Equitable Distribution Affidavit - North Carolina General Court Page 17
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33AFFIDAVIT OF HUSBAND/WIFE:
17
(13) SCHEDULE H
RETIREMENT BENEFITS
PLANS WITH ACCOUNT BALANCES
(IRA Accounts and Defined Contribution Plans such as:
401(k) Plans, Profit-Sharing Plans, and Retirement Savings Plans)
PROPOSED
DESCRIPTION OF ASSET
DOS NET
DISTRIB.
(Including Name of Plan, Type of Plan, and Account No.)
FMV
(H OR W)
1.
2.
3.
4.
PLANS WITH MONTHLY OR OTHER PAYMENTS
(Pension Plans and Other Defined Benefit Plans)
PROPOSED
DOS
DESCRIPTION
DISTRIB.
NET VALUE
(H OR W)
1.
First Plan:
Participant (H or W):
• Name of Plan:
• Date of birth:
• Date employment began:
• Date participation began:
• Is participant still participating:
• If not, date participation ended:
• Total accrued benefit as of DOS:
$
per ________________ (month, week, etc.)
2
Second Plan:
Participant (H or W):
• Name of Plan:
• Date of birth:
• Date employment began:
• Date participation began:
• Is participant still participating:
• If not, date participation ended:
• Total accrued benefit as of DOS:
$
per ________________ (month, week, etc.)
CCF-33
August 2000
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