Form 4 Property and Debt Listing (DNC) {4}

Page 1 of 1 Stip DNC Form 4 Ex A/Rev 2018 IN DISTRICT COURT, COUNTY, NORTH DAKOTA , } Plaintiff, } EXHIBIT A: } CONFIDENTIAL DIVISION OF vs. } PROPERTY & DEBTS & VALUES }}Civil No. , } Defendant. } Plaintiff and Defendant have reached an agreement resolving the values and division of all property and debt in this divorce proceeding. Plaintiff and Defendant222s entire agreement resolving the values and division of all property and debt is set forth in this Exhibit A: Confidential Division of Property and Debts and Values. 1.Debts and Liabilities:a.(Choose one)Plaintiff and Defendant DO NOT have any outstanding debts or liabilities.Plaintiff and Defendant agree on how to divide their debts and liabilities.b.Plaintiff and Defendant shall pay as their own the debts and liabilities listed intheir column.c.Plaintiff and Defendant listed all debts and liabilities they know of on Exhibit A.Any debts and liabilities not listed on Exhibit A shall be paid by the person whose nameis on the debt or liability. Description of Debts and Liabilities (Describe each debt/liability as clearly as possible. Include who the debt is owed to, purpose of the debt, whose name is on the debt and account numbers. Do not include mortgages on real estate. ) Plaintiff (Current amount owed) Defendant (Current amount owed) $ $ $ $ American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 1 Stip DNC Form 4 Ex A/Rev 2018 Description of Debts and Liabilities (Describe each debt/liability as clearly as possible. Include who the debt is owed to, purpose of the debt, whose name is on the debt and account numbers. Do not include mortgages on real estate. ) Plaintiff (Current amount owed) Defendant (Current amount owed) $ $ $ $ $ $ $ $ $ $ $ $ $ $ Total Debts and Liabilities to be Paid by Each Person $ $ 2.Vehicles and Watercraft:a.(Choose one)Plaintiff and Defendant DO NOT own any vehicles or watercraft.Plaintiff and Defendant agree on how to divide their vehicles and watercraft.b.Plaintiff and Defendant shall receive as their own, the vehicles and watercraftlisted in their column. Description of Vehicles/Watercraft (Include the type of vehicle/watercraft, year/make/model, vehicle identification number, name(s) on title, balance owed, monthly payment (if any). If you own a manufactured or mobile home that HAS NOT been converted to real property, list it here.) Plain tiff (Current agreed upon value) Defendant (Current agreed upon value) $ $ $ $ American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 1 Stip DNC Form 4 Ex A/Rev 2018 Description of Vehicles/Watercraft (Include the type of vehicle/watercraft, year/make/model, vehicle identification number, name(s) on title, balance owed, monthly payment (if any). If you own a manufactured or mobile home that HAS NOT been converted to real property, list it here.) Plain tiff (Current agreed upon value) Defendant (Current agreed upon value) $ $ $ $ $ $ Total Value of Vehicles/Watercraft to Each Person $ $ 3.Household Goods, Furniture, and Furnishings: Plaintiff and Defendant have alreadydivided the household goods, furniture and furnishings in an equitable manner to theirsatisfaction. Plaintiff Defendant Total Agreed Upon Value of Share of Household Goods, Furniture, and Furnishings to Each Person $ $ 4.Real Estate Jointly Owned by Plaintiff and Defendant:a.(Choose one)Plaintiff and Defendant DO NOT jointly own any real estate.Plaintiff and Defendant agree on how to divide their jointly owned real estate. b.Property 1: The street address of this property is , in the City of , County of , State of , and it is legally described as: American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 1 Stip DNC Form 4 Ex A/Rev 2018 This real property was purchased on for $. There is a mortgage or loan against the property in the amount of $. The market value of this property is $. AGREEMENT OF PLAINTIFF AND DEFENDANT: Plaintiff / Defendant (choose one) shall be awarded sole title and interest inProperty 1, described above, and subject to a mortgage or loan against the property inthe amount of $. c.Property 2: Does Not Apply. The street address of this property is , in the City of , County of , State of , and it is legally described as: This real property was purchased on for $. There is a mortgage or loan against the property in the amount of $. The market value of this property is $. AGREEMENT OF PLAINTIFF AND DEFENDANT: Plaintiff / Defendant (choose one) shall be awarded sole title and interest inProperty 2, described above, and subject to a mortgage or loan against the property inthe amount of $.5.Real Estate Solely Owned by Plaintiff:a.(Choose one)Plaintiff DOES NOT solely own any real estate.Plaintiff and Defendant agree on how to divide Plaintiff222s solely owned realestate. American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 1 Stip DNC Form 4 Ex A/Rev 2018 b.Property 1: The street address of this property is , in the City of , County of , State of , and it is legally described as: This real property was purchased on for $. There is a mortgage or loan against the property in the amount of $. The market value of this property is $. AGREEMENT OF PLAINTIFF AND DEFENDANT: Plaintiff / Defendant (choose one) shall be awarded sole title and interest inProperty 1, described above, and subject to a mortgage or loan against the property inthe amount of $. c.Property 2: Does Not Apply. The street address of this property is , in the City of , County of , State of , and it is legally described as: This real property was purchased on for $. There is a mortgage or loan against the property in the amount of $. The market value of this property is $. AGREEMENT OF PLAINTIFF AND DEFENDANT: Plaintiff / Defendant (choose one) shall be awarded sole title and interest inProperty 2, described above, and subject to a mortgage or loan against the property inthe amount of $. American LegalNet, Inc. www.FormsWorkFlow.com Page 6 of 1 Stip DNC Form 4 Ex A/Rev 2018 6.Real Estate Solely Owned by Defendant:a.(Choose one)Defendant DOES NOT solely own any real estate.Plaintiff and Defendant agree on how to divide Defendant222s solely owned realestate. b.Property 1: The street address of this property is , in the City of , County of , State of , and it is legally described as: This real property was purchased on for $. There is a mortgage or loan against the property in the amount of $. The market value of this property is $. AGREEMENT OF PLAINTIFF AND DEFENDANT: Plaintiff / Defendant (choose one) shall be awarded sole title and interest inProperty 1, described above, and subject to a mortgage or loan against the property inthe amount of $. c.Property 2: Does Not Apply. The street address of this property is , in the City of , County of , State of , and it is legally described as: This real property was purchased on for $. There is a mortgage or loan against the property in the amount of $. The market value of this property is $. American LegalNet, Inc. www.FormsWorkFlow.com Page 7 of 1 Stip DNC Form 4 Ex A/Rev 2018 AGREEMENT OF PLAINTIFF AND DEFENDANT: Plaintiff / Defendant (choose one) shall be awarded sole title and interest inProperty 2, described above, and subject to a mortgage or loan against the property inthe amount of $.7.Plaintiff222s Pensions, Profit-Sharing Plans, IRAs and Other Retirement Plans:a.(Choose one)Plaintiff DOES NOT have any pensions, profit-sharing plans, individualretirement accounts (IRAs) or other retirement plans.Plaintiff and Defendant agree on how to divide Plaintiff222s pensions, profit-sharing plans, individual retirement accounts (IRAs) and other retirement plans.b.Plaintiff222s pensions, profit-sharing plans, individual retirement accounts (IRAs)and other retirement plans shall be awarded as listed in Plaintiff222s and Defendant222scolumns.c.If Plaintiff222s retirement plan is divided between Defendant and Plaintiff, Plaintiffshall obtain the proposed qualified domestic relations order (QDRO). Description of Plaintiff222s Pensions, Profit - Sharing Plans, IRAs and Other Retirement Plans: (For each plan, list the employer, union, or other group that provides the plan; the date you started working at the job or date you joined the union or gr