1 STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE D ISTRICT COURT DIVISION COUNTY OF -CVD-______ , ) ) Plaintiff, ) ) EQUITABLE DISTRIBUTION ) AFFIDAVIT OF v s. ) ) _________________________ , ) ) Defendant. ) Date of marriage: Date of separation: Social Security #: THE ABOVE-NAMED PARTY, being duly sworn and under oath, states as follows: 1. I am filing with the Court, as required by its Rules, this affidavit for its use in entering a final judgment of equitable distribution. 2. I have read and understand the Instructions which are contained in this Affidavit. 3. In this Affidavit I have made a full and complete disclosure of: all marital property, separate property, and debts known to me and existing on 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. I further warrant to the Court that I have not intentionally furnished any false information to the Court. I understand that providing a false Affidavit to the Court could serve as a basis for setting aside a judgment in this proceeding as well as permitting the Court to impose sanctions against me. 4. I have provided to the opposing party copies of the documents listed in Part VI of this Affidavit. This the d ay of , 20 __ . ( Signature) Sworn to and subscribed before me this day of , 200 (Signature of Officer) (Title) CCF-33 August 2000 >>>> 2 2 INSTRUCTIONS TO PARTIES 1. IMPORTANT. READ THESE INSTRUCTIONS CAREFULLY . Failure to follow these instructions may result in your Affidavit not being allowed into evidence by the Court. 2. PURPOSE AND ORGANIZATION OF AFFIDAVIT. The main purpose of this Affidavit is to identify each partys contentions about the following matters: Which items of property are MARITAL PROPERTY (these are to be listed in Part I) Whether there is any DIVISIBLE PROPERTY (these are listed in Part II) Which items of property are the SEPARATE PROPERTY of a party (these are listed in Part III) What DEBTS existed on the date of separation and whether they were marital debts or non- marital debts (these are listed in Part IV). What property has been sold or otherwise disposed of after the date of separation (these are listed in Part V) If a party desires an unequal distribution, what DISTRIBUTIONAL FACTORS exist (See Part VII). A second purpose of this Affidavit is to identify documents which each party has provided to the other party (See Part VI). 3. FILING AND SERVICE. The ORIGINAL of this Affidavit must be filed with the Clerk of Superior Court, 800 East Fourth Street, Charlotte, NC 28202. A copy of this Affidavit must be served upon the opposing party (or that partys attorney, if the party is represented), either by delivery in person or by mail. You must sign a certificate of service indicating the date and manner of service; a form is attached as the last page of the Affidavit. 4. DUE DATE. You must file and serve this Affidavit on or before seven (7) days prior to the date set for the initial pretrial conference, unless that day is a Saturday, Sunday, or legal holiday, in which case the due date is the next business day. 5. PROCEDURE AND FORMAT. The information in your Affidavit must be typed or computer generated. CCF-33 August 2000 >>>> 3 3 You must sign the cover sheet in the presence of a notary public. You must complete Part I (Schedules A-L), and Parts II, III, IV, V, and VI. Note that there are several alternatives to Schedule G. Complete Part VII (Summary and Schedules M-O) only if you are seeking an unequal distribution. If you do not understand what is meant by the terms Marital Property, Separate Property, or Divisible Property, you should seek legal advice about these terms. You are responsible for understanding the differences in these types of property. If you do not have enough room on a Schedule to list all items of property or debts, use Schedule L or attach an additional page to this Affidavit. If you want to make comments about an item, footnote it on the Schedule or attach a separate page of comments. If you or your spouse own a partial interest in an asset (with one or more third parties), indicate the percentage or amount of your interest. You must complete the Summary Sheet with the totals from each Schedule. Instead of using the terms Plaintiff and Defendant, use the terms Husband and Wife. 6. DEFINITIONS. As used in this Affidavit, the following words and abbreviations have the following meanings: (a) E.D. means equitable distribution. (b) DOM means the date of your marriage to the opposing party. (c) DOS means the date of your separation from the opposing party (when you stopped living together). (d) Net Value and Net FMV mean fair market value, reduced by the amount of any debt which is a lien on the item of property. (e) Real estate includes land and all buildings and other things permanently attached to the land and includes all properties in which you and/or your spouse had some ownership interest (the residence, rental property, commercial or business property, vacation property, time shares, etc.). (f) Transportation means all types of motor vehicles (automobiles, trucks, motorcycles, vans, boats, airplanes, jet skis, etc.). (g) Accounts means all accounts maintained by you and/or your spouse, either individually or jointly with each other or with other persons, in all banks, credit unions, stock brokerage firms, mutual funds, and other financial institutions. It includes checking accounts, savings accounts, certificates of deposit, money market accounts, stock brokerage accounts, and dividend reinvestment accounts. (h) Collections means and includes artwork, gold and other precious metals, firearms, coin collections, and other types of collectibles (figurines, models, trading cards, etc.) CCF-33 August 2000 >>>> 4 4 (i) Household Goods means furniture, antiques, prints and wall hangings, appliances, electronics, linens, books, china, silver, crystal, kitchen utensils and cookware, outdoor furniture, sporting goods, tools, lawn and garden equipment, and all other items of personal property in or about the residence and/or office used by one or both of the parties. (j) Retirement Benefits means all vested benefits under qualified and non-qualified retirement plans, including pension plans, IRA accounts, 401(k) plans, profit sharing plans, deferred compensation plans, and ESO