Domestic Relations Financial Affidavit Page 3
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7Number of Exemptions Claimed
Your Pay Period (i.e., monthly, weekly, etc.):
by You for Tax Purposes:
(4) Assets
(List all assets here, including both non-marital and marital property. If you claim or agree that all or part of an
asset is non-marital, indicate the non-marital protion under the appropriate spouse's column and state the amount
that the basis: pre-marital, gift, inheritance, source of funds, etc. The total value of each asset must be listed in
the "value" column. "Value" means what you feel the item of property would be worth if it were offered for sale.)
Separate Asset of
Separate Asset of
Description
Value
Husband
Wife
Cash
Stocks, Bonds
CD's / Money Market Accounts
Bank Accounts (list each account
below):
(1)
(2)
401(K)
Other Retirement Accounts
Money Owed to You (or Spouse)
Tax Refund Owed to You
Real Estate (list properties &
mortgages):
Marital Residence
Approximate Value:
Approximate Debt:
Approximate Equity:
Automobiles/Vehicles (list vehicles &
amounts owed on each one):
(1)
Value less debt owed
(2)
Value less debt owed
Life Insurance (net cash value)
Furniture/Furnishings
______
Initials
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