Fill and Sign the Ancillary Financial Report Delaware Family Court Legal Forms

Form 465Rev 09/2018 The Family Court of the State of Delaware In and For New Castle County Kent County Sussex County ANCILLARY FINANCIAL DISCLOSURE REPORT PROPERTY DIVISION, ALIMONY, COUNSEL FEES Petitioner v. Respondent NOTE: If additional space is needed for a response, continue the response on the last page of this form. A. List names and dates of birth of minor children of the parties. Indicated with whom the child primarily resides by selecting (P) for Petitioner (R) for Respondent (S) for Shared. Petitioner v.RespondentB. List names and dates of birth of adult children of the parties. Indicate if the child is enrolled in school.Petitioner v.RespondentDATE OF MARRIAGE/CIVIL UNION: CASE NAME: DATE OF SEPARATION: FILE NUMBER: DATE OF DIVORCE: PETITION NUMBER: NameName Street Address (including Apt)Street Address (including Apt) P.O. Box NumberP.O. Box Number City/State/Zip CodeCity/State/Zip Code PhoneDate of BirthPhoneDate of Birth Employer Name Work PhoneEmployer Name Work Phone Employer Street AddressEmployer Street Address City/State/Zip CodeCity/State/Zip Code Years Employed Position or OccupationYears Employed Position or Occupation Current Annual IncomeCurrent Annual Income$ $ AttorneyAttorney Child’s Name (Minor): Resides With: Child’s Name (Minor): Resides With: (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) (P) (R) (S) Child’s Name (Adult): Enrolled in School? Child’s Name (Adult): Enrolled in School? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Form 465Rev 09/2018 C. List your employment history for the past five years. Start with your most recent employer.For each employer include: Name and Address Dates of Employment Ending Annual Income (annual income at the time of departure) Reason for Leaving (reason employment ended) Petitioner Dates of Employment Employer Name & Address StartEnd Ending Annual Income Reason for Leaving Respondent Dates of Employment Employer Name & Address StartEnd Ending Annual Income Reason for Leaving D. Do you have health/dental insurance benefiting you, your spouse and/or children of this marriage?If so, please state the name of your insurance company, the group and member numbers and cost: Petitioner RespondentE.Does your employer offer a qualified and/or non-qualified pension plan?Are you a participant in any pension and/or retirement plan at your current place of employment?Were you a participant in any other pension and/or retirement plan(s) through previous employment?F. Do you have any other deductions from your pay (not including taxes), such as union dues, mandatory pension deductions, or other?If so, please identify the deduction and monthly cost:Petitioner Respondent Petitioner: Yes No Respondent: Yes No Insurance Company Name: Insurance Company Name: Group Number: Member Number: Group Number: Member Number: Monthly Cost:$ Who is Covered: Monthly Cost:$ Who is Covered: Petitioner: Yes No Respondent: Yes No Petitioner: Yes No Respondent: Yes No Petitioner: Yes No Respondent: Yes No Petitioner: Yes No Respondent: Yes No DeductionMonthly CostDeductionMonthly Cost $ $ $ $ $ $ $ $ Form 465Rev 09/2018G. Do you participate in or own any life insurance on your life?If so, please state the following:Petitioner RespondentName of Plan (1): Name of Plan (1): Policy Number: Policy Number: Type: Whole Life Term Life Employer Type: Whole Life Term Life EmployerBeneficiary(ies): Beneficiary(ies): Face Value:$ Face Value:$ Cash Surrender Value:$ Cash Surrender Value:$ Monthly Cost:$ Monthly Cost:$ Basis for Non-Marital Claim: Basis for Non-Marital Claim: Name of Plan (2): Name of Plan (2): Policy Number: Policy Number: Type:* Type:* Beneficiary(ies): Beneficiary(ies): Face Value:$ Face Value:$ Cash Surrender Value:$ Cash Surrender Value:$ Monthly Cost:$ Monthly Cost:$ Basis for Non-Marital Claim: Basis for Non-Marital Claim: H. Do you claim any inability to pay support due to ill health, disability or extraordinary expenses which results in dependency upon the other party for support and/or impairment of earning capacity?If yes, please provide below and the name and address of all treating physicians and state the nature of the disability:Petitioner RespondentNature of Disability (1): Nature of Disability (1): Treating Physician Treating Physician Street AddressCity/State/Zip Code Street AddressCity/State/Zip Code Telephone Number Telephone Number Nature of Disability (2): Nature of Disability (2): Treating Physician Treating Physician Street AddressCity/State/Zip Code Street AddressCity/State/Zip Code Telephone Number Telephone Number I. Are you receiving any income from benefits such as Social Security retirement, Social Security Disability (SSDI), VA benefits, federal pension (CSRS or FERS), private disability or military pension?If so, please indicate from where you receive the benefit(s) and the monthly amount:Petitioner RespondentJ.During the last five (5) years, have you given, transferred, or entrusted your property (including cash) in excess of $1000.00 in the aggregate to anyone other than a party to this proceeding?If so, please name the recipient of each item and describe the item and its value:Petitioner Respondent Petitioner: Yes No Respondent: Yes No Petitioner: Yes No Respondent: Yes No BenefitMonthly CostBenefitMonthly Cost $ $ $ $ $ $ $ $ Petitioner: Yes No Respondent: Yes No Property TransferredEntrusted Recipient(s)ValueProperty TransferredEntrusted Recipient(s)Value $ $ Form 465Rev 09/2018 INCOME INFORMATION K. List annual gross income from all sources for the last 3 years, including estimated gross income for current year:Petitioner Respondent3 Years Ago$ 3 Years Ago$ 2 Years Ago$ 2 Years Ago$ 1 Year Ago$ 1 Year Ago$ Current$ Current$ ASSETS OF THE PARTIES “Assets” include all assets (property) of any kind, including real estate, and tangible and intangible personal property (such as bank accounts, stocks, bonds, etc.). Unless you explain otherwise, it will be presumed that you are the sole legal owner of any asset(s) identified in your answers. If you are not the sole legal owner, please explain the nature and extent of your ownership, including the name of all co-owners. If the space provided is insufficient, please attach additional pages, indicating whether the attachment is supplied by Petitioner or Respondent.All property will be considered marital and subject to division unless a party indicates to the contrary. Such an indication must be made by listing one of the following reasons for claiming the property is non-marital under the “Basis for Non-Marital Claim” category:1. Pre marital Property owned by a party before marriage/civil union). 2. Agre ement Property excluded by agreement of the parties.3. Post -Separation Property acquired after separation.4. Exch ange Property acquired in exchange for premarital/pre- union property. 5. Increase The increase in value of property acquired before marriage/civil union.6. Gift Property acquired by gift from a third person7. Inheritanc eProperty acquired by inheritance $ $ Form 465Rev 09/2018 REAL PROPERTY L. Interests in Real Estate:Street Address /City, State ZIP In Whose NameMarket Value Mortgage Balance Source of Funds for Purchase Petitioner Respondent $ $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent $ $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent $ $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent $ $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: MOTOR VEHICLES M. Automobiles, trailers, motorcycles, and other vehicles:Make, Model, YearIn Whose NameValue*Balance on LoanWho Drives? Petitioner Respondent Petitioner: $ Respondent: $ $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent Petitioner: $ Respondent: $ $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent Petitioner: $ Respondent: $ $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: * NOTE: The Court generally uses the current retail NADA book value for automobiles. Form 465Rev 09/2018 BANK ACCOUNTS N. Checking accounts, savings accounts, certificates of deposit:Name and Address of InstitutionAccount NumberPresent ValueIn Whose Name Petitioner: $ Respondent: $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner: $ Respondent: $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner: $ Respondent: $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner: $ Respondent: $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner: $ Respondent: $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner: $ Respondent: $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner: $ Respondent: $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner: $ Respondent: $ Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: RETIREMENT PLAN(S) O. Profit sharing plans and/or retirement plans (other than your pension) such as an IRA: Name of PlanIn Whose NameValue of Plan / Date of Value Does the Non-Contributor claim a share of Post-Separation Contributions? Petitioner Respondent $ / Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent $ / Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent $ / Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent $ / Petitioner Respondent Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent $ / Petitioner Respondent Basis for Non-Marital Claim Petitioner: Form 465Rev 09/2018 Name of PlanIn Whose NameValue of Plan / Date of Value Does the Non-Contributor claim a share of Post-Separation Contributions?Respondent: INVESTMENTS P. Stocks, mutual funds, securities, bonds and options:CorporationSharesClassIn Whose NameDate AcquiredMarket Value Petitioner Respondent $ Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent $ Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent $ Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent $ Petitioner: Basis for Non-Marital Claim Respondent: Petitioner Respondent $ Petitioner: Basis for Non-Marital Claim Respondent: ANNUITIES Q. AnnuitiesName & Address of CompanyAmount of PaymentDate of First PaymentDuration of Payments Beneficiary(ies) Upon DeathIn Whose Name $ Petitioner Respondent Petitioner: Basis for Non-Marital ClaimRespondent: $ Petitioner Respondent Petitioner: Basis for Non-Marital ClaimRespondent: $ Petitioner Respondent Petitioner: Basis for Non-Marital ClaimRespondent: $ Petitioner Respondent Petitioner: Basis for Non-Marital ClaimRespondent: $ Petitioner Respondent Petitioner: Basis for Non-Marital ClaimRespondent: Form 465Rev 09/2018 BUSINESSES R. If you have any interest in any business, please state:Petitioner Respondent HOUSEHOLD FURNISHINGS AND BELONGINGS If the parties do not agree how to divide their household furnishings and belongings, the Court generally divides them by the “two-list” method. One party prepares two lists dividing all of the marital furnishings and belongings. The other party chooses which of the two lists of household furnishings and belongings he or she will keep. The party who prepared the two lists will keep the household furnishings and belongings listed on the remaining list.The household furnishings and belongings:Have been divided.Petitioner Yes No Respondent Yes No Will be divided by the “two list” method.Petitioner Yes No Respondent Yes No OTHER ASSETS S. Other Assets:AssetIn Whose NameValue Petitioner Respondent $ Petitioner Respondent $ Petitioner Respondent $ Petitioner Respondent $ Petitioner Respondent $ Petitioner Respondent $ Petitioner Respondent $ Petitioner Respondent $ Name of Business Name of Business Street Address Street Address City/State/Zip Code City/State/Zip Code Percentage of Interest of Business Years of Operation Percentage of Interest of Business Years of Operation Name of Accountant Name of Accountant Street Address Street Address City/State/Zip Code City/State/Zip Code Basis for Claim that Property is Non-Marital Basis for Claim that Property is Non-Marital Are there any Buy/Sell Agreements? Yes No Are there any Buy/Sell Agreements? Yes No Form 465Rev 09/2018 DEBTS OF THE PARTIES T. Please complete the chart below regarding ALL of the debts incurred during the marriage/civil union:NOTE: Enter information for Petitioner next to ‘P’, and for Respondent next to ‘R’. Write the name of the creditor (the institution, company person, etc.) to whom money is owedWrite the name of the person responsible to the creditor Write the general purpose of the debt incurred (why was the money borrowed?) Write the date the debt was incurred Write the amount of money owed on the date of separationWrite the amount of money owed on the date of divorce If you want credit for the money you paid after the date of separation, write amount1. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 2. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 3. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 4. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 5. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 6. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 7. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 8. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 9. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 10. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 11. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 12. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 13. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 14. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 15. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 16. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 17. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 18. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 19. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ 20. ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ ‘P’ $ ‘R’ $ Form 465Rev 09/2018 PETITIONER’S EXPENSE INFORMATION U. List monthly expenses (1/12 of actual payments made during the preceding twelve (12) months) and estimated monthly expenses for the next year, including any expenses that have recently changed or are expected to change in the near future.Item Current Expense Estimated ExpenseRent $ .00 $ .00 Mortgage (taxes, insurance and escrow) $ .00 $ .00 Water $ .00 $ .00 Sewer $ .00 $ .00 Electric $ .00 $ .00 Gas $ .00 $ .00 Oil $ .00 $ .00 Garbage $ .00 $ .00 Cable Television $ .00 $ .00 Telephone $ .00 $ .00 Household items $ .00 $ .00 Household maintenance and repairs (list) Item: $ .00 $ .00Item: $ .00 $ .00 Groceries $ .00 $ .00 Clothing $ .00 $ .00 Health Insurance (COBRA) $ .00 $ .00 Out-of-pocket medical and dental expenses for self $ .00 $ .00 Medical and dental expenses for children $ .00 $ .00 Work-related child care $ .00 $ .00 School tuition for children of the parties $ .00 $ .00 School tuition for other children $ .00 $ .00 Laundry and dry cleaning $ .00 $ .00 Toys and presents $ .00 $ .00 Cosmetics and toiletries $ .00 $ .00 Hobbies $ .00 $ .00 Barber and Hairdresser $ .00 $ .00 Newspaper, magazine subscriptions $ .00 $ .00 Charitable and/or religious donations $ .00 $ .00 Vacation $ .00 $ .00 Entertainment and miscellaneous $ .00 $ .00 Transportation (other than auto) $ .00 $ .00 Automobile Monthly Payment: $ .00 $ .00Repairs and Maintenance: $ .00 $ .00Insurance: $ .00 $ .00Gasoline $ .00 $ .00 Life Insurance $ .00 $ .00 Other: Item: $ .00 $ .00Item: $ .00 $ .00Item: $ .00 $ .00Item: $ .00 $ .00Item: $ .00 $ .00Item: $ .00 $ .00Item: $ .00 $ .00Item: $ .00 $ .00 TOTAL $ .00 $ .00 Form 465Rev 09/2018 RESPONDENT’S EXPENSE INFORMATION V. List monthly expenses (1/12 of actual payments made during the preceding twelve (12) months) and estimated monthly expenses for the next year, including any expenses that have recently changed or are expected to change in the near future.Item Current Expense Estimated ExpenseRent $ .00 $ .00 Mortgage (taxes, insurance and escrow) $ .00 $ .00 Water $ .00 $ .00 Sewer $ .00 $ .00 Electric $ .00 $ .00 Gas $ .00 $ .00 Oil $ .00 $ .00 Garbage $ .00 $ .00 Cable Television $ .00 $ .00 Telephone $ .00 $ .00 Household items $ .00 $ .00 Household maintenance and repairs (list) Item: $ .00 $ .00Item: $ .00 $ .00 Groceries $ .00 $ .00 Clothing $ .00 $ .00 Health Insurance (COBRA) $ .00 $ .00 Out-of-pocket medical and dental expenses for self $ .00 $ .00 Medical and dental expenses for children $ .00 $ .00 Work-related child care $ .00 $ .00 School tuition for children of the parties $ .00 $ .00 School tuition for other children $ .00 $ .00 Laundry and dry cleaning $ .00 $ .00 Toys and presents $ .00 $ .00 Cosmetics and toiletries $ .00 $ .00 Hobbies $ .00 $ .00 Barber and Hairdresser $ .00 $ .00 Newspaper, magazine subscriptions $ .00 $ .00 Charitable and/or religious donations $ .00 $ .00 Vacation $ .00 $ .00 Entertainment and miscellaneous $ .00 $ .00 Transportation (other than auto) $ .00 $ .00 Automobile Monthly Payment: $ .00 $ .00Repairs and Maintenance: $ .00 $ .00Insurance: $ .00 $ .00Gasoline $ .00 $ .00 Life Insurance $ .00 $ .00 Other: Item: $ .00 $ .00Item: $ .00 $ .00Item: $ .00 $ .00Item: $ .00 $ .00Item: $ .00 $ .00Item: $ .00 $ .00Item: $ .00 $ .00Item: $ .00 $ .00 TOTAL $ .00 $ .00 Form 465Rev 09/2018 PetitionerSTATE OF Delaware : : SS. COUNTY OF :BE IT REMEMBERED that on this day of , appeared before me, a Notary Public for the State and County aforesaid, , who being by me duly sworn according to law, did depose (Name of Petitioner)and say that the foregoing answers are true and correct to the best of his/her knowledge and belief. (Petitioner’s Signature) NOTARY PUBLIC OR CLERK OF COURT COUNSEL FOR PETITIONER, IF ANY DATE RespondentSTATE OF Delaware : : SS. COUNTY OF :BE IT REMEMBERED that on this day of , appeared before me, a Notary Public for the State and County aforesaid, , who being by me duly sworn according to law, did depose (Name of Respondent)and say that the foregoing answers are true and correct to the best of his/her knowledge and belief. (Respondent’s Signature) NOTARY PUBLIC OR CLERK OF COURT COUNSEL FOR RESPONDENT, IF ANY DATE Form 465Rev 09/2018 The Family Court of the State of Delaware In and For New Castle Kent Sussex County Petitioner Respondent Name Name File Number Street Address (include apartment) Street Address (include apartment) P.O. Box Number P.O. Box Number Petition Number City/State/Zip City/State/Zip Attorney Name Attorney Name Type of Filing Attorne A AFFIDAVIT OF MAILING A proceeding involving the above-captioned case having been previously filed in this court, I, the:Petitioner/MovantAttorney for Petitioner/Movant(Check ONE)Respondent/MovantAttorney for Respondent/Movantaffirm that a true and correct copy of this: (Check ONE and complete as appropriate.) Answer to Petition Ancillary Financial Disclosure Report Motion or Response to Motion (Type of Motion) Other: (Other type of document mailed to opposing party/attorney) was placed in the U.S. Mail on this date, , and sent first classpostage pre-paid to the: (Check ONE and complete as appropriate.) Opposing party at the address listed aboveAttorney for opposing party at the address listed below SWORN TO AND SUBSCRIBED before me this date, . Party/Movant/Attorney Notary Public or Clerk of CourtForm 850 Rev 01/18) Form 465Rev 09/2018Additional Information If additional space is needed for any of the above items, list the item number/title and the information requested under that title.Petitioner Item Number/TitleAdditional Information RespondentItem Number/TitleAdditional Information