Fill and Sign the Domestic Relations Civil Forms Supreme Court Approved

DOMESTIC RELATIONS CIVIL FORMS Supreme Court Approved 4A-131October 29, 2001 [NEW MATERIAL] 4A-131 [1-123] STATE OF NEW MEXICO COUNTY OF ___________________________ ___________________ JUDICIAL DISTRICT _________________________________________, Petitioner, v. No. ________________ _________________________________________, Respondent. [PETITIONER] [AND] [RESPONDENT]'S COMMUNITY PROPERTY AND LIABILITIES SCHEDULE Neither party is required to submit a proposed distributi on. Any stipulation regarding value or distribution should be indicated by an asterisk. ASSETS Value Husband Wife Combined DOMESTIC RELATIONS CIVIL FORMS Supreme Court Approved 4A-131October 29, 2001 [NEW MATERIAL] 1. Cash $_________ $_________ $_________ 2. Financial institution accounts: 1 a. __________ Account # _________ $_________ $_________ $_________ b. __________ Account # _________ $_________ $_________ $_________ c. __________ Account # _________ $_________ $_________ $_________ d. __________ Account # _________ $_________ $_________ $_________ 3. Stocks, bonds and mutual funds: a. ____________ Sh.___________ $_________ $_________ $_________ b. ____________ Sh.___________ $_________ $_________ $_________ c. ____________ Sh.___________ $_________ $_________ $_________ 4. Insurance policies: a. Company _________________ [Face amount $____________] DOMESTIC RELATIONS CIVIL FORMS Supreme Court Approved 4A-131October 29, 2001 [NEW MATERIAL] 3 Cash value $___________ $_________ $_________ Loan balance $ __________ $___________ $_________ $_________ b. Company _______________ [Face amount $_________] Cash value $___________ $_________ $_________ Loan balance $ __________ $___________ $_________ $_________ 5. Real estate: a. ___________ $________ Mortgage ($/mo) $________ REC ($/mo) $________ Cost of sale ($/%) $________ $________ $__________ $________ b. ___________ $________ Mortgage ($/mo) $________ REC ($/mo) $________ Cost of sale DOMESTIC RELATIONS CIVIL FORMS Supreme Court Approved 4A-131October 29, 2001 [NEW MATERIAL] 4 ($/%) $________ $________ $_________ $________ 6. Vehicles: a. ___________ $________ Lien ($/mo) $________ $________ $_________ $________ b. ___________ $________ Lien ($/mo) $________ $________ $_________ $________ 7. Business assets $________ $_________ $________ 8. Household furniture and goods $________ $_________ $________ 9. Tax refunds $________ $________ $________ 10. IRA/Keogh/Annuity $________ $_________ $________ DOMESTIC RELATIONS CIVIL FORMS Supreme Court Approved 4A-131October 29, 2001 [NEW MATERIAL] 5 11. Retirement $________ $_________ $________ 12. Retirement $________ $_________ $________ 13. Other total assets $________ $_________ $________ Total assets $_________ $_________ $________ LIABILITIES (Mo/Pmt) Value: Husband: Wife: 1. ____________ $(_____) $________ $________ $________ 2. ____________ $(_____) $________ $________ $________ 3. ____________ $(_____) $________ $________ $________ 4. ____________ $(_____) $________ $________ $________ 5. Tax Liability $(_____) $________ $________ $________ Total liabilities: $(_____) $________ $________ $________ DOMESTIC RELATIONS CIVIL FORMS Supreme Court Approved 4A-131October 29, 2001 [NEW MATERIAL] 6 ESTIMATED NET ASSETS: $________ $________ $________ Equalization of Assets: $________ $________ $________ EQUAL ASSETS: $________ $________ $________ I have read the foregoing and the amounts are true and correct. I understand that if I make a material misstatement of fact, I may be p rosecuted and punished for perjury. ________________________________________ Signature _____________________________________ __ Name (print) _____________________________________ __ Address (print) DOMESTIC RELATIONS CIVIL FORMS Supreme Court Approved 4A-131October 29, 2001 [NEW MATERIAL] 7 _____________________________________ __ City, state and zip code (print) _____________________________________ __ Telephone number NOTARY PUBLIC Signed and sworn to before me this _____ day of ______ ____________, ______. My commission expires: ____________________________. USE NOTE 1. Include all checking, savings and money market acco unts and certificates of deposit. [Approved, effective November 1, 2000 until November 1, 200 1; approved, effective November 1, 2001.]