Fill and Sign the Final Declaration Disclosure Form

Petitioner's Final Disclosure Statement - 11 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28                         Attorney for Petitioner MONTANA       JUDICIAL DISTRICT COURT,       COUNTY IN RE THE MARRIAGE OF: Cause No.             Petitioner And       PETITIONER’S FINAL Respondent DISCLOSURE * * * * * * * * * * * * * * * * * * * * STATEMENT 1. Petitioner's Final Asset Disclosure Exhibit attached sets forth the identity of all assets in which Petitioner has or may have an interest regardless of the characterization of the asset. These assets include, but are not limited to, any real or personal property of any nature, however and whenever acquired, whether the property is tangible or intangible, whether the property is currently existing or contingent, and whether the title is in the name of husband or wife or both. Petitioner's percentage of ownership in each asset is set forth in Exhibit A when property is not solely owned by one or both of the parties. This Exhibit includes all material facts regarding: a. The characterization of all assets, and b. Valuation of all assets that are contended to be marital. Petitioner's Final Disclosure Statement - 21 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2. Petitioner's Final Liability Disclosure Exhibit attached sets forth the identity of all abilities for which Petitioner may be liable, regardless of the characterization of the liability. These liabilities include, but are not limited to, any debt or obligation, however and whenever acquired, whether the debt or obligation is currently existing or contingent or is in the name of the husband or wife or both. This Exhibit includes all material facts regarding: a. The characterization of all liabilities, and b. Amounts of all obligations that are contended to be marital obligations or for which it is contended that the marital estate has liability. 3. Petitioner's Final Income Declaration Exhibit attached sets forth the income of Petitioner. Petitioner's income includes earnings and accumulations from any source. 4. Petitioner's Final Personal Living Expense Disclosure Exhibit attached sets forth the personal living expenses of Petitioner. 5. SUMMARY INFORMATION FROM ATTACHED EXHIBITS: NET WORTH: $       TOTAL MARITAL ASSETS $       TOTAL MARITAL LIABILITIES $       NET WORTH TO BE DIVIDED $       MONTHLY INCOME AND EXPENSE: $       TOTAL AVERAGE MONTHLY INCOME $       TOTAL AVERAGE MONTHLY EXPENSE $       DATED:       , 20       . ________________________________________ Printed Name:       Attorney for Petitioner Petitioner's Final Disclosure Statement - 31 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 STATE OF MONTANA ) )ss. County of       ) Petitioner, _______________________ , being first duly sworn, states under penalty of perjury that the facts and matters contained in this Final Disclosure Statement are true, accurate, and complete to the best of my knowledge. I understand that the failure of a party to disclose an asset or liability in this document and attached exhibits is presumed to be grounds for the court, without taking into account the equitable division of the marital estate, to award the undisclosed asset to the opposing party or the undisclosed liability to the noncomplying party. I understand that in addition to any other civil or criminal remedy available under law for perjury, the court may set aside the judgment, or part of the judgment, if the court discovers, within 5 years from the date of entry of judgment, that a party has committed perjury in a Final Declaration of Disclosure. CERTIFICATE OF MAILING I certify that a copy of Petitioner's Final Disclosure Statement was served on the following by mailing a correct copy on       , 20 , postage prepaid and addressed as follows:                   __________________________________, Petitioner Petitioner's Final Disclosure Statement - 41 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 SUBSCRIBED AND SWORN to before me on this day of       , . NOTARY PUBLIC for the State of Montana Residing at       Montana My commission expires on       Petitioner's Final Disclosure Statement - 51 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PETITIONER'S FINAL ASSET DISCLOSURE EXHIBIT Item Market Value Title Characterization Checking Accounts:       $                         $                   Savings Accounts:       $                         $                   Cash on Hand;       $                         $                   Stocks, Bonds & CDs:       $                         $                         $                   Real Estate:       $                         $                   Automobiles:       $                         $                   RVs:       $                   Retirement Accounts:       $                   Cash Value Life Insurance:       $                         $                         $                         $                   Petitioner's Final Disclosure Statement - 61 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PETITIONER'S FINAL ASSET DISCLOSURE EXHIBIT (con't) Business Fixtures, Equipment and Goodwill:       $                         $                         $                         $                         $                         $                         $                   Household:       $                         $                         $                         $                         $                         $                         $                         $                         $                         $                   PROPERTY TOTAL $       Petitioner's Final Disclosure Statement - 71 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PETITIONER'S FINAL LIABILITY DISCLOSURE EXHIBIT Creditor Current Balance Who Incurred What For Monthly Payment Debt Secured by Real Estate:       $                   $       Other Secured Debt:       $                   $             $                   $             $                   $       Credit Cards:       $                   $             $                   $             $                   $             $                   $       Other Unsecured Debt:       $                   $             $                   $             $                   $             $                   $             $                   $             $                   $             $                   $       LIABILITY TOTAL $       Petitioner's Final Disclosure Statement - 81 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PETITIONER'S FINAL INCOME DECLARATION EXHIBIT Description Average Monthly Amount Income from Wages: Salary, commissions and bonuses $       Self Employment income $       Pensions, social security $       Capital Gains Income $       Interest $       Earned Income Credit $       Other Taxable Income $       Other Non-taxable Income $       Income from Public Assistance: TANF $       Foodstamps $       SSI $       Other public assistance $       Value of Employment Fringe Benefits: Company $       Free or reduced rent/housing $       Food $       Utilities $       Vehicle expense reimbursements $       TOTAL GROSS AVERAGE MONTHLY INCOME $       Mandatory Deductions from Income: Court Ordered Child Support $       Court Ordered Maintenance $       Petitioner's Final Disclosure Statement - 91 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Court Ordered Health Insurance for Children $       Federal Income Tax $       State Income Tax $       Social Security $       Retirement Contributions $       Required Employment Expense $       Old Fund Liability Tax $       Dependent Care Expense for children not of this marriage $       Other mandatory deductions from income $       TOTAL MANDATORY DEDUCTIONS FROM INCOME $       NET AVERAGE MONTHLY INCOME $       PETITIONER'S FINAL PERSONAL LIVING EXPENSES DISCLOSURE EXHIBIT Description Average Monthly Amount Housing Rent $       Mortgage $       Maintenance $       Utilities Heat $       Electricity $       Telephone $       Cable TV $       Water $       Petitioner's Final Disclosure Statement - 101 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Food Groceries $       Dining $       Transportation Gas/oil $       Maintenance $       Registration $       Car Payment/lease $       Clothing Purchases $       Laundry/dry cleaning $       Insurance Life $       Health $       Disability $       Auto $       Unreimbursed Medical Expenses Self $       Children for whom support calculated $       Other Expenses Entertainment $       TOTAL PERSONAL LIVING EXPENSES $       (including children's expenses)