Ohio > County (Court Of Common Pleas) > Cuyahoga > Domestic Relations
Pretrial Statement And Affidavit - Ohio
| Pretrial Statement And Affidavit Form. This is a Ohio form and can be used in Domestic Relations Cuyahoga County (Court Of Common Pleas) . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CUYAHOGA COUNTY, OHIO _________________________________________ Plaintiff _________________________________________ Address _________________________________________ City, State, Zip Code Marital Residence: Yes No : : : : : : : : Judge: ___________________________________ Case Number: ___________________________________ _________________________________________ Day Time Telephone Number _________________________________________ Attorney _________________________________________ Attorney Address _________________________________________ Attorney Telephone vs. PRE-TRIAL STATEMENT WITH AFFIDAVIT OF PROPERTY, INCOME & EXPENSES _________________________________ (Your Name) : _________________________________________ Defendant _________________________________________ Address _________________________________________ City, State, Zip Code Marital Residence: Yes No : : : WIFE HUSBAND _________________________________________ Day Time Telephone Number _________________________________________ Attorney _________________________________________ Attorney Address _________________________________________ Attorney Telephone : : : : Date of Marriage: ____________________________ Date of Separation ____________________________ THIS STATEMENT MUST BE FILED WITH THE COURT 7 DAYS PRIOR TO THE PRE-TRIAL CONFERENCE, IF ONE IS HELD OR IF NO PRE-TRIAL CONFERENCE IS HELD, THEN NO LATER THAN 14 DAYS PRIOR TO THE TRIAL DATE OR 3 DAYS AFTER RECEIPT OF NOTICE OF THE TRIAL DATE, WHICHEVER IS LATER, AND IN ACCORDANCE WITH LOCAL RULE 12 OF THIS COURT. A TIME-STAMPED COPY OF THIS STATEMENT SHALL ALSO BE DELIVERED TO THE ASSIGNED JUDGE'S SCHEDULER ON THE DATE OF FILING. BRING TO THE PRE-TRIAL CONFERENCE ALL DOCUMENTS AND OTHER SUPPORTING INFORMATION NECESSARY TO VERIFY OR EXPLAIN THE STATEMENTS MADE IN THIS PRE-TRIAL STATEMENT, INCLUDING, BUT NOT LIMITED TO, TAX RETURNS, PAY STUBS, CHECKBOOKS, DAY CARE RECEIPTS, CANCELLED CHECKS, INSURANCE CARDS, CERTIFICATES AND POLICIES. FAILURE BY EITHER PARTY TO COMPLETE, FILE AND PRESENT THIS FORM AS REQUIRED WILL SUBJECT THAT PARTY AND COUNSEL TO THE SANCTIONS PROVIDED IN DDR RULE 11(C)(2). ANY FALSE STATEMENT MADE HEREON MAY SUBJECT YOU TO CRIMINAL PENALTIES FOR PERJURY, AND MAY BE CONSIDERED A FRAUD UPON THE COURT. IF YOU FAIL TO DISCLOSE ANY ASSET, DEBT, INCOME OR EXPENSE, THE COURT MAY COMPENSATE YOUR SPOUSE WITH UP TO THREE (3) TIMES THE VALUE OF THE UNDISCLOSED ITEM(S), PER ORC 3105.171(E)(5). PLEASE USE THE YELLOW FORM FOR THE WIFE AND THE BLUE FORM FOR THE HUSBAND. DRPTS Revised 7/10 Initial: ________ Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com I. PROPERTY List ALL OF YOUR PROPERTY AND DEBTS, those of your spouse, and joint property and debts. Do not leave any category blank. For each item, if none, write "NONE." If you do not know exact figures for any item, give your best estimate and write "EST." A. Real estate interests: PLEASE STATE WHETHER ANY LEGAL ACTIONS ARE PENDING (i.e. FORECLOSURES, ETC.) If more space is needed, attach extra pages. See additional pages: YES Address (Check box if legal action is pending) Titled to Husband, Wife or Joint (Check box) H W Joint $ Present Fair Market Value Names & Addresses of Mortgage/Lien Holders Mortgage/Lien Balance Due Monthly Mortgage/Lien Payments $ $ $ $ A. $ $ B. H W Joint $ $ $ B. Other assets: PLEASE STATE WHETHER ANY LEGAL ACTIONS ARE PENDING. If more space is needed, attach extra pages. See additional pages: Titled to: Present Fair (H, W or Market Value Joint) YES Balance on Liens/Loans (if any) Monthly Payment on Liens/Loans Category A. Vehicles Description Include automobiles, trucks, motorcycles, boats, motor homes, etc. Identify year, make and name of Lien Holder In Possession of H or W Check box if subject of pending legal action. $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ B. Financial Accounts Include checking, savings CDs, POD accounts, money market accounts, etc. $ $ $ Check box if subject of pending legal action. $ $ $ $ $ $ $ $ $ $ $ $ C. Pensions & Retirement Plans Identify each plan, including profit-sharing, IRAs, 401(k)s, etc. $ $ $ Check box if subject of pending legal action. $ $ $ $ $ $ $ $ $ D. Publicly Held Stocks, Bonds, Securities & Mutual Funds Identify name of company, type of shares, and number of shares. $ $ $ Check box if subject of pending legal action. $ $ $ $ $ $ $ Initial: ________ $ $ Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com DRPTS Revised 7/10 Category E. Closely Held Business Interests Check box if subject of pending legal action. Description Identify business, type of ownership and percentage of stock Titled to: (H, W or Joint) Present Fair Market Value Balance on Liens/Loans (if any) Monthly payment on Liens/Loans $ $ $ $ $ $ $ $ $ $ $ $ F. Life insurance Identify policy, beneficiary and whether a term life or whole life policy $ Specify the amount of any cash surrender value. $ $ $ $ $ $ $ Check box if subject of pending legal action. $ $ $ $ $ $ $ $ $ $ G. Safe Deposit box(es) Check box if subject of pending legal action. Give location and describe contents $ $ $ Include collections, rare books, stamps, guns, antiques, art objects, computers machinery, personal injury/workers compensation claims, promissory notes, loans to others, tax refunds due, interests in estates or trusts, franchises, copyrights, etc. $ $ $ $ $ $ H. Miscellaneous Assets Check box if subject of pending legal action. $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ I. Furniture and Appliances Attach detailed inventory if more space is needed See attached inventory $ In your possession $ $ $ $ $ $ $ $ $ $ $ $ In spouse's possession $ $ $ $ $ $ $ $ $ DRPTS Revised 7/10 Initial: ________ $ $ Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com J. Transferred Assets Explanation: List the name and address of any person (other than your spouse and creditors listed on this affidavit) to whom you have given money or property exceeding $100.00 in value in the past 12 months. Name and Address of Transferee Present Fair Market Value $ Reason for Transfer Check box if subject of pending legal action. $ $ $ $ C. Unsecured Debts: If you do not know exact figures for any item, give your best estimate and write "EST." List ALL UNSECURED DEBTS, INCLUDING CREDIT CARDS; (SECURED DEBTS SHOULD BE LISTED BESIDE THE ASSET SECURING THAT DEBT IN SECTIONS A & B ON PAGES 2 AND 3). If more space is needed, attach extra pages. See additional pages: YES Name of Creditor Pu
|
|||||||
