Free D-19A F05 EquiDistribAffidavit.PDF - All

NORTH CAROLINA CABARRUS COUNTY

IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION
FILE NUMBER 01 CVD

____________________________ Plaintiff, vs. _____________________________ Defendant.

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EQUITABLE DISTRIBUTION INVENTORY AFFIDAVIT

NOW COMES the plaintiff in the above-entitled equitable distribution action, and, in accordance with the provisions of G.S. 50-22(a) and the 19A Local Rules, itemizes for the Court and the opposing party what he or she alleges to be the marital and separate property of the parties hereto, as well as the marital debts of the parties hereto, all as set out on the following schedules which are attached hereto and incorporated herein by reference as if fully set out at this point. Plaintiff certifies that he/she has made a full and complete disclosure of all marital and separate property known to him/her. Plaintiff has filed the original of this Affidavit with the Clerk, and has served a filed copy of this affidavit on the defendant, or attorney for defendant, as witnessed by the Certificate of Service attached hereto. Pursuant to the 19A Local Rules, the defendant is required to complete his or her portion of the Affidavit as indicated thereon within thirty days from its receipt. Defendant must then file the same promptly thereafter with the Clerk, and forward a completed copy of the Affidavit to the plaintiff. This the _________ day of ____________________, 2001.

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SCHEDULE I REAL PROPERTY AND MOBILE HOME PLAINTIFF'S CONTENTIONS DEFENDANT'S CONTENTIONS
PROPERTY DOS FMV DOS MTG. WHO HAS POSS. X IF YOU WANT X IF YOU WANT X IF YOU AGREE DOS FMV DOS MTG. COMMENTS

1. 2. 3. 4. 5. 6.

SCHEDULE II MOTOR VEHICLES PLAINTIFF'S CONTENTIONS DEFENDANT'S CONTENTIONS
PROPERTY DOS FMV DOS MTG. WHO HAS POSS. X IF YOU WANT X IF YOU WANT X IF YOU AGREE DOS FMV DOS MTG. COMMENTS

1. 2. 3.

SCHEDULE III HOUSEHOLD FURNISHINGS REAL PROPERTY AND MOBILE HOME PLAINTIFF'S CONTENTIONS DEFENDANT'S CONTENTIONS
ITEM DOS NET VALUE WHO HAS POSS. X IF YOU WANT X IF YOU WANT X IF YOU AGREE DOS NET VALUE WHO HAS POSS. COMMENTS

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40.

SCHEDULE IV MISCELLANEOUS PERSONAL PROPERTY (Tools, Guns, Lawn Equipment, Jewelry) PLAINTIFF'S CONTENTIONS DEFENDANT'S CONTENTIONS
PROPERTY DOS FMV DOS MTG. WHO HAS POSS. X IF YOU WANT X IF YOU WANT X IF YOU AGREE DOS FMV DOS MTG. COMMENTS

1. 2. 3. 4. 5 6. 7.

SCHEDULE V ACCOUNTS (Checking, Savings, CD's, Stocks)

PLAINTIFF'S CONTENTIONS

DEFENDANT'S CONTENTIONS

FINANCIAL INSTITUTION _____________________________________________________ ______________________________________________________________________________ DOS VALUE _________________________ X IF YOU WANT _____________________ X IF YOU AGREE ____________________ WHO HAS POSS _____________________ COMMENTS
_____________________________________________________________________________________________

X IF YOU WANT X IF YOU AGREE DOS VALUE

SCHEDULE VI RETIREMENT (Pension, 401(k), Profit-sharing, IRA)

NAME-INSTITUTION _________________________________________________________ _____________________________________________________________________________ DOS VALUE __________________ MARITAL VALUE _________________ PL/DEF. _________________

SCHEDULE VII DEBTS

CREDITOR __________________________________________________________________ ____________________________________________________________________________ DOS VALUE $ ___________________________________ AMOUNT OWED $ ________________________________________________ PARTY PAID ____________________________________________________ SINCE SEPARATION _____________________________________________AMOUNT PAID___________________________________________________________

NORTH CAROLINA CABARRUS COUNTY

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VERIFICATION OF PLAINTIFF

_____________________________________________, being first duly sworn, deposes and says: That he/she is the plaintiff in the foregoing equitable distribution action; that he/she has prepared the foregoing Equitable Distribution Inventory Affidavit and knows the contents thereof; that the same is true to his or her own knowledge, except as to those matters and things therein set out on information and belief, and as to those matters and things, he/she believes it to be true.

SWORN TO and subscribed before me this the ______ day of ________, 2001.

_______________________________ Notary Public My Commission Expires: __________

CERTIFICATE OF SERVICE

I hereby certify that I served a copy of the foregoing EQUITABLE DISTRIBUTION INVENTORY AFFIDAVIT upon ________________________, ______________________, ____________________, North Carolina, by depositing a copy thereof in the United States mail in an envelope with sufficient postage thereon addressed to him/her at the aforesaid address. This the _____ day of _________________ , ______ .

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