Preliminary Verified Disclosure Statement Page 8
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8AOC-238
Rev 1-11
Actual
Anticipated
Page 8 of 8
Professional Dues/Club Memberships:
_______________________________________________________________________________________________
Social Clubs:
_______________________________________________________________________________________________
Barber/Beauty Shop:
_______________________________________________________________________________________________
Tuition/School Expenses:
_______________________________________________________________________________________________
State/Federal/Local Taxes Not Withheld:
_______________________________________________________________________________________________
Child support paid for prior born child
_______________________________________________________________________________________________
Child support for child of marriage
_______________________________________________________________________________________________
Maintenance paid to prior spouse
_______________________________________________________________________________________________
Maintenance paid to current spouse
_______________________________________________________________________________________________
Athletic and Activity Fees (list)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Debt payments (list)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Other Monthly Expenses (list)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
TOTAL MONTHLY EXPENSES
$
$
0.00
0.00
_______________________________________________________________________________________________
Petitioner Respondent states that the above information is true and correct to the best of my knowledge and belief,
and that it results from a diligent, good faith effort to ascertain the information sought herein, based upon information
and documents available to me and/or within my possession or control. All documents upon which this information
is based and the documents requested herein have been produced and are currently in the office of my counsel.
_____________________________________________
Petitioner
Respondent
STATE OF KENTUCKY
)
) SCT.
COUNTY OF______________ )
Subscribed and sworn to before me by _____________________________________, on this the _______ day
of _____________, 2______.
___________________________________________
Notary Public, _____________________
My commission expires: ________________________.
CERTIFICATE OF SERVICE
This is to certify that the foregoing Preliminary Verified Disclosure Statement was mailed hand-delivered to
counsel for Petitioner Respondent on this the _____ day of __________________, _______, and documents
requested and supporting the information set forth herein are currently available at the undersigned’s office or are
in the undersigned’s possession and are available for inspection and copying at the requesting party’s expense.
________________________________________________
ATTORNEY FOR PETITIONER RESPONDENT
or PETITIONER RESPONDENT
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