Asset And Debt Statement

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CASE NUMBER
STATE OF HAWAII
ASSET AND DEBT STATEMENT
FAMILY COURT
Plaintiff
Defendant
Both Parties
FC-D NO.
CIRCUIT
This document is prepared by
Plaintiff
Attorney For Plaintiff
Atty. For Defendant
_______________________________________
_______________________________________
PLAINTIFF
Name
(Your Full Name)
_______________________________________
_______________________________________
VS.
Address
_______________________________________
_______________________________________
City, State, Zip
_______________________________________
DEFENDANT
(Your Spouse’s Full Name)
Phone
1. Cash (on hand or held by others for me)
$_______________________________________
2. CREDIT UNION ACCOUNTS:
Name
Title (H, W, J)
Credit Balance
Debt Balance
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. BANK AND SAVINGS ACCOUNTS: (Include Trustee Accounts)
Company and Branch
Type of Account
Title (H, W, J)
Current Balance
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4. SECURITIES: (Stocks, Bonds, Mutual Funds, Certificates of Deposit, etc.)
Company
Title (H, W, J)
Date of Acquisition
Cost
Market Value Debt Owed Against
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

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