Free IN DISTRICT COURT, _____________________ COUNTY, NORTH DAKOTA - North Dakota

IN DISTRICT COURT, _____________________ COUNTY, NORTH DAKOTA

_____________________________, Plaintiff, vs.

_____________________________, Defendant. ASSETS 1. Real Estate

) ) ) ) ) ) )

PROPERTY AND DEBT LISTING CIVIL NO. _____________

Agreed upon values

$ $ $ $ Subtotal

0 $_________________

2. Business/Farm $ $ $ $ Subtotal 3. Financial $ $ $ $ Subtotal $_________________0 $_________________0

4. Retirement/Pensions $ $ $ $ Subtotal $_________________0

5. Vehicles/Watercraft $ $ $ $ Subtotal $_________________0

6. Household Goods/Personal Property $ $ $ $ Subtotal $_________________0

7. Debts $ $ $ $ Subtotal $_________________0

8. Summary Real Property Business/Farm Assets Financial Assets Retirement/Pensions Vehicles/Watercraft Household Goods/Personal Property Debts Subtotal

$ $ $ $ $ $ $

0 0 0 0 0 0 0

$_________________ 0

Dated and signed on ___________________, 20_____

________________________________________________ Plaintiff's Signature

Subscribed and sworn before me on __________________________, 20______.

________________________________________________ Notary Public My Commission Expires:

Dated and signed on ____________________, 20_____

________________________________________________ Defendant's Signature

Subscribed and sworn before me on ____________________________, 20_____. ________________________________________________ Notary Public My Commission Expires: