NORTH CAROLINA 10th JUDICIAL DISTRICT WAKE COUNTY IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION ________-CVD-_____________ EQUITABLE DISTRIBUTION INVENTORY FOR _________________________________________, Plaintiff -v_________________________________________, Defendant [ ] PLAINTIFF [ ] DEFENDANT The undersigned affiant, after being duly sworn as shown below, states as follows: I AM THE PLAINTIFF in this matter and I have prepared this Equitable Distribution Inventory in accord with the Wake County Family Court Rules – Domestic and in accord with G.S. 50-21. The attached list of property and debts labeled [ ] Wife [ ] Husband are all the assets and liabilities accumulated and/or owned on the date of separation (DOS) or acquired since the DOS and prior to the completion of this document to the best of my knowledge as of the date of the signing of this Inventory. This Inventory is submitted for purposes of pre-trial discovery and in no way is intended to be an exhaustive list of all assets that may exist. However, I certify that the following list is a full and complete disclosure of all assets and liabilities within my knowledge as of the date of submitting this Inventory to the opposing party. The affiant also certifies that the values listed herein are estimated in good faith subject to further discovery, appraisals and my final Equitable Distribution Affidavit. This the _____ day of _______________ 20___. ____________________________________ Name (Plaintiff) ____________________ County, North Carolina I certify that ____________________________ personally appeared before me this day, and acknowledged to me he or she voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated. Date: ______________________ ________________________________________ _____________________________, Notary Public (Notary’s printed name) My Commission Expires: ________________ WAKE-DOM-18 (REV 2/23/06) (PAGE 1 OF 28) American LegalNet, Inc. www.USCourtForms.com The undersigned affiant, after being duly sworn as shown below, states as follows: I AM THE DEFENDANT in this matter and I have prepared this Equitable Distribution Inventory in accord with the Wake County Family Court Rules – Domestic and in accord with G.S. 50-21. The attached list of property and debts labeled [ ] Wife [ ] Husband are all the assets and liabilities accumulated and/or owned on the date of separation (DOS) or acquired since the DOS and prior to the completion of this document to the best of my knowledge as of the date of the signing of this Inventory. This Inventory is submitted for purposes of pre-trial discovery and in no way is intended to be an exhaustive list of all assets that may exist. However, I certify that the following list is a full and complete disclosure of all assets and liabilities within my knowledge as of the date of submitting this Inventory to the opposing party. The affiant also certifies that the values listed herein are estimated in good faith subject to further discovery, appraisals and my final Equitable Distribution Affidavit. This the _____ day of _______________ 20___. ______________________________ Name (Defendant) ____________________ County, North Carolina I certify that ____________________________ personally appeared before me this day, and acknowledged to me he or she voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated. Date: ______________________ ________________________________________ _____________________________, Notary Public (Notary’s printed name) My Commission Expires: ________________ WAKE-DOM-18 (REV 2/23/06) (PAGE 2 OF 28) American LegalNet, Inc. www.USCourtForms.com INSTRUCTIONS TO PARTIES FOR COMPLETION OF EQUITABLE DISTRIBUTION INVENTORY 1. READ THESE INSTRUCTIONS CAREFULLY. Your Inventory must be fully and accurately prepared. Submission of this Inventory is required by the Wake County Family Court Rules – Domestic. A copy of the Rules is available on the website for the North Carolina Administrative Office of the Courts at http://www.nccourts.org/Courts/CRS/Policies/LocalRules/Default.asp . Please refer to Rule 11: “Equitable Distribution Claims” regarding the preparation of this Inventory. If you are not represented by counsel, you should obtain a copy of the Domestic Rules so that you comply with them and assure that you do not prejudice your case. Your interests in this lawsuit will be harmed if your Inventory does not contain all the information required and if that information is not accurate. If you are not represented by an attorney, the Wake County Family Court Rules – Domestic apply equally to you and it is your responsibility to fully comply with these instructions. 2. READ THE INVENTORY FORM THOROUGHLY AND CAREFULLY. If you have any questions or are unsure how to list certain information, ask your attorney first so that your Inventory will be complete and correct before it is placed in final typed form. Failure to fully comply with these instructions may result in sanctions being imposed against you by the Court. 3. The Inventory, when served on the opposing party or attorney, must be typed and must substantially conform to this form. Your signature must be notarized. 4. With regard to the mechanics of filling out the Inventory, on each page you need to complete the information asked for on each page, including putting a check mark beside Plaintiff if you are the plaintiff or by the Defendant if you are the defendant. You also need to write in your Date of Marriage beside the “DOM” and write in your Date of Separation beside “DOS”. 5. Each individual item must be listed separately. You must list the items under the appropriate categories as set forth in the “Schedules”. If you have additional property that needs to be listed on a particular schedule, please add additional pages as necessary to give complete information about your property. You may omit sections or categories of assets that are not included in your case. 6. The moving party must deliver, in person or by mail, a copy of the original, typed Equitable Distribution Inventory on the attorney representing the opposing party or to the opposing party directly if he/she is representing him/herself no later than 30 days following the filing of the complaint / claim for equitable distribution. The responding party shall serve his/her Equitable Distribution Inventory within 30 days of receipt of the moving party’s Inventory. THESE DEADLINES ARE IMPORTANT AND FAILURE TO COMPLY WITH THE DEADLINES MAY RESULT IN THE IMPOSITION OF SANCTIONS. This Inventory should not be filed with the Court; however, the Certificate of Service, at the end of this document, shall be filed with the Court. 7. THIS INVENTORY MUST BE COMPLETED BY BOTH PARTIES AND THE SAME FORM IS TO BE USED BY BOTH PARTIES. In addition to serving the opposing counsel (or party, if not represented) with a hard copy of the completed Inventory via personal delivery or mail, the moving party must also submit a completed Inventory to opposing counsel (or party, if not represented) electronically by e-mail or by service of a disk or CD, if an e-mail address is not known or available. The responding party must complete the Inventory served by the moving party within the time prescribed by these instructions. Following completion, the responding party shall serve the moving party with a hard copy of the completed Inventory via personal delivery or mail, as well as submitting the completed Inventory electronically by e-mail or by service of a disk or CD, if an email address is not known or available. 8. The second party to serve their Inventory must follow the same order of listing the assets as the original filing party and must list each item under the appropriate category as set forth in the “Schedules”. Rule 11 requires the moving party to submit an electronic copy of the completed Inventory on the responding party. The responding party shall use this form and fill in his/her information in the appropriate categories. If the first party fails to list an asset/debt on their Inventory, the second party would list the “missing” item at the bottom of the list, on that schedule. A failure to sequentially follow the classification scheme will result in the Court and counsel needlessly consuming time as they compare the Plaintiff’s and Defendant’s Inventories for information containing the same asset. Under the “Comments” section list out any information that you feel is relevant and should be considered by the Court regarding the asset/debt relating to the classification, value or distribution of each item of property or debt. (For example, if you claim the described property was purchased with your separate property.) WAKE-DOM-18 (REV 2/23/06) (PAGE 3 OF 28) American LegalNet, Inc. www.USCourtForms.com 9. The following are the statutory definitions for “Marital”, “Separate”, and “Divisible” Assets: a. “Marital property” means all real and personal property acquired by either spouse or both spouses during the course of the marriage and before the date of the separation of the parties, and presently owned, except property determined to be separate property or divisible property. Marital property also includes all vested and nonvested pension, retirement, and other deferred compensation rights, and vested and nonvested military pensions eligible under the Federal Uniformed Services Former Spouses’ Protection Act. It is presumed that all property acquired after the date of marriage and before the date of separation is marital property except property which is separate property. b. “Separate property” means all real and personal property acquired by a spouse before marriage or acquired by a spouse by bequest, devise, descent, or gift during the course of the marriage. However, property acquired by gift from the other spouse during the course of the marriage shall be considered separate property only if such an intention is stated in the conveyance. Property acquired in exchange for separate property shall remain separate property regardless of whether the title is in the name of the husband or wife or both and shall not be considered to be marital property unless a contrary intention is expressly stated in the conveyance. The increase in value of separate property and the income derived from separate property shall be considered separate property. All professional licenses and business licenses which would terminate or transfer shall be considered separate property. c. “Divisible property” means all real and personal property as set forth below: i. All appreciation and diminution in value of marital property and divisible property of the parties occurring after the date of separation and prior to the date of distribution, except that appreciation or diminution in value which is the result of postseparation actions or activities of a spouse shall not be treated as divisible property. ii. All property, property rights, or any portion thereof received after the date of separation but before the date of distribution that was acquired as a result of the efforts of either spouse during the marriage and before the date of separation, including, but not limited to, commissions, bonuses, and contractual rights. iii. Passive income from marital property received after the date of separation, including, but not limited to, interest and dividends. iv. Increases in marital debt and financing charges and interest related to marital debt. 10. This Inventory is comprised of four Schedules, titled: SCHEDULE I: MARITAL ASSETS; SCHEDULE II: MARITAL DEBTS; SCHEDULE III: SEPARATE ASSETS; and SCHEDULE IV: SEPARATE DEBTS. The following is a list of abbreviations used in this Inventory: FMV: Fair Market Value Jt: Joint (as in joint names listed on a title) DOS: Date of Separation DOM: Date of Marriage Poss.: Possession Class.: Classification H: Husband W: Wife M: Martial Property S: Separate Property 11. If you require further information and/or guidance in the preparation of this Inventory, you may refer to the North Carolina General Statutes, Chapter 50 and to the Wake County Family Court Domestic Rules. WAKE-DOM-18 (REV 2/23/06) (PAGE 4 OF 28) American LegalNet, Inc. www.USCourtForms.com SCHEDULE I: MARITAL ASSETS See Schedules A-H below for a description of items to be listed on each individual schedule. You must state your contention as to the classification of each item listed. M = marital property. S = separate property. If you contend the asset is separate property, you must state whether you contend the asset is your separate property or the separate property of your spouse. Fair market value (FMV) means what you believe the property was worth on the date you and your spouse separated. DOS = date of separation. A. REAL ESTATE 1. 2. 3. 4. 5. 6. 7. 8. C. Primary Residence Residential Rental Property Commercial/Business Property Recreational/Secondary Residence Time Share Other real estate and property ALL FINANCIAL ACCOUNTS INCLUDING BANK ACCOUNTS, STOCKS, BONDS, MUTUAL FUNDS AND STOCK OPTIONS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. B. Checking Accounts Savings Accounts/Share Accounts Certificates of Deposit Money Market Accounts Common/Preferred Stocks Bonds & Debentures Stock Options Mutual Funds/Mutual Fund Accounts Commodities/Commodity Accounts Cash in hand or held by others Treasury Bills/Notes Trusts Other Financial/Brokerage Accounts WAKE-DOM-18 (REV 2/23/06) (PAGE 5 OF 28) TRANSPORTATION, RECREATIONAL VEHICLES, AIRPLANES, AND ALL OTHER FORMS OF TRANSPORTATION 1. 2. 3. 4. 5. 6. 7. 8. 9. D. Automobiles Trucks Vans Motorcycles Boats Water Crafts Airplanes Mobile Homes Other forms of transportation RETIREMENT BENEFITS AND IRA ACCOUNTS 1. 2. 3. 4. 5. 6. 7. 8. 9. 401(k)/403(b) Plans Keogh, SEP/IRA Plans Annuities Profit Sharing/Pension Plans Deferred Compensation Plans Defined Benefit IRA’s Retirement Plans All Other Retirement Benefits American LegalNet, Inc. www.USCourtForms.com E. ARTWORK, METALS, AND OTHER COLLECTABLES, JEWELRY AND ANIMALS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. G. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Furniture (including antiques) Pictures, prints & other wall hangings (if not included on Schedule E) Appliances (washer, dryer, refrigerator), if not included with real estate Electronics (including TV, VCR/DVD, Computers and equipment, stereo, video equipment, cameras, etc.) Linens Rugs Books Outdoor Furniture Sporting Goods Tools (hand tools & woodworking) Lawnmowers & Yard Equipment Silverware (if not listed on Schedule E) China & Crystal Other Household Items (not previously listed) WAKE-DOM-18 (REV 2/23/06) (PAGE 6 OF 28) BUSINESS INTERESTS AND INTELLECTUAL PROPERTY 1. 2. 3. 4. 5. 6. 7. 8. 9. Artwork Gold & Silver Guns Coins Stamps Furs Jewelry Records/CD's Musical Instruments Animals (horses, farm animals, animals raised for monetary gains, show animals, etc.) Other Collectables HOUSEHOLD GOODS AND EQUIPMENT 1. 2. F. H. General Partnership Interest Sole Proprietorship Interest Stock Ownership Interest Limited Liability Partnership Interest Limited Liability Company Interest Professional Limited Liability Company Interest Other Business Interests Intellectual Properties (Patents, Copyrights, Trademarks) OTHER ASSETS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Life Insurance Other Insurance with cash value Promissory Notes Debts/Notes/Money Payable (owed to either party) Other Income Producing Assets Tax Refunds Contents of Safety Deposit Box(es) (not otherwise listed) Personal Injury/Insurance Claims Other Miscellaneous Assets (not otherwise listed) Frequent Flyer Miles Country Club Memberships American LegalNet, Inc. www.USCourtForms.com SCHEDULE II: MARITAL DEBTS 1. Secured Consumer Indebtedness: Loans secured by a lien on any property (real or personal) from any institutional lender, including but not limited to banks and credit unions. 2. Unsecured Consumer Indebtedness: Loans for which a signature is the only security offered from any institutional lender, including but not limited to banks and credit unions. 3. Credit Card Indebtedness: Visa, MasterCard, Discover, American Express and any retail store (including department stores, gasoline cards). 4. Family Indebtedness: Loans from non-institutional lenders, made for any purpose. 5. Business Indebtedness: Loans to any business for which you and/or your spouse are responsible for repayment or have personally guaranteed that the business will repay. 6. Other Indebtedness: Any other loans, debts or other indebtedness that you and/or your spouse are responsible for repayment or have personally guaranteed. WAKE-DOM-18 (REV 2/23/06) (PAGE 7 OF 28) American LegalNet, Inc. www.USCourtForms.com ED Inventory for: [ ] Plaintiff or [ ] Defendant Date of Marriage: ____________________ Date of Separation: __________________ SCHEDULE I: MARITAL ASSETS SCHEDULE A REAL ESTATE Specific Instructions for Schedule A: Within the description section for each asset listed, if known you must provide the street address, city and state and in what name the property is titled. Item # RESIDENTIAL REAL ESTATE (Description of property & how titled) Wife Estimated NET value on DOS Current Possession (FMV less 1st, 2nd mortgages and/or home equity line – show all amounts) Wife Current Estimated NET value W’s Classification (M/S) Husband Estimated NET value on DOS Husband Current Estimated NET value H’s Classification (M/S) A1. Comments: A2. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 8 OF 28) American LegalNet, Inc. www.USCourtForms.com SCHEDULE A (Continued) REAL ESTATE Item # RESIDENTIAL REAL ESTATE (Description of property & how titled) Wife Estimated NET value on DOS Current Possession (FMV less 1st, 2nd mortgages and/or home equity line – show all amounts) Wife Current Estimated NET value W’s Classification (M/S) Husband Estimated NET value on DOS Husband Current Estimated NET value H’s Classification (M/S) A3. Comments: A4. Comments: A5. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 9 OF 28) American LegalNet, Inc. www.USCourtForms.com ED Inventory for: [ ] Plaintiff or [ ] Defendant Date of Marriage: __________________ Date of Separation: ________________ SCHEDULE B TRANSPORTATION, RECREATIONAL VEHICLES, AIRPLANES, AND ALL OTHER FORMS OF TRANSPORTATION Specific Instructions for Schedule B: Within the description section for each asset listed, please give a complete description of the vehicle, including make, model, year, how titled and a description of any liens on said vehicle. Item # Description of Transportation/ Vehicle; date acquired; how titled; liens Current Poss. Wife Estimated FMV Value on DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOS Husband Current Estimated FMV Value H’s Class. B1. Comments: B2. Comments: B3. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 10 OF 28) American LegalNet, Inc. www.USCourtForms.com SCHEDULE B (Continued) TRANSPORTATION, RECREATIONAL VEHICLES, AIRPLANES, AND ALL OTHER FORMS OF TRANSPORTATION Item # Description of Transportation/ Vehicle; date acquired; how titled; liens Current Poss. Wife Estimated FMV Value on DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOS Husband Current Estimated FMV Value H’s Class. B4. Comments: B5. Comments: B6. Comments: B7. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 11 OF 28) American LegalNet, Inc. www.USCourtForms.com ED Inventory for: [ ] Plaintiff or [ ] Defendant Date of Marriage: __________________ Date of Separation: ________________ SCHEDULE C ALL FINANCIAL ACCOUNTS INCLUDING BANK ACCOUNTS, STOCKS, BONDS, MUTUAL FUNDS AND STOCK OPTIONS Specific Instructions for Schedule C: Within the description section, if known you must provide the account number, how the account is titled, the name and address of the institution where the asset is held or, if held by a person, identify that person by full name and address. Item # Description of Account Current Poss. Wife Estimated FMV Value on DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOS Husband Current Estimated FMV Value H’s Class. C1. Comments: C2. Comments: C3. Comments: C4. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 12 OF 28) American LegalNet, Inc. www.USCourtForms.com SCHEDULE C (CONTINUED) ALL FINANCIAL ACCOUNTS INCLUDING BANK ACCOUNTS, STOCKS, BONDS, MUTUAL FUNDS AND STOCK OPTIONS Item # Description of Account Current Poss. Wife Estimated FMV Value on DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOS Husband Current Estimated FMV Value H’s Class. C5. Comments: C6. Comments: C7. Comments: C8. Comments: C9. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 13 OF 28) American LegalNet, Inc. www.USCourtForms.com ED Inventory for: [ ] Plaintiff or [ ] Defendant Date of Marriage: __________________ Date of Separation: _________________ SCHEDULE D RETIREMENT BENEFITS AND IRA ACCOUNT’S Specific Instructions for Schedule D: Within the description section, you must provide if known, the account number for all retirement accounts and IRA’s; identify by name and address the provider of all retirement benefits; and identify the owner of the retirement benefit/account. Within the description section for each account/benefit listed, you must state whether the retirement account/benefit is a vested account/benefit. Item # Description of Account Current Poss. Wife Estimated FMV Value on DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOS Husband Current Estimated FMV Value H’s Class. D1. Comments: D2. Comments: D3. Comments: D4. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 14 OF 28) American LegalNet, Inc. www.USCourtForms.com ED Inventory for: [ ] Plaintiff or [ ] Defendant Date of Marriage: __________________ Date of Separation: _________________ SCHEDULE D (CONTINUED) RETIREMENT BENEFITS AND IRA ACCOUNT’S Item # Description of Account Current Poss. Wife Estimated FMV Value on DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOS Husband Current Estimated FMV Value H’s Class. D5. Comments: D6. Comments: D7. Comments: D8. Comments: D9. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 15 OF 28) American LegalNet, Inc. www.USCourtForms.com ED Inventory for: [ ] Plaintiff or [ ] Defendant Date of Marriage: __________________ Date of Separation: _________________ SCHEDULE E ARTWORK, METALS, AND OTHER COLLECTABLES, JEWELRY AND ANIMALS Specific Instructions for Schedule E: Within the description section, you must identify the person in possession of the asset and describe the asset with sufficient particularity for it to be identified by the opposing party. Item # Description of Asset Current Poss. Wife Estimated FMV Value on DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOS Husband Current Estimated FMV Value H’s Class. E1. Comments: E2. Comments: E3. Comments: E4. Comments: E5. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 16 OF 28) American LegalNet, Inc. www.USCourtForms.com ED Inventory for: [ ] Plaintiff or [ ] Defendant Date of Marriage: __________________ Date of Separation: _________________ SCHEDULE F BUSINESS INTERESTS AND INTELLECTUAL PROPERTY Specific Instructions for Schedule F: Within the description section, you must provide a complete description of the asset and location, including name of business, type of business, address of business, and type of entity (whether incorporated, sole proprietorship, partnership, joint venture, etc.). Identify each partner/shareholder and the percentage of ownership for each person so identified. For Intellectual Property, include all identifying information: office where registered, or patented, or where patent application is pending; patent number, trademark or copyright registration number; title, mark or trade name; brief description; dates filed and issued; original price or costs to create and to register; etc. Item # Description of Business Interest / Intellectual Property Current Poss. Wife Estimated FMV Value on DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOS Husband Current Estimated FMV Value H’s Class. F1. Comments: F2. Comments: F3. Comments: F4. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 17 OF 28) American LegalNet, Inc. www.USCourtForms.com ED Inventory for: [ ] Plaintiff or [ ] Defendant Date of Marriage: __________________ Date of Separation: _________________ SCHEDULE G HOUSEHOLD GOODS & EQUIPMENT Specific Instructions for Schedule G: Within the description section, you must identify the asset with sufficient particularity for it to be identified by the opposing party. Within the description section, for the purposes of this Inventory, you may describe property in groups (e.g. master bedroom furniture). If either party requests, additional identification will be required. It is not a sufficient description for this Inventory to merely state: "household furnishings." Item # Description of Item / Asset Current Poss. Wife Estimated FMV Value on DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOS Husband Current Estimated FMV Value H’s Class. G1. Comments: G2. Comments: G3. Comments: G4. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 18 OF 28) American LegalNet, Inc. www.USCourtForms.com SCHEDULE G (CONTINUED) HOUSEHOLD GOODS & EQUIPMENT Item # Description of Item/Asset Current Poss. Wife Estimated FMV Value on DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOS Husband Current Estimated FMV Value H’s Class. G5. Comments: G6. Comments: G7. Comments: G8. Comments: G9. Comments: G10. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 19 OF 28) American LegalNet, Inc. www.USCourtForms.com SCHEDULE G (CONTINUED) HOUSEHOLD GOODS & EQUIPMENT Item # Description of Item/Asset Current Poss. Wife Estimated FMV Value on DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOS Husband Current Estimated FMV Value H’s Class. G11. Comments: G12. Comments: G13. Comments: G14. Comments: G15. Comments: G16. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 20 OF 28) American LegalNet, Inc. www.USCourtForms.com ED Inventory for: [ ] Plaintiff or [ ] Defendant Date of Marriage: __________________ Date of Separation: _________________ SCHEDULE H OTHER ASSETS (not otherwise listed) Specific Instructions for Schedule H: Within the description section for each insurance policy listed if known, you must state the type of insurance; the provider of the described insurance and policy number (if known); whether or not the insurance has any cash surrender value; how policy is titled; and the amount of the cash value. For each promissory note or other debt owing to either party, you must state the amount owed; the name and address of the person(s) owing the debt; and the terms of the note/debt. For any other assets, including tax refunds; contents of safety deposit box, or personal injury/insurance claims, give a complete description of the asset, including account/box location and number, source of funds; payment terms; and other identifying information. Item # Description of Asset Current Poss. Wife Estimated FMV Value on DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOS Husband Current Estimated FMV Value H’s Class. H1. Comments: H2. Comments: H3. Comments: H4. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 21 OF 28) American LegalNet, Inc. www.USCourtForms.com ED Inventory for: [ ] Plaintiff or [ ] Defendant Date of Marriage: __________________ Date of Separation: _________________ SCHEDULE II: MARITAL DEBTS Specific Instructions Marital Debts: Within the description section for each debt listed, if known you must provide the name and address of the lender; the account number of the loan/debt; the nature/purpose of the debt; the identity of the person receiving the loan/incurring the debt; and describe the property which serves as security for the payment of the loan. In addition, under the comments section, list out any payments made by either party after the date of separation, including which party made the payments and the amounts. Item # Description of Debt Wife Estimated Debt Owed on DOS Wife Current Estimated Debt Owed W’s Class. Husband Estimated Debt Owed on DOS Husband Current Estimated Debt Owed H’s Class. 1. Comments: 2. Comments: 3. Comments: 4. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 22 OF 28) American LegalNet, Inc. www.USCourtForms.com SCHEDULE II: MARITAL DEBTS (Continued) Item # Description of Debt Wife Estimated Debt Owed on DOS Wife Current Estimated Debt Owed W’s Class. Husband Estimated Debt Owed on DOS Husband Current Estimated Debt Owed H’s Class. 5. Comments: 6. Comments: 7. Comments: 8. Comments: 9. Comments: 10. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 23 OF 28) American LegalNet, Inc. www.USCourtForms.com ED Inventory for: [ ] Plaintiff or [ ] Defendant Date of Marriage: __________________ Date of Separation: _________________ SCHEDULE III: SEPARATE ASSETS Specific Instructions for Separate Assets: For any asset/item, that has not previously been listed in this Inventory that you contend is your separate property, or your spouses separate property, you must provide a complete description of the asset, including any account numbers, how the asset/account is titled, the name and address of the institution where the asset is held, or, if held by a person, identify that person by full name and address; the location of property/asset and you must identify the asset with sufficient particularity for it to be identified by the opposing party. In addition, under the comments section you must include your basis and contentions as to why it is a separate asset. Item # Description of Asset / Property Current Poss. Wife Estimated FMV Value on DOM and DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOM and DOS Husband Current Estimated FMV Value H’s Class. 1. Comments: 2. Comments: 3. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 24 OF 28) American LegalNet, Inc. www.USCourtForms.com SCHEDULE III: SEPARATE ASSETS (Continued) Item # Description of Asset / Property Current Poss. Wife Estimated FMV Value on DOM and DOS Wife Current Estimated FMV Value W’s Class. Husband Estimated FMV Value on DOM and DOS Husband Current Estimated FMV Value H’s Class. 4. Comments: 5. Comments: 6. Comments: 7. Comments: 8. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 25 OF 28) American LegalNet, Inc. www.USCourtForms.com ED Inventory for: [ ] Plaintiff or [ ] Defendant Date of Marriage: __________________ Date of Separation: _________________ SCHEDULE IV: SEPARATE DEBTS Specific Instructions for Separate Debts: For any debt, that has not previously been listed in this Inventory that you contend is your separate debt, or your spouses separate debt, you must provide a complete description of the debt, including (if known) the name and address of the lender; the account number of the loan/debt; the nature/purpose of the debt; the identity of the person receiving the loan/incurring the debt; and describe the property which serves as security for the payment of the loan/debt. You must identify the debt with sufficient particularity for it to be identified by the opposing party. In addition, under the comments section you must include your basis and contentions as to why it is a separate debt and list out any payments made by either party after the date of separation, including which party made the payments and the amounts. Item # Description of Debt Wife Estimated Debt Owed on DOM and DOS Wife Current Estimated Debt Owed W’s Class. Husband Estimated Debt Owed on DOM and DOS Husband Current Estimated Debt Owed H’s Class. 1. Comments: 2. Comments: 3. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 26 OF 28) American LegalNet, Inc. www.USCourtForms.com SCHEDULE IV: SEPARATE DEBTS (Continued) Item # Description of Debt Wife Estimated Debt Owed on DOM and DOS Wife Current Estimated Debt Owed W’s Class. Husband Estimated Debt Owed on DOM and DOS Husband Current Estimated Debt Owed H’s Class. 4. Comments: 5. Comments: 6. Comments: 7. Comments: 8. Comments: WAKE-DOM-18 (REV 2/23/06) (PAGE 27 OF 28) American LegalNet, Inc. www.USCourtForms.com NORTH CAROLINA 10th JUDICIAL DISTRICT WAKE COUNTY IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION ________-CVD-_____________ _________________________________________, Plaintiff -v_________________________________________, Defendant CERTIFICATE OF SERVICE FOR EQUITABLE DISTRIBUTION INVENTORY I am the [ ] PLAINTIFF [ ] DEFENDANT in this matter and I hereby certify that a copy of my Equitable Distribution Inventory has been served on the opposing attorney/party in the following manner: [ ] By depositing a copy in the US Mail in a properly addressed, postpaid envelope to: [ ] By hand delivery to: [ ] Other: AND BY DELIVERING AN ELECTRONIC COPY ON THE OPPOSING ATTORNEY/PARTY BY: [ ] E-mail delivery to ________________________________ [ ] Providing a copy via disk or CD [ ] Other: _________________________________ Date:_______________________-- _____________________________________________________ [ ] Plaintiff [ ] Attorney for Plaintiff [ ] Defendant [ ] Attorney for Defendant A COPY OF THIS CERTIFICATE OF SERVICE MUST BE FILED WITH THE COURT. WAKE-DOM-18 (REV 2/23/06) (PAGE 28 OF 28) American LegalNet, Inc. www.USCourtForms.com