Fill and Sign the Montana Disclosure Form

___________________________ Name ___________________________ Mailing Address ___________________________ City, State Zip Code ___________________________ Phone Number ___________________________ E-mail Address (optional) Petitioner Respondent Co Petitioner☐ ☐ ☐ Appearing without a lawyer MONTANA ____________JUDICIAL DISTRICT COURT, _______________ COUNTY In re the Marriage of: _________________________________, ☐ Petitioner, and _________________________________, ☐ Respondent ☐ Co Petitioner . Case No: _________________________ ☐ Petitioner ☐ Respondent ☐ Co-Petitioner ☐ Amended Disclosure of Income and Expenses Warning: Montana law, §40-4-252, M.C.A. requires the full disclosure of all assets, debts, income, and expenses. I understand that I am required to tell my spouse about all of the assets, debts, income and expenses that I know about. My spouse is required to do the same for me. This Disclosure of Income and Expenses along with Form MP-500 Proposed Property Distribution has been served on my spouse. If I don’t tell my spouse about something, the court may give me a penalty. The court gets to decide what the penalty will be. I am providing all of the information I know about the income and expenses listed on this form and writing “unknown” in the spaces for the information I don’t know. NOTE: This Document is served on the other party only and cannot be filed with the Court unless the Court specifically orders you to file it. The following is being served as required by §§ 40-4-252 through 254, M.C.A. MP-510 Income and Expense Disclosure © 2015 Montana Supreme Court and Montana Legal Services Association Page 1 of 4 1. Disclosure of Income Source of Income Amount per Month Gross Wages, Salary, Commissions Petitioner Respondent Income from Rents, Interest, Dividends Petitioner Respondent Self Employment Earnings Petitioner Respondent Unemployment or Worker’s Compensation Petitioner Respondent Social Security Benefits, including SSI, SSDI Petitioner Respondent Public Assistance (including TANF and LIEAP) Petitioner Respondent Food Stamps Petitioner Respondent Pension, Retirement Petitioner Respondent Child Support Petitioner Respondent Dependent’s Benefits Petitioner Respondent MP-510 Income and Expense Disclosure © 2015 Montana Supreme Court and Montana Legal Services Association Page 2 of 4 Other Income ( describe ): Petitioner Respondent Monthly Total Petitioner Respondent ( If you have additional income, complete and staple Form MP-510-A to this document.) 2. Disclosure of Expenses Description of Expense Amount per Month Taxes and withholdings Petitioner Respondent Retirement Contribution Petitioner Respondent Health Insurance (self and children) Petitioner Respondent Medical Expenses Petitioner Respondent Rent or Housing (including property taxes and insurance relating to housing) Petitioner Respondent Transportation Petitioner Respondent Car Insurance Petitioner Respondent Student Loans Petitioner Respondent Utilities Petitioner Respondent Telephone (cell phone and land line) Petitioner MP-510 Income and Expense Disclosure © 2015 Montana Supreme Court and Montana Legal Services Association Page 3 of 4 Respondent Clothing Petitioner Respondent Food and Household Supplies Petitioner Respondent Child Care Petitioner Respondent Union Dues Petitioner Respondent Child Support Payments Petitioner Respondent Other: (describe) Petitioner Respondent Monthly Total Petitioner Respondent ( If you have additional expenses, complete and staple Form MP-510-B to this document.) I declare under penalty of perjury and under the laws of the state of Montana that the information in this document is true and correct. I understand that it is a crime to give false information in this document. Dated this __________day of ___________________, 20__. City ____________________ State ______ Sign Here: ______________________________ Print Name: ______________________________ ☐ Petitioner ☐ Respondent ☐ Co-Petitioner MP-510 Income and Expense Disclosure © 2015 Montana Supreme Court and Montana Legal Services Association Page 4 of 4