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Verifying Declaration

VERIFYING DECLARATION

(Marital Property Disclosures & Mediated Property Division Table)

We declare under penalty of perjury that we have carefully completed and reviewed this Mediated Property Division Table

setting forth our marital assets and debts and this is a true, complete and correct statement of all of our marital property and our

good faith estimates of the net asset values of that property as we last determined them (during our mediation).

____________________________

Martha FictionalClient

James FictionalClient

STATE OF COLORADO

)

STATE OF COLORADO

)

) ss.

COUNTY OF ___________ )

Subscribed and sworn to before me this _______ day of

________________, 2006 by Martha FictionalClient. Witness

________________, 2006 by James FictionalClient. Witness

my hand and official seal.

My Commission expires:_________________________

__________________________________

NOTARY PUBLIC (Name)

NOTARY PUBLIC

__________________________________

Address

Verifying Declaration