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Date: Assets and debts in the marriage of: 1. The family home:
Type Address or location Date purchased Price Current Valuea) b) c) d) Amount & source Balance owed Title in name Amount of + or - of down payment on property of H/W/other cash flow per montha) b) c) d) 3. Automobiles Registered to Year Make & model Amount owed Approx Miles Valuea) b) c) d) 4. Personal property: Identify items of special monetary or sentimental value, then lump the rest into general categories such as furniture, appliances, tools, garden equipment, hobby equipment, books, records, sports equipment, paintings, et cetera.
Description Value Amt owing Whose is it? (H/W/H&W/other)a) b) c) d) e) f) g) h) i) j) k) l) m) n) 5. Cash accounts (Checking, saving, credit union, money market, T-bills, certificates of deposit):
In name of Where held & Balance at Balance Maturity Who controls H/W/other type of Acct separation now date it? H/W/othera) b) c) d) e) 6. Retirement accounts (IRA or Keogh) held by either spouse:
In name of Institution Type of Approximate Maturity H/W/other and Branch Account value/amount datea) b) c) d) 7. Securities (Mutual funds, bonds, limited partnerships, stocks) owned by either spouse:
In name of Description Approximate H/W/other Broker (# of shares, % interest at separation) net valuea) b) c) d) 8. Life insurance policies on either spouse or children:
Company Policy # Whole or term? Face Value Cash value Beneficiary Insureda) b) c) d) 9. Pension, retirement or profit-sharing benefits in which either spouse may have an interest:
In name of Company or Years in Terms, amount H or W Union, address Acct # plan of benefitsa) b) c) d) 10. Business interests. Describe any interest held by either spouse in any business, professional practice or corporation, giving approximate value of interest where possible.
The last year for which we filed a joint return was
Balance at Balance
Creditor Purpose separation today
a)b) c) d) e)
Part of debt incurred Annual interest Monthly Written Who has
before sep./during marriage rate payment agreement? records?
a)b) c) d) e)
13. Education & training. If community funds were used for education or training of either spouse that substantially increased that spouse's earning capacity, indicate how much and who it was for:
Description How was it acquired? Whose is it?
a)b) c) d) e) f)
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