A. Real Estate - List interest in real estate owned by you, including leaseholds. Include street address. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award 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. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award 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 number. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award D. Cash on Hand. 38th Circuit Form 9 (Rev. 1-1-2000) 2 American LegalNet, Inc. www.FormsWorkFlow.com 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. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award 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. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award 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 an interest. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award 38th Circuit Form 9 (Rev. 1-1-2000) 3 American LegalNet, Inc. www.FormsWorkFlow.com H. Interest in trust. List any interest which you hold in a trust. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award 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, if any. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award J. Interest in pending litigation or suit not yet filed held by you. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award K. Interest in farm equipment, crops, animals. List the nature of the property and location held by you. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award 38th Circuit Form 9 (Rev. 1-1-2000) 4 American LegalNet, Inc. www.FormsWorkFlow.com 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. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award M. Interests in sole proprietorships, partnerships or joint ventures held by you. List the names of all other persons who share an interest in this business with you and the percent interest you hold. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award 38th Circuit Form 9 (Rev. 1-1-2000) 5 American LegalNet, Inc. www.FormsWorkFlow.com N. Household goods 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. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award O. Other Assets. List all assets below not already listed herein in which you hold any interest. H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award Non-Marital Property H Value W Value Ct. Value H Debt W Debt Ct. Debt H Request W Request Ct. Award 38th Circuit Form 9 (Rev. 1-1-2000) 6 American LegalNet, Inc. www.FormsWorkFlow.com Liabilities: List all loans from any bank, credit union, savings and loan association or other lending institution. Also, list all credit card balances and store charges, and list all other indebtedness and give the name of the creditor. Liabilities H W Ct. H W Ct. Amount Amount Amount Apport. Apport. Apport. 38th Circuit Form 9 (Rev. 1-1-2000) 7 American LegalNet, Inc. www.FormsWorkFlow.com