District Of Columbia > Statewide > Superior Court > Multi-Door Dispute Resolution Division
Assets - District Of Columbia
| Assets Form. This is a District Of Columbia form and can be used in Multi-Door Dispute Resolution Division Superior Court Statewide . |
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FAMILY MEDIATION PROGRAM Client's Name Multi-Door Number ASSETS Please attach documentation Real Estate (Please attach appraisals, current mortgage statements) Property 1 - Address: Property 2 - Address: Purchase Price Purchase Date Current Value $ Purchase Price Purchase Date $ $ Current Value Outstanding Mortgage $ $ Outstanding Mortgage $ Other liens Estimated Equity $ $ Other liens Estimated Equity $ $ Name(s) on Title: 1 Husband 1Wife 1Both 1 Other Name(s) on Mortgage: 1Husband 1Wife 1Both 1 Other Name(s) on other Liens: 1Husband 1Wife 1Both 1 Other Name(s) on Title: 1Husband 1 1Other Wife 1Both Name(s) on Mortgage: 1Husband 1Wife 1Both 1Other Name(s) on other Liens: 1Husband 1 Wife 1Both 1Other Bank Accounts (Please attach current statements) Name of Bank Type of Account Name(s) on Account Current Balance (& date) Account Number 1 American LegalNet, Inc. www.FormsWorkFlow.com Pensions/Retirement Plans (Please attach plan statements, current personal benefits statements) Type of Plan Name of Plan Individual Covered Current Value (& date) IRAs (Please attach current statements) Type Institution Individual Covered Current Value (& date) Stocks, Bonds, Notes (Please attach current statements) Name of Instrument Type (and # of shares) Estimated Value (& date) Life Insurance (Please attach current statements) Name of Plan Type of Plan (term, whole life, etc.) Individual Covered by Plan Beneficiaries Face Value Current Value Business Or Professional Interests (Please attach appraisals, valuations) Type of Interest Estimated Value 2 American LegalNet, Inc. www.FormsWorkFlow.com Automobiles (Please attach blue book values, current statements of liens) Model &Year In Whose Possession In Whose Name Estimated Value Lien Personal Property (Please attach supporting documentation for estimated values, such as receipts or appraisals, and current statements of liens. Attach list if necessary.) Property In Whose Possession In Whose Name Estimated Value Lien Inheritance Or Trust Fund (Please attach current statements) From Whom To Whom Property Effective Date Estimated Value Other Assets (Please attach appraisals, current statements of liens) Type In Whose Possession Estimated Value Lien 3 American LegalNet, Inc. www.FormsWorkFlow.com 1111111111111111111111111111111111111111111111111111111111 11111111 LIABILITIES / DEBTS Please attach documentation Real Estate - Property 1 Address: Outstanding Mortgage (Please attach current statement and check off below what is included in the payment): 9 Principal Company 9 Account # Interest 9 In Whose Name(s) Property Taxes Monthly Payment 9 Insurance % Interest Current Balance (& date) 2nd Trust/Home Equity Line(s) (Please attach current statements) Company Account # In Whose Name(s) Monthly Payment % Interest Current Balance (& date) Other Lien(s) on Property (Please attach current statements) Company Account # In Whose Name(s) Monthly Payment % Interest Current Balance (& date) Real Estate - Property 2 Address: Outstanding Mortgage (Please attach current statement and check off below what is included in the payment): 9 Principal 9 Account # Interest 9 Property Taxes In Whose Name(s) 4 Monthly Payment 9 Insurance % Interest Current Balance American LegalNet, Inc. www.FormsWorkFlow.com Company (& date) 2nd Trust/Home Equity Line(s) (Please attach current statements) Company Account # In Whose Name(s) Monthly Payment % Interest Current Balance (& date) Other Lien(s) on Property (Please attach current statements) Company Account # In Whose Name(s) Monthly Payment % Interest Current Balance (& date) Credit Cards (Please attach current statements) Card Account # In Whose Name(s) Monthly Payment % Interest Current Balance (& date) Loans (Please attach current statements of balances due) Creditor In Whose Name(s) Purpose Terms Current Balance (& date) 5 American LegalNet, Inc. www.FormsWorkFlow.com Other Debts (taxes, personal, etc.) (Please attach current statements of balances due) Creditor In Whose Name(s) Purpose Terms Current Balance (& date) 1111111111111111111111111111111111111111111111111111111111 11111111 SWORN STATEMENT I solemnly swear or affirm under criminal penalties for the making of a false statement that I have read the foregoing paper and that the factual statements made in it are true to the best of my personal knowledge, information and belief. Date Signature 6 American LegalNet, Inc. www.FormsWorkFlow.com 1111111111111111111111111111111111111111111111111111111111 11111111 EXPENSES / BUDGET Please attach documentation Total Gross Monthly Income Payroll Deductions Federal Tax State Tax Local Tax FICA Retirement Health Insurance Other: $ $ $ $ $ $ $ $ $ $ $ $ $ Total Deductions Total Net Monthly Income Monthly Expenses Housing Rent Insurance Mortgage (PITI) Principal and Interest Property Taxes Insurance Condo Fee Repairs/Maintenance Cleaning Service Yard Service $ $ $ $ $ $ $ $ $ Utilities Electricity Telephone Water Gas Fuel Oil Cable Internet $ $ $ $ $ $ $ 7 American LegalNet, Inc. www.FormsWorkFlow.com Food Drug Store Products (do not include prescriptions) $ $ $ Clothing Transportation Car Payment Car Repairs/Maintenance Insurance Tags Gas/Oil Parking Bus/Metro Taxis $ $ $ $ $ $ $ $ Children's Expenses Child Care Babysitting School: Tuition Books/School Supplies Fees (field trips, activities) Uniforms School lunch Transportation Tutoring Out-of-school Activities: Sports Lessons Unreimbursed medical expenses: Doctor Dentist Orthodontist Mental Health Professional $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 8 American LegalNet, Inc. www.FormsWorkFlow.com Prescriptions Eyeglasses Clothing Allowance Summer Camp/Expenses Other: $ $ $ $ $ $ $ Medical Expenses Health Insurance (if not taken as deduction from salary) Eyeglasses Unreimbursed expenses: Doctor Dentist Mental Health Professional Prescriptions $ $ $ $ $ $ Insurance (if not taken as deduction from salary) Life Disability $ $ $ $ $ $ $ Entertainment (please specify) Vacations Miscellaneous Cell phone, pager Dry Cleaning Hair Cuts/Salon Gifts Dues/Fees Newspapers Subscriptions Contributions Other: $ $ $ $ $ $ $ $ $ 9 American LegalNet, Inc. www.FormsWorkFlow.com Monthly Payments - Old Debts Closed credit card / store accounts Account pay-off date $ $ $ Student loan Outstanding tax bills $ $ $ Other: $ $ Total Expenses Total Remaining (Or Deficit) Monthly $ $ Revised 1/07 10 American LegalNet, Inc. www.FormsWorkFlow.com
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