Fill and Sign the Kentucky Self Help Divorce Packet with Children Form

IN RE THE MARRIAGE OF: ________________________________________ PETITIONER and _____ ___________________________________ RESPONDENT All sections must be completed. If an amount is unknown, write “unknown”, if the question is inapplicable, write “N/A”. If a question requires further documentation or an additional schedule, please attach. If maintenance is an issue or there are property distribution issues, please proceed to use the full Mandatory Case Disclosure Form. I, ________________________________________, declare under oath that my personal information is: Name: ______________________________________________________ Address: ____________________________________________________ ____________________________________________________ ____________________________________________________ Age/Place birth: _______________________________________________ Date/Place marriage: __________________________________________ Spouse’s name: ______________________________________________ Spouse’s age: ________________________________________________ I am currently employed at: ______________________________________ I earn _________________ per ________________ (weekly, monthly, etc.) ****** My total gross monthly income (from all sources) is _______________ OTHE R LEGAL ACTIONS Please give the style, the case number, and the name of the Court or administrative agency for any case you are a party in or have been within the last year as well as a brief description of the nature of the case and present status. ______________________________________________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________ REQ UIRED ATTACHMENTS “A” = to indicate that the requested document/information is attached “U” = to indicate that the requested document/information is unavailable (Provide explanation on a separate page) “N/A” = if not applicable I have provided a copy of the following documents to opposing party or opposing counsel: ____ 1. My three (3) most recent pay stubs ____ 2. A full and complete copy of my last Federal Tax Return ____ 3. First page of my last State Tax Return ACKNOWLEDGMENT OF q PRELIMINARY q FINAL VERIFIED DISCLOSURE STATEMENT* lex et justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE Case No. ____________________ Court ____________________ County ____________________ Division ____________________ q AOC-238.3 Doc. Code: ACKPDS q AOC-239.3 Doc. Code: ACKFDS Rev. 1-15 Page 1 of 2 Commonwealth of Kentucky Court of Justice www.courts.ky.gov FCRPP 2 and FCRPP 3 q AOC-238.3 Doc. Code q AOC 239.3 Doc. Code Rev- 1-15 Disclosure of _____________________________________ Page 2 of 2 Case No. _________________________________________ I hereby acknowledge that the information contained in _____________________________’s Veri�ed Disclosure Statement is a true and accurate re�ection of the �nancial disputes in this matter and that there are no additional assets, debts or issues which require disclosure to the best of my knowledge and belief. Further, I hereby certify that the foregoing information is true to the best of my knowledge, information and belief. ____________________________________________ q Petitioner q Respondent {check one } STATE OF ____________________________ ) ) SS COUNTY OF ____________________________ ) Subscri bed and sworn before me by ____________________________ , this _____ day of _________________, ________. My commission expires: ______________________ ___ ___________________________________ NOTARY PUBLIC/TITLE When this form is utilized in lieu of the AOC-238, Preliminary Veri�ed Disclosure Statement, unless otherwise ordered by the Court or required by Local Rule, this form is NOT to be �led with the Court. FCRPP 2(3). However, the entire form and all attachments are to be exchanged between the parties within 45 days of service of the petition on the respondent, and objections thereto shall be exchanged within 20 days thereafter. When this form is utilized in lieu of the AOC-239, Final Veri�ed Disclosure Statement, or AOC-239.2, Af�davit of No Change in Circumstances, pursuant to FCRPP 3(3), this form is to be �led with the Court no later than 5 days prior to the trial if property matters are in dispute at that trial. A copy of this Acknowledgment shall also be provided to the opposing party 15 days prior to trial unless otherwise ordered by the Court. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a copy of this Acknowledgment Of Veri�ed Disclosure Statement (with schedules and attachments) was served by q mail, postage prepaid, or q hand-delivery, or q electronic means, in accordance with Kentucky Rule of Civil Procedure (CR) 5.02, on ( name) ___________________________________________________ at ( address ) _____________________________________________________________________________________, this the _______ day of ________________________, _________. __ __________________________________________ Signature q Attorney for Petitioner q Attorney for Respondent q Petitioner q Respondent Address : ____________________________________________ ____________________________________________ ____________________________________________ Phone: ( ) ________________________________ Fax: ( ) _________________________________ Email: _____________________________________ *NOTE