COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS HAMILTON COUNTY, OHIO Plaintiff / Petitioner Date: Case No. -vs/andFile No. CSEA No. Defendant / Petitioner Property Statement NOTICE OF SCHEDULING CONFERENCE A HEARING WILL BE HELD ON The ____________ day of ___________________________________, 20_______ , at ______________.M. for 15 minutes before Magistrate ___________________________________________, Room ______________, Domestic Relations Court, 800 Broadway, Cincinnati, Ohio 45202-1332. ---------------------------------------------------------------------------------------------If the Court finds that the issues to be decided are limited, and in the event that Defendant fails to answer or appear for the scheduling conference, the Court may make all such final orders including all parenting orders, child support, spousal support, attorney fees and costs, and a division of property as are necessary and appropriate to the resolution of this matter on the above date and time. ---------------------------------------------------------------------------------------------INSTRUCTIONS Pursuant to O.R.C. §3105.171 (B) every asset and liability, both marital and separate property, is subject to the jurisdiction of the Court. Therefore, every asset and liability of either party must be listed. Pursuant to O.R.C. §3105.171 (A) (2) "during the marriage" for purposes of identifying marital property is defined as from the date of marriage to the date of final hearing "unless it would be inequitable to use such dates." For purpose of this property statement "during the marriage" is defined as the following dates: ______________________________ (date of marriage). _____________________________________________________________________________________________ (other) to _____________________________ (date of separation), _________________________________________________(date of filing complaint) __________________________ (date of final hearing) ______________________________________________ (other specify) _____________________________________. Date of Valuation used for purpose of this statement ______________________________________________ 1: REAL ESTATE Address/Title __________________________________ __________________________________ __________________________________ Appraisal/ Market Value _______________ _______________ _______________ Marital/Separate Mixed ___________________ ___________________ ___________________ Source of Valuation ______________ ______________ ______________ Equity _______________ _______________ _______________ Comment: ____________________________________________________________________________________________________ 2: HOUSEHOLD GOODS (Please attach inventory of property claimed to be separate as well as marital property for which you request an individual award. If all household goods are to be divided equally, please so indicate.) Comment: ____________________________________________________________________________________________________ DR 4.1 (Revised 02/22/2017) Pg. 1 American LegalNet, Inc. www.FormsWorkFlow.com 3: AUTOMOBILES Year & Make ______________ ______________ ______________ Appraisal or Current Market Price ______________ ______________ ______________ Marital/Separate Mixed ______________ ______________ ______________ Source of Valuation ______________ ______________ ______________ Equity Description/Title ______________ ______________ ______________ ______________ ______________ ______________ Comment: ____________________________________________________________________________________________________ 4: FUNDS ON DEPOSIT Description/Title __________________________________ __________________________________ __________________________________ 5: STOCKS AND BONDS Description/ Number _______________ _______________ _______________ Appraisal or Current Market Price ____________ ____________ ____________ Source of Valuation ___________________ ___________________ ___________________ Marital/Separate Mixed _________________ _________________ _________________ Type of Account _____________________ _____________________ _____________________ Number ___________________ ___________________ ___________________ Marital/Separate Mixed _______________________ _______________________ _______________________ Comment: ____________________________________________________________________________________________________ Location/Title __________________________________ __________________________________ __________________________________ Comment: ____________________________________________________________________________________________________ 6: RETIREMENT SAVINGS PLANS/PENSIONS/PROFIT SHARING Year of Name of Plan/Employer Employment Years in Plan H: _____________________________ W: _____________________________ ______________ ______________ _____________ _____________ Marital/Separate Mixed _________________ _________________ Vested? _______ _______ Amount ________ ________ Comment: ____________________________________________________________________________________________________ 7: TAX REFUNDS Year H: __________________________ W: __________________________ J: ___________________________ Source ______________ ______________ ______________ Present Value _________________ _________________ _________________ Date of Receipt _______________ _______________ _______________ Marital/Separate Mixed _________________ _________________ _________________ How many tax exemptions are you presently claiming, including yourself? _________________________________________________ 8: LIFE INSURANCE Name of Company ______________________ ______________________ ______________________ Policy No. __________ __________ __________ Insured _________ _________ _________ Owner __________ __________ __________ Beneficiary __________ __________ __________ Face Amount _________ _________ _________ Cash Value _______ _______ _______ Marital/Separate Mixed ______________ ______________ ______________ Comment: _________________________________________________________________________________________ 9: EXPECTANCIES AND INHERITANCES OF THE PARTIES Location/Titled _______________________________ Value of Fund ________________ Date of Valuation __________________ Source of Valuation _____________ Marital/Separate Mixed ____________________ Comment: ____________________________________________________________________________________________________ DR 4.1 (Revised 02/22/2017) Pg. 2 Amer