Hawaii > Local County > 1st Circuit - Oahu > Family Court > Divorce
Asset And Debt Statement 1F-P-840 - Hawaii
| Asset And Debt Statement Form. This is a Hawaii form and can be used in Divorce Family Court 1st Circuit - Oahu Local County . |
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STATE OF HAWAI`I FAMILY COURT FIRST CIRCUIT ASSET AND DEBT STATEMENT ~ Plaintiff ~ Defendant ~ Both Parties This document is prepared by: C A S E N U MB E R FC-CU No. Atty for Plaintiff ~ Plaintiff ~ Defendant ~ (Full Name) ~ Atty for Defendant , PLAINTIFF, Name Address v. City, State, Zip Code (Full Name) , DEFENDANT. Telephone 1. CASH (on hand or held by others for m e).... $ 2. CREDIT UNION ACCOUNTS: Name Title (Plaintiff, Defendant, Joint, Other) Credit Balance Debt Balance 3. BANK AND SAVINGS ACCOUNTS: Name (Include Trustee Accounts) Type of Account Title (Plaintiff, Defendant, Joint, Other) Current Balance 4. SECURITIES: (Stocks, Bonds, Mutual Funds, Certificates of Deposit, etc.) Title (Pltf, Dft, Jt, Other) Date of Acquisition Cost Market Value Debt Owed Against Company In accordance with the Americans with Disabilities Act and other applicable state and federal laws, if you require a reasonable accommodation for a disability, please contact the ADA Coordinator at the Office of the Chief Administrator at PHONE NO. 954-8200, FAX 954-8308, or TTY 539-4853 at least ten (10) working days prior to your hearing or appointment date. FOR COURT USE ONLY Please call Ho`okele, WKH 6HOIHelp Desk, at 954-8290, if you have any questions about how to fill out this form . Form N o. 073925; FC A dm 12/11 PAGE 1 CUDA ASSET AND DEBT STATEMENT Reprographics (01/12)1F 1F-P-840 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF HAWAI`I FAMILY COURT FIRST CIRCUIT 5. VEHICLES: Year ~ ASSET AND DEBT STATEMENT Plaintiff ~ Defendant ~ Both Parties Page 2 of 3 Pages C A S E N U MB E R FC-CU No. (Autos, Trucks, Motorcycles, Trailers, Cam pers, Boats, etc.) Make Title (Pltf, Deft, Jt, Other) Current Market Value Debt Owed Against 6. REAL PROPERTY: Address Fee or Lease Date of Acquisition Cost Current Gross Value Total Debt Owed 7. LIFE INSURANCE: Company Person Insured Face Amount Beneficiary Title (Pltf, Deft, Jt, Other.) Cash Value Debt Owed Against 8. RETIREMENT; PENSION; PROFIT SHARING ACCOUNTS: Employer or Company Title (Plaintiff, Defendant, Joint, Other) Type of Plan Years in Plan Total Value 9. ALL OTHER MAJOR ASSETS: (Furniture, Household Effects, Art, Stam ps, Coins, Tools, Equipm ent, Jewelry, Accounts Receivable, Investm ent Assets, Business Assets, Cem etery Plots or Niches, Tax Refund Due, etc.) General Description Title (Plf, Deft, Jt, Other) Estimated Gross Value Debt Owed Against Form N o. 073925; FC A dm 12/11 PAGE 2 C U D A A S SE T A N D D E B T S TA T E ME N T American LegalNet, Inc. www.FormsWorkFlow.com 1F-P-840 STATE OF HAWAI`I FAMILY COURT FIRST CIRCUIT in paragraph 3.) Description ~ ASSET AND DEBT STATEMENT Plaintiff ~ Defendant ~ Both Parties Page 3 of 3 Pages C A S E N U MB E R FC-CU No. 10. PROPERTY HELD IN TRUST FOR OR BY THIRD PERSON(S): Trustee(s) (Aside from Bank & Savings Accounts Noted Value Debt Owed Beneficiaries 11. ALL OUTSTANDING DEBTS: (Include those listed parts in paragraphs 2, 4, 5, 6, 7, 9, and 10 above, in addition to all credit cards, charges, finance com panies, and personal loans.) Creditor Debtor (Pltf, Deft, Jt, Other) Security Total Minimum Mo./Yr. Debt Incurred Balance Owed Monthly Payment Total Debt in Plaintiff''s Name Alone: Total Debt in Defendant's Name Alone: Total Debt in Joint Names: CERTIFICATION I hereby declare under the penalty of perjury that I have supplied the information used in this Asset and Debt Statement and have reviewed this Statement and I certify that the information is accurate, complete, and correct. DATE G PLANTIFF'S G PLANTIFF'S G DEFENDANT'S G DEFENDANT'S SIGNATURE DATE SIGNATURE Form N o. 073925; FC A dm 12/11 PAGE 3 C U D A A S SE T A N D D E B T S TA T E ME N T 1F-P-840 American LegalNet, Inc. www.FormsWorkFlow.com
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