4A-215. Separate property and debts schedule. STATE OF NEW MEXICO COUNTY OF ___________________________ ___________________ JUDICIAL DISTRICT _________________________________, Petitioner, v. _________________________________, Respondent. SERVE THIS FORM ON THE OTHER PARTY. DO NOT FILE WITH THE COURT. SEPARATE PROPERTY AND DEBTS SCHEDULE ASSETS: Petitioner 1. Checking & Savings Accounts: a. __________ Bk, Ck. #__________ b. __________ Bk, Sav. #_________ c. __________ CD # ____________ d. __________ Cr Un #___________ Bonds/Stocks: a. ____________ Sh.___________ b. ____________ Sh.___________ Financial institution accounts:1 a. __________ Account # _________ b. __________ Account # _________ c. __________ Account # _________ d. __________ Account # _________ Stocks, bonds and mutual funds: a. ____________ Sh.___________ b. ____________ Sh.___________ c. ____________ Sh.___________ Insurance policies: a. Company ___________________ Policy No. __________________ $_________ $_________ $_________ $_________ Respondent $_________ $_________ $_________ $_________ No. __________ 2. $_________ $_________ $_________ $_________ 3. $_________ $_________ $_________ $_________ $_________ $_________ $_________ $_________ 4. $_________ $_________ $_________ $_________ $_________ $_________ 5. American LegalNet, Inc. www.FormsWorkFlow.com Face amount $______________ Cash value $______________ Loan balance $______________ b. Company ___________________ Policy No. __________________ Face amount $______________ Cash value $______________ Loan balance $______________ $_________ $_________ $_________ $_________ 6. Real estate: a. _______________ Present value $______________ Mortgage ($/mo) $______________ REC ($/mo) $______________ b. _______________ Present value $______________ Mortgage ($/mo) $______________ REC ($/mo) $______________ $_________ $__________ $_________ $__________ 7. Vehicles: a. ________________ Lien ($/mo) b. ________________ Lien ($/mo) $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ 8. 9. 10. 11. 12. 13. 14. Business assets Household furniture and goods Tax refunds IRA/Keogh/Annuity Retirement Retirement Other total assets Total Separate Assets: DEBTS: American LegalNet, Inc. www.FormsWorkFlow.com a. ________________________ b. ________________________ c. ________________________ d. ________________________ Total Separate Debts: NET SEPARATE PROPERTY: $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ I, _______________________, affirm under penalty of perjury under the laws of the State of New Mexico that I am the [ ] Petitioner (or) [ ] Respondent in the above-entitled cause, and I know and understand that the contents of this Schedule are true to the best of my knowledge and belief. ______________________________________ Signature of party Date ______________________________________ Name (print) ______________________________________ Mailing address (print) ______________________________________ City, state, and zip code (print) ______________________________________ Telephone number [Approved, effective November 1, 2000 until November 1, 2001; approved, effective November 1, 2001; 4A-132 recompiled and amended as 4A-215 by Supreme Court Order No. 13-8300-010, effective for all pleadings and papers filed on or after May 31, 2013, in all cases pending or filed on or after May 31, 2013; as amended by Supreme Court Order No.14-8300-011, effective for all pleadings and papers filed on or after December 31, 2014, in all cases filed or pending on or after December 31, 2014.] American LegalNet, Inc. www.FormsWorkFlow.com