Appendix V - Family Part Case Information Statement Form Page 9

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Statement of Liabilities
Name of
Responsible
If you contend liability should
Monthly
Total
Description
Date
Party
not be shared, state reason
Payment
Owed
(P, D, J)
1. Real Estate Mortgages
2. Other Long Term Debts
3. Revolving Charges
4. Other Short Term Debts
5. Contingent Liabilities
TOTAL GROSS LIABILITIES:
$
(excluding contingent liabilities)
NET WORTH:
$
(subject to equitable distribution)
TOTAL SUBJECT TO EQUITABLE DISTRIBUTION:
$
TOTAL NOT SUBJECT TO EQUITABLE DISTRIBUTION:
$
Revised to be effective September 1, 2017. CN: 10482 (Court Rules Appendix V)
Page 9 of 10

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