STATE OF NORTH CAROLINA Harnett County File Number In The General Court Of Justice District Court Division Name of Plaintiff(s) VERSUS Name of Defendant(s) EQUITABLE DISTRIBUTION INVENTORY AFFIDAVIT PLAINTIFF DEFENDANT The undersigned affiant, after being duly sworn as shown below, states as follows: 1. That I am filing this affidavit with the court as required by Rule 7.5 of the 11th Judicial District Court Rules for Domestic Court. 2. I have read and understand the "Instructions" contained in local ED Form B.2, and the information contained in this affidavit is true, accurate, and complete to the best of my ability. 3. I have made a full and complete disclosure of all marital, divisible and separate property/debts known to me. I have provided my best estimate as to the date of separation and present value of all assets and debts. 4. Certification: I hereby certify that all Disclosures required by any schedule on which I have listed property or debt have been served with this affidavit on the opposing party or his/her counsel as required by Rule 7.5 and 7.6 of the 11th Judicial District Court Rules for Domestic Court. 5. This affidavit consists of this page and the attached pages. ________________________________________________ AFFIANT Plaintiff Defendant STATE OF ________________ COUNTY OF ______________ Sworn and subscribed personally before me, this the ______ day of __________________ 20______. __________________________________________________ Notary Public My Commission Expires: _____________________________ ED Form B.1 (rev. 10/2014) District 11 ­ Equitable Distribution Page 1 American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF DEFENDANT LIST OF MARITAL PROPERTY Item No. Description of Asset Possession (P or D) Net Fair Market Value as of Date of Separation Proposed Distribution (P or D) ED Form B.1 (rev. 10/2014) District 11 ­ Equitable Distribution Page 2 American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF DEFENDANT LIST OF DIVISBLE PROPERTY Item No. Description of Asset Possession (P or D) Net Fair Market Value as of Date of Separation Proposed Distribution (P or D) ED Form B.1 (rev. 10/2014) District 11 ­ Equitable Distribution Page 3 American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF DEFENDANT LIST OF PLAINTIFF'S SEPARATE PROPERTY Item No. Description of Asset Possession (P or D) Net Fair Market Value as of Date of Separation Other Relevant Information ED Form B.1 (rev. 10/2014) District 11 ­ Equitable Distribution Page 4 American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF DEFENDANT LIST OF DEFENDANT'S SEPARATE PROPERTY Item No. Description of Asset Possession (P or D) Net Fair Market Value as of Date of Separation Other Relevant Information ED Form B.1 (rev. 10/2014) District 11 ­ Equitable Distribution Page 5 American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF DEFENDANT LIST OF MARITAL DEBTS Item No. Full Name and Address Of Creditor Amount Owed on Date of Separation Is debt secured? If secured, give item number Proposed Distribution "P" or "D" ED Form B.1 (rev. 10/2014) District 11 ­ Equitable Distribution Page 6 American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF DEFENDANT LIST OF PLAINTIFF'S SEPARATE DEBTS Item No. Full Name and Address of Creditor Amount Owed on Date of Separation Is this Debt Secured by a Lien or Security Interest in Real or Personal Property? If Secured by a Lien, List Item # ED Form B.1 (rev. 10/2014) District 11 ­ Equitable Distribution Page 7 American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF DEFENDANT LIST OF DEFENDANT'S SEPARATE DEBTS Item No. Full Name and Address of Creditor Amount Owed on Date of Separation Is this Debt Secured by a Lien or Security Interest in Real or Personal Property? If Secured by a Lien, List Item # ED Form B.1 (rev. 10/2014) District 11 ­ Equitable Distribution Page 8 American LegalNet, Inc. www.FormsWorkFlow.com