q AOC-238.3 Doc. Code
q AOC 239.3 Doc. Code
Disclosure of
Rev- 1-15
_____________________________________
Page 2 of 2
Case No. _________________________________________
I hereby acknowledge that the information contained in _____________________________’s Verified Disclosure
Statement is a true and accurate reflection of the financial disputes in this matter and that there are no additional assets, debts
or issues which require disclosure to the best of my knowledge and belief. Further, I hereby certify that the foregoing information
is true to the best of my knowledge, information and belief.
____________________________________________
Petitioner
Respondent
{check one}
q
q
STATE OF ____________________________
)
) SS
COUNTY OF ____________________________
)
Subscribed and sworn before me by ____________________________, this _____ day of _________________,
________.
My commission expires: ______________________
______________________________________
NOTARY PUBLIC/TITLE
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a copy of this Acknowledgment Of Verified Disclosure Statement (with schedules
and attachments) was served by
q mail, postage prepaid, or q hand-delivery, or q electronic means, in accordance with
Kentucky Rule of Civil Procedure (CR) 5.02, on (
) ___________________________________________________
name
at (
) _____________________________________________________________________________________,
address
this the _______ day of ________________________, _________.
____________________________________________
Signature
q Attorney for Petitioner q Attorney for Respondent
q Petitioner q Respondent
Address:
____________________________________________
____________________________________________
____________________________________________
Phone: (
) ________________________________
Fax: (
) _________________________________
Email: _____________________________________
*NOTE
When this form is utilized in lieu of the AOC-238, Preliminary Verified Disclosure Statement, unless otherwise
ordered by the Court or required by Local Rule, this form is NOT to be filed with the Court. FCRPP 2(3). However,
the entire form and all attachments are to be exchanged between the parties within 45 days of service of the
petition on the respondent, and objections thereto shall be exchanged within 20 days thereafter.
When this form is utilized in lieu of the AOC-239, Final Verified Disclosure Statement, or AOC-239.2, Affidavit
of No Change in Circumstances, pursuant to FCRPP 3(3), this form is to be filed with the Court no later than 5
days prior to the trial if property matters are in dispute at that trial. A copy of this Acknowledgment shall also be
provided to the opposing party 15 days prior to trial unless otherwise ordered by the Court.
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