Ohio > County (Court Of Common Pleas) > Summit > Domestic Relations
Dissolution Affidavit Of Property And Income - Ohio
| Dissolution Affidavit Of Property And Income Form. This is a Ohio form and can be used in Domestic Relations Summit County (Court Of Common Pleas) . |
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IN THE COMMON PLEAS COURT OF SUMMIT COUNTY, OHIO DIVISION OF DOMESTIC RELATIONS Case No. Petitioner (1) Address Attorney JUDGE Atty Address Atty Phone V. Petitioner (2) SS# Dissolution DOB Affidavit of Property and Income Address Attorney Date of Marriage Atty Address Date of Separation Atty Phone Note: In accordance with Local Rule 2.03, this affidavit must be filed with every dissolution. You are under a continuing legal duty to file an updated version of this form if you learn of any additional information. If more space is needed, attach additional page(s). I. Children: Minor or Dependent Children of this Marriage (Include adopted children and any child of the parties who is over 18 a nd handicapped) Childs Name Social Security # Date of Birth Male / Female Age Residing with II. Affidavit of Property: List ALL YOUR PROPERTY AND DEBTS, those of your spouse, and joint property and debts. Do not leave any category blank. For each item, if none, put NONE. If more space is needed, attach extra pages. A. Real Estate Interests: Address Titled to Wife, Present Fair Mortgages: Monthly Payment Husband, or Both Market Value Balance Due A. B. Page 1 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 B. Other Assets: Category Description (Also list who has possession) Titled to Wife, Present Fair Balance Husband, or Both Market Value Due A. Vehicles (Include automobiles, trucks, motorcycles, boats, motors, motor homes, etc.) 1. 2. 3. 4. B. Financial Accounts (Include checking, savings, CDs, POD accounts, money market accounts, etc.) 1. 2. 3. C. Pensions & (Include profit-sharing, IRAs, 401K plans, etc. Retirement Plans Describe each type of plan.) 1. 2. 3. D. Publicly Held Stocks, Bonds, Securities, & Mutual Funds 1. 2. E. Closely Held Stocks (Describe type of business and type of & Other Business ownership.) Interests 1. 2. (Include insurance provided by employer, term, F. Life Insurance whole life, any cash value or loans.) 1. 2. G. Furniture & (Estimate value of those in your possession, and Appliances value of those in your spouses possession.) 1. In Your Possession 2. In Spouses Possession H. Safe Deposit Box (Give location and describe contents) (Include collections, rare books, stamps, guns, I. All Other Assets 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.) 1. 2. 3. Page 2 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 3 III. Affidavit of Income [As defined in R.C. 3119.01]: A. Gross Yearly Income from Employment Husband / Father Wife / Mother Total Gross Annual Total Gross Annual Income Income Employer Employer Payroll Address Payroll Address City, State, Zip City, State, Zip Paychecks per year 12 24 26 52 12 24 26 52 Paychecks per year B. Other Income All other income, including but not limited to pension, social security, workers compensation, commissions, royalties, disability benefits, unemployment benefits, rents, dividends, interest, OWF, SSI, food stamps, spousal support received from a prior spouse, etc. Husband / Father Wife / Mother Describe Per Year Describe Per Year C. Debts: List ALL YOUR DEBTS, debts of your spouse, and joint debts. Do not leave any category blank. For each item, if none, put NONE. If you dont know exact figures for any item, give your best estimate, and put EST. If more space is needed, attach extra pages. Type Name of Creditor / Purpose of Debt In name of H, Total Debt Due Monthly W, or Both Payment A. Secured debts (Mortgages, car, etc.) 1. 2. 3. B. Unsecured debts, including credit cards 1. 2. 3. 4. 5. 6. OATH OF AFFIANTS I hereby swear or affirm that the information set forth in this Affidavit of Income and Property above is true, complete, and accurate. I understand that falsification of this document may result in a contempt of court finding against me which could result in a jail sentence and fine, and that falsification of this document may also subject me to criminal penalties for perjury (R.C. 2921.22). _____________________________________________ _____________________________________________ Petitioner (1) Petitioner (2) Sworn to and subscribed before me this Day of , . _____________________________________________ Revised 8/03 Notary Public Page 3 American LegalNet, Inc. www.USCourtForms.com
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