DR 602B Rev. 8/05 IN THE COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS BUTLER COUNTY, OHIO Judge Sharon L. Kennedy Judge Eva D. Kessler _____________________________________ Plaintiff/1st Petitioner/Petitioner DOB ________________________________ Address ______________________________ _______________________________ Case No. ___________________ Affidavit of Property ________________________ V. (Name of Affiant) _____________________________________ Defendant/2nd Petitioner/Respondent DOB ________________________ Address Date of Marriage __________________ Date of Separation_________________ ______________________ _____________________________ Note: This affidavit must be completed and exchanged in accordance with Local Rules of Court in every action for divorce, dissolution, legal separation, and annulment. You are under a continuing legal duty to file an updated version of this form if you learn of any additional information. If more space is needed, attach additional page(s). List ALL YOUR PROPERTY AND DEBTS, the property and debts of your spouse, and any joint property or debts. Do not leave any category blank. For each item, if none, put "NONE”. If you don't know exact figures for any item, give your best estimate, and put "EST". If more space is needed, attach extra pages. I. Bankruptcy: Filed by: Wife Husband, Both Date of Filing: Case Number Date of Discharge or Relief from Stay Type of Case (Ch. 7, 11, 12, 13) Current Monthly Payments 1. 2. II. Real Estate Interests: Address Titled to Husband, Wife, or Both Present Fair Market Value Mortgages: Balance Due Monthly Mortgage Payments 1. 2. 3. 4. III. Other Assets: Initialed Property Affidavit Page 1 American LegalNet, Inc. www.USCourtForms.com Category A. Vehicles, Other Licensed Property Description (Also list who has possession) Titled to Husband, Wife, or Both Present Fair Market Value (Also list balance due on any liens) (Include automobiles, trucks, motorcycles, boats, motors, motor homes, etc.) 1. 2. 3. B. Financial Accounts (Include checking, savings, CD's, POD accounts, money market accounts, etc.) Pensions & Retirement Plans (Include profit-sharing, IRA's, 401K plans, etc. Describe each type of plan.) 1. 2. 3. C. 1. 2. 3. D. Publicly Held Stocks, Bonds, Securities, & Mutual Funds 1. 2. E. Closely Held Stocks & Other Business Interests (Describe type of business and type of ownership.) 1. 2. F. 1. Life Insurance (Include insurance provided by employer, term, whole life, any cash value or loans.) Furniture & Appliances (Estimate value of those in your possession, and value of those in your spouse's possession.) 2. G. 1. In Your Possession 2. In Spouse's Possession H. Safe Deposit Box (Give location and describe contents) 1. Initialed Property Affidavit Page 2 American LegalNet, Inc. www.USCourtForms.com 2. I.. Transfer of Assets Explanation: List the name and address of any person [other than creditors listed on your Affidavit] who has received money or property from you exceeding $100 in value in the past 12 months and the reason for each transfer. 1. 2. J. Lost Assets Explanation: List any item you claim is lost or missing as of this date, and its value. 1. 2. IV. Debts: List ALL OF YOUR DEBTS, the debts of your spouse, and any joint debts. Do not leave any category blank. For each item, if none, put "NONE". If you don't know exact figures for any item, give your best estimate, and put “EST”. If more space is needed, attach extra pages. Type A. Name of Creditor / Purpose of Debt Total Debt Due Monthly Payment Secured debts (Mortgages, car, etc.) 1. 2. 3. 4. B. Unsecured debts, including credit cards 1. 2. 3. 4. 5. 6. 7. 8. 9. Initialed Property Affidavit Page 3 American LegalNet, Inc. www.USCourtForms.com V. Separate Property Claims: [As defined in O.R.C. 3105.171(A)(6)(a)] If you are making any claims in any of the categories below, explain the nature and amount of your claim. This includes but is not limited to inheritances, property owned before marriage and pre-nuptial agreements. Category Description Why do you claim this as a separate property? Present Fair Market Value Present Debt OATH OF AFFIANT (print) hereby swear or affirm that the information set forth in this I, Affidavit of Property above is true, complete, and accurate. I understand that falsification of this document may result in a contempt of court finding against me which could result in a jail sentence and fine, and that falsification of this document may also subject me to criminal penalties for perjury (O.R.C. 2921.22). AFFIANT Sworn to and subscribed before me this ` Day of , . Notary Public Initialed Property Affidavit Page 4 American LegalNet, Inc. www.USCourtForms.com