STATE OF NORTH CAROLINA COUNTY OF _______________________ File No. _________________ IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION Plaintiff vs. EQUITABLE DISTRIBUTION AFFIDAVIT OF _____________________________ Defendant THE AFFIANT, being duly sworn and under oath as shown below, states as follows: 1. That I am filing with the Court, as required by its Rules, this affidavit for its use in entering final judgment of equitable distribution of marital assets. 2. That this affidavit consists of this sheet and the attached ____ pages. 3. That I have read and understand the “Instructions” which accompanied this affidavit, and the information contained in this affidavit is true, accurate, and complete. This the ____ day of _____________________ , 2____ . Affiant (Typed Name) Subscribed and sworn to before me This ___________ day of ________________, 2____ . (Signature of Officer)_______________________ District 1 FDCVD-7 Equitable Distribution Affidavit – 9/83 (Title) Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com : Calendar No. Marital Property Current Outstanding Lien or Debt Current Net Fair Market Value Current Fair Market Value : Part I, Page _ JUDICIAL SUBPOENA Source of Funds for Acquisition : Original Purchase Price Plaintiff(s) Date Acquired -against- Wife / (P1) (Def) Title Owner (H) or (W) Husband Description of Asset and Location Item No. AFFIDAVIT OF Index No. : Proposed Distribution (H) or (W) COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : For Court Use Only : Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, District 1 FDCVD-7 Equitable Distribution Affidavit – 9/83 , one of the Justices of the day of , 20 Page 1 of 6 (Attorney must sign above and type name below) American LegalNet, Inc. www.FormsWorkFlow.com Attorney(s) for COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : AFFIDAVIT OF Husband Wife / Plaintiff(s) (P1) (Def) 1. Income and Expense -againstGROSS INCOME STATEMENT Weekly Monthly Bi-Monthly Salary & Wages (include commissions, bonuses, Calendar No. : Marital Property JUDICIAL SUBPOENA Part II, Page _ : : Deductions From Gross Income (continued) Union or Other Dues $ overtime, and tips) $ : Pensions and Retirement $ Retirement or Pension Fund Defendant(s) : Social. Security. . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ . . . . . . . . . . . . Savings .... ....... . Disability and Unemployment Benefits $ Other Deductions (specify) Public Assistance (AFDC payments, food stamps, etc.) $ Rents $ THE PEOPLE OF THE STATE OF NEW YORK Child Support/Alimony Payments $ Dividends and Interest $ TO Income From All Other Sources (list each) $ $ TOTAL DEDUCTIONS $ NET INCOME (Gross Income less Deductions) GREETINGS: $ $ Expenses: Weekly Monthly WE COMMAND YOU, that all business$ excuses being laid aside, you and each of you attend before and Residence Payments , the Honorable Court Rent or Mortgage $at the TOTAL GROSS INCOME located at County of Taxes and Insurance in room , on the day of , 20 , at o'clock in the noon, and at any recessed Deductions from GROSS INCOMEevidence as a witness in this action on the part of the Maintenance or adjourned date, to testify and give Federal Income Taxes $ Food and Household Supplies State Income Taxes $ Clothing and Laundry Social Security $ Medical and Dental Your failure to comply with this subpoena is punishable as a contemptCare Medical Insurance $ Child of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Other result of your failure to comply. TOTAL EXPENSES (Add lines) Witness, Honorable Court in County, District 1 FDCVD-7 Equitable Distribution Affidavit – 9/83 day of , 20 $ $ $ $ $ $ $ $ $ $ Bi-Monthly $ $ $ $ $ $ $ $ $ $ (The one of theshould reflect only the expenses of the affiant and not , expenses Justices of the others of the household for which the affiant has no legal obligation.) Page 2 of 6 (Attorney must sign above and type name below) American LegalNet, Inc. www.FormsWorkFlow.com Attorney(s) for : Calendar No. Separate Property : : Current Net Fair Market Value JUDICIAL SUBPOENA Current Outstandin g Lien or Mortgage : Current Fair Market Value Plaintiff(s) Original Purchase Price -against- Wife / (P1) (Def) Date Acquired Husband Description of Asset and Present Location Item No. AFFIDAVIT OF Index No. Part II, Page _ Other Relevant Informatio n COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : For Court Use Only : Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. $ $ $ $ Total of this page of Part II-2; and if this is last Witness, Honorable page, total of all pages of II-2. Court in County, day of District 1 FDCVD-7 Equitable Distribution Affidavit – 9/83 $ $ ,$one of the Justices of the $ , 20 Page 3 of 6 (Attorney must sign above and type name below) American LegalNet, Inc. www.FormsWorkFlow.com Attorney(s) for COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : Separate Property Part II, Page _ JUDICIAL SUBPOENA Plaintiff(s) List All Real Or Personal Property Which Is Your Separate Property. This Means Property Owned By You Which Is Not Marital Property -against: And Was Not Listed In Part I Of This Affidavit. Other Relevant Informatio n Current Net Fair Market Value : Current Outstandin g Lien or Mortgage : Current Fair Market Value Original Purchase Price Wife / (P1) (Def) Date Acquired Item No. 2. Husband Description of Asset and Present Location AFFIDAVIT OF For Court Use Only Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to $ $ $ $ the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Total ofof your failure to II-2; and if this is last result this page of Part comply. page, total of all pages of II-2. Witness, Honorable Court in County, District 1 FDCVD-7 Equitable Distribution Affidavit – 9/83 , one of the Justices of the day of , 20 Page 4 of 6 (Attorney must sign above and type name below) American LegalNet, Inc. www.FormsWorkFlow.com Attorney(s) for COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : AFFIDAVIT OF Husband Wife / (P1) (Def) Index No. Calendar No. Separate Property : JUDICIAL 3. a. Have you been married prior to your marriage to the opposing party in this case? Plaintiff(s) Part II, Page _ SUBPOENA -againstb. If so, what support obligations do you now have arising out : that marriage? of (List only if not included in answer to Part II, 1.) (Monthly, weekly, etc.) : 4. a. State the date of marriage and number of years married to the opposing party: (Date) _______________________ _____________ : Years Per $ b. State your present age and date of birth: _______________ Years ______________________ , 19 _____ . Defendant(s) : ...................................................... c. Name and describe all physical or mental disorders, illnesses, diseases, or conditions which you now have: THE PEOPLE OF THE STATE OF NEW YORK TO 5.GREETINGS:now have custody of any children born of your marriage to the opposing party? a. Do you b. If so, do you want and need to own or occupy the marital residence and to use or own its household effects: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before c. If so, state , the Honorable reasons: (You may refer to complaint/answer in existing case file.) at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, District 1 FDCVD-7 Equitable Distribution Affidavit – 9/83 , one of the Justices of the day of , 20 Page 5 of 6 (Attorney must sign above and type name below) American LegalNet, Inc. www.FormsWorkFlow.com Attorney(s) for COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : AFFIDAVIT OF Husband Wife / (P1) (Def) Index No. Calendar No. Separate Property Part II, Page _ : : Other Relevant Information Amount Paid Or To Be Paid How Paid (Weekly, Monthly Or Annually, Etc.) Total Value At Time Payments To You began Or Will Begin Total Current Value Source Of Pension Or Retirement Fund 6. Date Payments To You Began Or Will Begin : JUDICIAL Separate Property Complete The Following Concerning AllPlaintiff(s) Retirement Rights Which Are SUBPOENA And Which You Will Receive Or Pension Or Expect To Receive.. -against: For Court Use Only Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable r Court in County, TOTALS District 1 FDCVD-7 Equitable Distribution Affidavit – 9/83 day of r , 20 r , one of the Justices of the r Page 6 of 6 (Attorney must sign above and type name below) American LegalNet, Inc. www.FormsWorkFlow.com Attorney(s) for COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : AFFIDAVIT OF 7. Husband Wife / (P1) (Def) (Leave Blank; for use by Court only,). Plaintiff(s) -against- Index No. Calendar No. Separate Property : Part II, Page _ JUDICIAL SUBPOENA : : : Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: 8. Did you, by direct or indirect contribution, help educate or develop the career potential of the other spouse: If so, WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before describe in detail: , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, District 1 FDCVD-7 Equitable Distribution Affidavit – 9/83 , one of the Justices of the day of , 20 Page 7 of 6 (Attorney must sign above and type name below) American LegalNet, Inc. www.FormsWorkFlow.com Attorney(s) for COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : AFFIDAVIT OF Wife / (Pl) (Def) Calendar No. Separate Property Part II, Page _ Detailed Explanatio n Time Of Your Contributi on Amount Of Your Contributi on To Increase In Value : JUDICIAL SUBPOENA If There Was An Increase In Value, During The Course Of Your Marriage, Of An Item Claimed By The Opposing Party As “Separate Plaintiff(s) Property,” Did You Make A Direct Contribution To That Increased Value? ______________________ -against: Description Of Property 9. Husband Index No. : : For Court Use Only Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, District 1 FDCVD-7 Equitable Distribution Affidavit – 9/83 , one of the Justices of the day of , 20 Page 8 of 6 (Attorney must sign above and type name below) American LegalNet, Inc. www.FormsWorkFlow.com Attorney(s) for COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : AFFIDAVIT OF 10. Husband Wife / (Pl) (Def) Plaintiff(s) -against- Index No. Calendar No. Separate Property : Part II, Page _ JUDICIAL SUBPOENA : : : Defendant(s) : ...................................................... 11. THE PEOPLE OF THE STATE OF NEW YORK TO 12. GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 13. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, District 1 FDCVD-7 Equitable Distribution Affidavit – 9/83 , one of the Justices of the day of , 20 Page 9 of 6 (Attorney must sign above and type name below) American LegalNet, Inc. www.FormsWorkFlow.com Attorney(s) for