Financial Declaration Form Page 3
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5Other Debts and Obligations not payable in monthly installments
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Creditor
For
Date Payable
Balance
Owed by
Are you currently in Bankruptcy?
YES
NO
Are any obligations listed above, including mortgage and note payments, in arrears?
YES
NO
If yes, please list the obligations in arrears.
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
All Marital Property Known to Parties
Assets
Husband/Father
Wife/Mother
Joint
Cash and Money in Checking Account(s)
Money in Savings Account(s), Credit Union, Money Market,
or Cert. of Dep.
Value of Voluntary Retirement Account(s)
Value of Pension Account
Value of Publicly Held Stocks, Bonds, Securities, Mutual
Funds
Value of Privately Held Stocks and Other Business
Value of Real Estate – Net of Mortgage Balances
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Value of All Other Property
TOTAL ASSETS
Any Non Marital Property Known to Parties
Description of Asset
Title Owner
Date of
Source of Funds to
Estimate Present market
Acquisition
Acquirer
Value
If total assets are less than $300,000.00, sign and have notarized.
If total assets are greater than $300,000.00, itemize assets by completing additional sections below and
sign and have notarized.
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Financial Accounts Section
Owner
Name of Institution
Type of Account
Balance
SCCA 430 (12/2009)
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