§ Property and Debt Statement
Property and Debt Statement
[Publisher's note: Referenced interactive forms can be accessed at www.selfrepresent.mo.gov]
In what Missouri county was the In the Circuit Court of
custody or support judgment entered? MISSOURI
What is the case number of the custody or support
judgment?
Case Number Division Number
Answer all questions on this form completely.
Your Information My current full name is:
__________________ ______________ ________________ ___________
(First Name) (Middle Name) (Last Name) (Jr./Sr./III)
[ ] I filed the original case. (Petitioner/Plaintiff)
[ ] I did not file the original case. (Respondent/Defendant)
[ ] I am the Mother
[ ] I am the Father
Other Party's
Information
The current full name of the other party is:
__________________ ______________ ________________ ___________
(First Name) (Middle Name) (Last Name) (Jr./Sr./III)
Property Owned by
You Item of Property Present Fair Monthl Amount Owed on
Property?
Market Value (DoIncome from Property?
Property
not deduct amount (List Debt in Table 2)
owed from this
value)
Property is anything you own or you are in the process of buying. Anything you consider yours is
property that should be listed. This includes anything that you might own with another person.
[ ] Yes
[ ] No
[ ] Yes
[ ] No
[ ] Yes
[ ] No
[ ] Yes
[ ] No
[ ] Yes
[ ] No
[ ] Yes
[ ] No
[ ] Yes
[ ] No
[ ] Yes
[ ] No
[ ] Yes
[ ] No
Property and Debt Statement--Page 1 of 3
Form CAFC140-7/1/ This form is available for free at www.selfrepresent.mo.gov
2010
Property Owned by
You Item of Property Present Fair Monthly Amount Owed on
Market Value (DoIncome from Property?
not deduct amount
owed from this (List Debt in Table 2)
value)
[ ] Yes
[ ] No
[ ] Yes
[ ] No
[ ] Yes
[ ] No
[ ] Yes
[ ] No
[ ] Yes
[ ] No
[ ] Yes
[ ] No
Debts Owed by You Creditor Current Monthly Security for Loan
Balance Payment on (This property should be
Loan listed in Table 1)
A debt is anything that you owe or that someone claims you owe.
Property and Debt Statement--Page 2 of 3
Form CAFC140-7/1/ This form is available for free at www.selfrepresent.mo.gov
2010
I certify under oath that I have given the other party a copy of this Property and Debt Statement pursuant to Missouri Supreme Court Rule 43.01(d) by: (You MUST check at least ONE of the following four boxes)
[ ] Mailing a copy to the other party or his or her attorney on __________(Date) at the following address:
_________________________________________________________________________
(Street)
_____________________________ _____________ _____________________________
(City) (State) (Zip)
[ ] Handing a copy to the other party or his or her attorney on __________ (Date).
[ ] Sending a copy to the other party or his or her attorney by fax to __________(fax number) on __________(Date) at
__________(Time).
[ ] (To be used only by written consent of the party filed with the court) Sending a copy via electronic mail to the other
party or his or her attorney at __________(Email Address) on __________(Date).
Instructions: The following information MUST be filled in before a notary public. This Property and Debt Statement is
required to be verified before a notary public. The “Affiant” is the person that is completing this document.
COUNTY OF
_________________________________
)
) ss.
STATE OF _________________________________ )
Affiant, of lawful age, being duly sworn on his or her oath, states that he or she is the affiant named herein and that the facts stated in this Property and Debt Statement are true according to his or her best knowledge and belief.
_____________________________________________ ___________________________
Affiant--SIGN HERE (Sign here in front of a Notary Public) Affiant--PRINT YOUR NAME HERE
Subscribed and sworn to on
_________________________________________________.
_________________________________________________
Notary Public
My Commission Expires:
_________________________________________________
Property and Debt Statement--Page 3 of 3
Form CAFC140-7/1/ This form is available for free at www.selfrepresent.mo.gov
2010
[Publisher's note: Referenced interactive forms can be accessed at www.selfrepresent.mo.gov]