Respondent'S Mandatory Case Disclosure Acknowledgment
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1NO. (A)____________________
___________________ CIRCUIT COURT
FAMILY DIVISION _________
(B)__________________________
PETITIONER
(Print name of Petitioner)
SELF-HELP FORM #2C
v.
RESPONDENT’S MANDATORY CASE
DISCLOSURE ACKNOWLEDGMENT
(C)__________________________
RESPONDENT
(Print name of Respondent)
I, ___________________,hereby acknowledge that I have received the
Name (Respondent)
Petitioner’s Mandatory Case Disclosure and acknowledge that it is a true statement of our
assets and liabilities.
______________________________
SIGNATURE OF RESPONDENT
**MUST BE SIGNED IN THE PRESENCE OF A NOTARY**
COMMONWEALTH OF KENTUCKY
)
)
COUNTY OF ________________________ )
Subscribed and sworn to before me by the above-named Respondent on this ______ day
of ___________________, 20____.
My commission expires: _______________________.
NOTARY PUBLIC
STATE
AT
LARGE,
KENTUCKY
1
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