Oregon > Statewide > Circuit Court > Family Law > Miscellaneous
Statement Of Assets And Liabilities (6N) - Oregon
| Statement Of Assets And Liabilities (6N) Form. This is a Oregon form and can be used in Miscellaneous Family Law Circuit Court Statewide . |
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IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF _________________ In the Matter of the Marriage of: ________________________________, Petitioner, and ________________________________, Respondent. ) ) ) ) ) ) ) ) Case No. ____________________ PETITIONER'S RESPONDENT'S STATEMENT OF ASSETS AND LIABILITIES Attached as Exhibit 1 is Petitioner's Respondent's Statement of Assets and Liabilities as required by UTCR 8.010(4). ____ (number of sheets) additional sheets are attached. Petitioner Respondent, Signature DATED: _______________________, 20 _____. Print Name Certificate of Document Preparation. You are required to truthfully complete this certificate regarding the document you are filing with the court. Check all boxes and complete all blanks that apply: I selected this document for myself and I completed it without paid assistance. I paid or will pay money to ________________________________ for assistance in preparing this form. Submitted by: Petitioner Respondent, Signature Print Name Address or Contact Address City, State, Zip I certify that this is a true copy: ____________________________________ Petitioner Respondent, Signature Telephone or Contact Telephone STATEMENT OF ASSETS AND LIABILITIES - Page 1 of 4 6D-Z.MiscForms: 6NStatementAssetsLiab-Ver01.doc (2/08) American LegalNet, Inc. www.FormsWorkFlow.com EXHIBIT 1 DESCRIPTION OF ASSETS 1. REAL PROPERTY (Include Address) CLAIMED VALUE PROPOSED DISTRIBUTION 2. VEHICLES 3. HOUSEHOLD FURNISHINGS AND APPLIANCES 4. OTHER PERSONAL PROPERTY 5. BANK ACCOUNTS (List all bank accounts including Checking Accounts, Savings Accounts, CDs (Certificates of Deposit), Money Markets, etc.) STATEMENT OF ASSETS AND LIABILITIES - Page 2 of 4 6D-Z.MiscForms: 6NStatementAssetsLiab-Ver01.doc (2/08) American LegalNet, Inc. www.FormsWorkFlow.com 6. CASH ON HAND 7. PENSIONS AND INVESTMENTS (401Ks, IRAs, Retirement/Pension Accounts, Stocks, Bonds, Mutual Funds, etc.) 8. BUSINESS INTERESTS (Co-ownerships, Partnerships, LLCs, Sole Proprietorships, etc.) 9. INSURANCE POLICIES WITH CASH SURRENDER OR LOAN VALUE 10. OTHER ACCOUNTS OR ASSETS 11. TOTAL ASSETS FROM ADDITIONAL SHEETS TOTAL ASSETS: STATEMENT OF ASSETS AND LIABILITIES - Page 3 of 4 6D-Z.MiscForms: 6NStatementAssetsLiab-Ver01.doc (2/08) American LegalNet, Inc. www.FormsWorkFlow.com DESCRIPTION OF DEBTS 1. STUDENT LOANS CLAIMED VALUE PROPOSED DISTRIBUTION 2. MORTGAGES 3. CREDIT CARD BALANCES 4. OTHER LOANS 5. TAXES 6. SUPPORT ARREARAGES 7. OTHER DEBTS 8. TOTAL DEBTS FROM ADDITIONAL SHEETS TOTAL DEBTS: STATEMENT OF ASSETS AND LIABILITIES - Page 4 of 4 6D-Z.MiscForms: 6NStatementAssetsLiab-Ver01.doc (2/08) American LegalNet, Inc. www.FormsWorkFlow.com
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