AOC-238.3 Doc. Code: ACKPDS
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Case No. ____________________
AOC-239.3 Doc. Code: ACKFDS
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Rev. 1-15
l e x
Court
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e t
j u s t i t i a
Page 1 of 2
County
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Commonwealth of Kentucky
ACKNOWLEDGMENT OF
Court of Justice
Division
____________________
PRELIMINARY
FINAL VERIFIED
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FCRPP 2 and FCRPP 3
DISCLOSURE STATEMENT*
IN RE THE MARRIAGE OF:
________________________________________
PETITIONER
and
________________________________________
RESPONDENT
All sections must be completed. If an amount is unknown, write “unknown”, if the question is inapplicable, write “N/A”.
If a question requires further documentation or an additional schedule, please attach. If maintenance is an issue or
there are property distribution issues, please proceed to use the full Mandatory Case Disclosure Form.
I, ________________________________________, declare under oath that my personal information is:
Name: ______________________________________________________
Address: ____________________________________________________
____________________________________________________
____________________________________________________
Age/Place birth: _______________________________________________
Date/Place marriage: __________________________________________
Spouse’s name: ______________________________________________
Spouse’s age: ________________________________________________
I am currently employed at: ______________________________________
I earn _________________ per ________________ (weekly, monthly, etc.)
****** My total gross monthly income (from all sources) is _______________
OTHER LEGAL ACTIONS
Please give the style, the case number, and the name of the Court or administrative agency for any case you are
a party in or have been within the last year as well as a brief description of the nature of the case and present status.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
REQUIRED ATTACHMENTS
“A” = to indicate that the requested document/information is attached
“U” = to indicate that the requested document/information is unavailable
(Provide explanation on a separate page)
“N/A” = if not applicable
I have provided a copy of the following documents to opposing party or opposing counsel:
____ 1.
My three (3) most recent pay stubs
____ 2.
A full and complete copy of my last Federal Tax Return
____ 3.
First page of my last State Tax Return
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