STATE OF NORTH CAROLINA GUILFORD COUNTY IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION _____CvD___________ ____________________________ Plaintiff, V. ____________________________ Defendant. ) ) ) ) ) ) EQUITABLE DISTRIBUTION INVENTORY AFFIDAVIT OF ______________________ Date of Marriage: ___________ Date of Separation: __________ THE ABOVE-NAMED PARTY, being duly sworn and under oath, states as follows: 1. I am filing with the Court, pursuant to Civil Case Management Rule 31 and NCGS 50-21(a), this affidavit for its use in entering a final judgment of Equitable Distribution. 2. I have read and understand the instructions for compiling this Affidavit and have complied with those instructions to the best of my ability. 3. I married the opposing party on the date indicated above and separated from the opposing party on the date indicated above. 4. In this Affidavit, I have made a full and complete disclosure of: all marital property, separate property and debts known to me and existing at the date of separation; all divisible property and other property acquired since the date of separation; and all property disposed of since the date of separation and the estimated date-of-separation fair market value of each item. 5. I warrant to the Court that I have not intentionally furnished any false or misleading information to the Court. I understand that providing a false or misleading Affidavit could serve as the basis for setting aside any judgment in this proceeding as well as subjecting me to sanctions, both civil and criminal, at the citation of the Court. 6. The schedules attached hereto shall constitute my contentions with regard to all property subject to Equitable Distribution by the Court, including the existence, classification, value and distribution thereof. I understand these schedules are subject to amendment and shall not be binding at trial as to completeness or value. They are as complete and accurate as I can make them. This the ____ day of ________________, 20___. ________________________________ (Signature) Sworn to and subscribed before me this ___ day of ___________, 20__ _____________________________ _____________________________ (Signature of Officer) (Title) Appendix C, Form 9 (Rev. 05/04 (Seal) 1 American LegalNet, Inc. www.USCourtForms.com