Vermont > Statewide > Family Court
Financial Affidavit (Property And Assets) 813B - Vermont
| Financial Affidavit (Property And Assets) Form. This is a Vermont form and can be used in Family Court Statewide . |
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STATE OF VERMONT SUPERIOR COURT Unit Plaintiff Name DOB FAMILY DIVISION Docket No. Defendant Name DOB / / V. / / FORM 813 B - FINANCIAL AFFIDAVIT: Property and Assets My Name and Address: I am: (Please check appropriate box) Plaintiff Defendant Other Name Street Town/City State Zip INSTRUCTIONS: You are required to complete and file the 813B if1. You are a party in a newly filed divorce, civil union dissolution, legal separation or annulment and you and the other party have minor children; OR 2. You are ordered by the Court to complete and file this form or the other party requests that you fill out the form as part of the discovery process. DEADLINE FOR FILING: This form must be filed with the court before or at your first case manager's conference. If no conference is scheduled it must be filed at least five days before your first scheduled court hearing. YOU MUST SEND A COPY OF YOUR COMPLETED FORM TO THE OTHER PARTY AT THE SAME TIME THAT YOU FILE IT WITH THE COURT. When you have completed the form and filled in all the required information, you must sign the Affirmation section below and have your signature notarized. AFFIRMATION I have read and filled in all the information requested. I hereby affirm of my own knowledge that the facts and financial information I have stated are true and correct as of the date of this Affirmation and that I am not omitting any source or amount of income or other information requested on this form. I understand that any false information may constitute perjury by me. I also understand that if I fail to provide the required information or give misinformation, the judge may order sanctions against me. Signature of person making affidavit Sworn to me on Notary Public , 20 My Commission Expires: / / ,20 10/10 SML 12 American LegalNet, Inc. www.FormsWorkFlow.com SUMMARY OF ASSETS Please check each box that applies to you or the other party REAL ESTATE: (primary residence, camps, land, timeshares, etc.) I have an interest in (own) real estate either individually or jointly with another. The other party has/may have an interest in (own) real estate either individually or jointly with another. PERSONAL PROPERTY: (furniture, antiques, jewelry, electronics, etc.) I own personal property Yes No Yes No The other party owns/may own personal property VEHICLES: (cars, trucks, ATV's, boats, motorcycles, campers, etc.) Yes No I own vehicles either individually or jointly. The other party owns/may own vehicles either individually or jointly. BANK ACCOUNTS: No I have bank accounts either individually or jointly. Yes The other party has/may have bank accounts either individually or jointly. INVESTMENTS: (stocks, bonds, mutual funds, trusts, annuities) Yes No I own investments either individually or jointly. The other party owns/may own investments either individually or jointly. RETIREMENT ACCOUNTS (IRA, 401 K, pensions, deferred compensation, etc.) Yes No I own retirement accounts. No The other party owns/may own retirement accounts. Yes LIFE INSURANCE POLICIES: Yes I have life insurance. The other party has/may have life insurance. Yes Yes No No Yes No Yes No Yes No No Yes No BUSINESSES: Yes I own or have an ownership interest in a business. The other party owns/may own an interest in a business. No Yes No TRANSFER/SALE OF ASSETS Have you or the other party sold or transferred ownership of any asset in the last 12 months? Yes No Have you or the other party withdrawn funds from an account in the last 12 months for a purpose other than Yes No paying normal household expense payments? If you answered ''Yes'' to either of the above questions, please list asset sold or transferred OR account from which withdrawal was made, amounts received or withdrawn and any expenditure made from amounts received. YOU MUST COMPLETE THE REMAINING PAGES OF THIS FORM IF YOU ANSWERED ''YES'' TO ANY OF THE QUESTIONS ABOVE. IF YOU ANSWERED ''NO'' TO ALL QUESTIONS ABOVE, THEN YOU DO NOT HAVE TO COMPLETE THE REMAINING PAGES OF THIS FORM. 13 10/10 SML American LegalNet, Inc. www.FormsWorkFlow.com SECTION I - REAL ESTATE Description of Property Including Location Primary Residence: Second Home: Camp: Timeshare: Unimproved Land: Mobile Home: Residential Rental Real Estate Owned: Commercial Real Estate: Other Real Estate Interests: a. b. C. d. e. TOTAL VALUE OF REAL ESTATE INTERESTS IF ANY OF THE ABOVE PROPERTIES GENERATE RENTAL INCOME, YOU MUST EITHER: 1. ATTACH SCHEDULE E FROM YOUR LAST 2 TAX RETURNS Market Value Mortgages, Liens, Equity (value minus Attachments liens) or if you did not file taxes 2. FILL OUT RENTAL INCOME ATTACHMENT (Page 10 of Form 813A) 14 10/10 SML American LegalNet, Inc. www.FormsWorkFlow.com SECTION II - PERSONAL PROPERTY Please list all personal property owned by you and/or the other party. In estimating the market value, please use the amount you could reasonably receive if you sold the item today. Do not use the purchase price or replacement value. Description of Items Market Value Check if item is in your possession Loans/debts on property Person paying on loan/debt Jewelry Antiques Artwork Guns Coins/Stamps Tools Collectibles Piano/Musical instruments China/Crystal/Silverware Appliances Electronics Furnishings Computers Other: a. b. C. . 10/10 SML American LegalNet, Inc. www.FormsWorkFlow.com 15 SECTION III - VEHICLES and BOATS "Market value'' for motor vehicles is the retail value indicated in the NADA Blue Book or other similar price guide. Title Holder Vehicle Description (Year, make, model) Car #1 Car #2 Truck #1 Truck #2 Motorcycle #1 Motorcycle #2 Boat #1 Boat #2 Snowmobile #1 Snowmobile #2 ATV #1 ATV #2 Camper RV Plane Other Vehicles: Market Value Outstanding Equity Loan (Value minus Amount Loan) SECTION IV - BUSINESS OWNERSHIP Name of Business, Type of Business Activity and Legal Structure of Business (e.g. Sole proprietor, Partnership, Corporation, S- Corporation) Date of % of Fair Market Interest last Value Owned valuation Owner You Must Attach an 813A Self Employment Attachment or a Schedule C and/or Form K-1 from your last two (2) federal income tax returns for any business from which you earn or receive income, profits, distributions, in-kind income, etc. 10/10 SML American LegalNet, Inc. www.FormsWorkFlow.com 16 SECTION V - INVESTMENTS Type of Investment (stocks, bonds, annuities, mutual funds, trusts, etc.) Description (name of company, fund, bank, trust and trustee etc.) Number of Shares Owner Market Value SECTION VI - BANK ACCOUNTS and CASH
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