Asset And Debt Statement Page 3
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10.
PROPERTY HELD IN TRUST FOR OR BY THIRD PERSON/S: (Aside from Bank &
Savings Accounts Noted in paragraph 3)
Descriptions
Trustee/s
Beneficiaries
Value
Debt Owed Against
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
11.
ALL OUTSTANDING DEBTS: (Include those listed parts in 2, 4, 5, 6, 7, 9, and 10 above,
in addition to all credit cards, charges, finance companies, and personal loans.)
Debtor
Mo./Yr.
Total
Minimum Monthly
Creditor
(H, W, J or Other)
Security
Debt Incurred
Balance Owed
Payment
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Total Debt in Wife’s Name Alone: __________________________________________________
Total Debt in Husband’s Name Alone: _______________________________________________
Total Debt in Joint Names: ________________________________________________________
CERTIFICATION
I hereby declare under the penalty of perjury that I have supplied the information used in this Asset and
Debt Statement and have reviewed this statement and I certify that the information is accurate, complete
and correct.
DATE
PLAINTIFF’S
DEFENDANT’S SIGNATURE
DATE
PLAINTIFF’S
DEFENDANT’S SIGNATURE
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