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Form Wake-Dom-17b - Certification Of Initial Disclosure (Equitable Distribution) - County Of Wake, North Carolina Page 4

[ ]

Income. Documents showing all income from all sources since the party’s last filed tax

return.

CERTIFICATION: I, [ ] the Plaintiff [ ] the Defendant in this action, hereby certify that

all of the documents as indicated above and required by Rule 11.6 of the Wake County

Family Court Rules - Domestic have been disclosed and provided to the opposing

party/counsel. I further certify that if good cause exists for not providing certain documents,

I have given a detailed explanation of such good cause in the space provided above.

This the _____ day of ______________________ , 20 ___.

Signature of Certifying Party

[ ] Plaintiff [ ] Defendant

CERTIFICATE OF SERVICE

I hereby certify that a copy of this Certification of Initial Disclosure (Equitable Distribution) has

been served in the following manner:

[ ] By depositing a copy in the US Mail in a properly addressed, postpaid envelope to:

[ ] By hand delivery to

[ ] Other:

Date:

[ ] Plaintiff

[ ] Attorney for Plaintiff

[ ] Defendant

[ ] Attorney for Defendant

WAKE-DOM-17B (2/06) (PAGE 4 OF 4)

Form Wake-Dom-17b - Certification Of Initial Disclosure (Equitable Distribution) - County Of Wake, North Carolina Page 4