(Apr 2019) Statement of Assets and Liabilities You will need to file a Statement of Assets and Liabilities if the respondent files a Response and you have not reached an agreement as your trial date nears. Each party222s Statement must be filed with the court and served on the other party at least 14 days before your trial. Check your local court222s Supplementary Local Rules , Chapter 8 for other time limits and requirements. Give or mail a copy to the other party and complete the Certificate of Service at the end of the form before filing with the court. Most courts prefer that you complete ONE joint form so that you don222t have one form listing 223house 1224 and the other calling it 223123 Main St.224 Your Statement should name the asset as specifically as possible. You and the other party should do everything you can to agree on the value of your assets and liabilities. Then list who the court should give each asset or liability to. You can use one of the formats below. NOTE: if there is a restraining order, protective order, or no-contact order between you and the other party, submit separate forms. Tax debts, student loans, and support arrears can be totaled for each party, details are not required. In the examples below, the parties disagree about the value of the Ford Ranger but agree that it should be awarded to Petitioner. The parties agree about the value of the Kia Soul but disagree about who it should be awarded to. Leave the last 2 columns blank 226 the judge will make a final decision about the value of each asset and who it is awarded to. American LegalNet, Inc. www.FormsWorkFlow.com Statement of Assets & Liabilities Page 1 of 5 (Apr 2019) Statement of Assets and Liabilities Case # DESCRIPTION OF ASSETS PETITIONER Name: RESPONDENT Name: COURT Claimed Value Proposed Distribution (Pet or Resp ) Claimed Value Proposed Distribution (Pet or Resp) Value Distribution (Pet or Resp) 1. Real Proper ty (address) 2. Vehicles (car, truck, boat, ATV, etc.) 3. Bank Accounts (bank, type, & name on the account) 4. Cash on Hand 5. Furniture/Appliances 6. Per sonal Property (by type) Petitioner Respondent American LegalNet, Inc. www.FormsWorkFlow.com Statement of Assets & Liabilities Page 2 of 5 (Apr 2019) Claimed Value Proposed Distribution (Pet or Resp) Claimed Value Proposed Distribution (Pet or Resp) Val ue Distribution (Pet or Resp) 7. Business Interests 8. Insurance Policies (with cash surrender or loan value) 9. Pensions and Investments 10. Expected Assets (inheritance, tax refund, pending lawsuit) 11. Other assets TOTAL ASSETS: Additional page attached DESCRIPTION OF LIABILITIES PETITIONER RESPONDENT COURT Claimed Value Proposed Distribution (Pet or Resp) Claimed Value Proposed Distribution (Pet or Resp) Value Distribution (Pet or Resp) 12. Mortgages 13. Vehicle loans 14. Tax Debt American LegalNet, Inc. www.FormsWorkFlow.com Statement of Assets & Liabilities Page 3 of 5 (Apr 2019) Claimed Value Proposed Distribution (Pet or Resp) Claimed Value Proposed Distribution (Pet or Resp) Value Distribution (Pet or Resp) 15. Student Loans 16. Credit Card Debt 17. Support Arrears 18. Court Fines 19. Expected Liabilities (college costs, pending lawsuit) 20. Other Debt/Loans TOTAL LIABILITIES: Additional page attached American LegalNet, Inc. www.FormsWorkFlow.com Statement of Assets & Liabilities Page 4 of 5 (Apr 2019) USE THIS PAGE F OR ADDITIONAL ASSETS & LIABILITIES NOT LISTED ABOVE DESCRIPTION PETITIONER RESPONDENT COURT Claimed Value (mark 223+224 for assets and 223-224 for liabilities) Proposed Distribution (Pet or Resp) Claimed Value (mark 223+224 for assets and 223-224 for liabilities) Proposed Distribution (Pet or Resp) Value Distribution (Pet or Resp) TOTAL ADDITIONAL ASSETS: TOTAL ADDITIONAL LIABILITIES: American LegalNet, Inc. www.FormsWorkFlow.com Statement of Assets & Liabilities Page 5 of 5 (Apr 2019) Certificate of Document Preparation. Check all that apply: I chose this form for myself and completed it without paid help A legal help organization helped me choose or complete this form, but I did not pay money to anyone I paid (or will pay) for help choosing, completing, or reviewing this form Guide & File selected and completed this form and I did not pay anyone to review the completed form Date Signature Name (printed) Contact Address City, State, ZIP Contact Phone Certificate of Service I certify that on (date): I placed a true and complete copy of this Statement in the United States mail to (name) at (address): or gave a true and complete copy to (name) in person Date Signature Name (printed) American LegalNet, Inc. www.FormsWorkFlow.com