§ Dissolution Property Statement
Dissolution Property Statement
IN THE CIRCUIT COURT OF __________________________, MISSOURI
(County where court is located)
In re the Marriage of }
}
__________ __________ __________ _________ }
(First) (Middle) (Last) (Jr./Sr./III) }
Petitioner, } Case No.___________________________
}
-and- }
} Division
No.___________________________
__________ __________ __________ __________ }
(First) (Middle) (Last) (Jr./Sr./III) }
Respondent. }
}
WARNING: Read Carefully
You are encouraged to consult with a lawyer in the preparation of this document and the presentation of your case to the court. A dissolution of marriage proceeding can substantially affect your financial and personal life for many years. A lawyer is trained to assist you in protecting your rights.
Statement of Property and Debt and
Proposed Separation Agreement
Are you Petitioner or the Respondent? (Check one of these boxes)
[ ] I am the Petitioner. (The party that filed the original petition)
[ ] I am the Respondent. (The party that answers the original petition filed by his or her spouse)
Are you the Husband or the Wife? (Check one of these boxes)
[ ] I am the Wife.
[ ] I am the Husband.
What does this document cover?
There are two parts to this document. Part One is your division of property and debt and Part Two pertains to spousal support or “maintenance.” This document does not pertain to child support or custody. Issues addressing child support and custody are contained in a parenting plan.
Do I have to file this document?
Yes. You must file this document with either your “Petition for Dissolution of Marriage” or your “Answer,” even if it is not signed by both parties.
What is a separation agreement?
It is an agreement in which you and your spouse agree to a distribution of property and debt and to provisions concerning maintenance and attorney's fees. If both you and you spouse sign this document, it is called a “Separation Agreement.” It does not include provisions for child custody and child support.
Statement of Property and Debt and Proposed Separation Agreement--Page 1 of _____
Form CAFC040-10/2/ This form is available for free at www.selfrepresent.mo.gov
2008
Can the court do something different than what I have proposed?
Absolutely. Even if both you and your spouse have signed the agreement, the court is not bound by it. If the court finds that your agreement is “unconscionable” or does not divide all property and marital debt, it will not be approved by the court. The court can divide the property in any manner it considers fair, and it may or may not order maintenance to be paid.
Part One. Division of Property and Debt
What is the most common mistake unrepresented parties make in their dissolution case?
Without a doubt it is the failure to correctly list all marital and nonmarital property and marital debt. The rest of this form explains in detail how to avoid this mistake.
How do I complete Part One?
Part One consists of these instructions and six tables.
Table 1--Marital property to be received by Wife
Table 2--Marital property to be received by Husband
Table 3--Nonmarital property to be received by Wife
Table 4--Nonmarital property to be received by Husband
Table 5--Debts to be paid by Wife
Table 6--Debts to be paid by Husband
You must list all of your marital and nonmarital property and marital debt on one of these six tables.
Use a separate row for each item of property or debt. You should draw a line through all rows that do not contain an item of property. This is very important because someone could alter this document after you have signed it. Keep a copy of this document after you have signed it.
What is marital property?
RSMo § 452.330 defines marital property. Usually marital property is property acquired by either spouse during the marriage of the parties other than property acquired by gift, inheritance, or in exchange for nonmarital property. This means that all wages earned during the marriage are martial property. All property owned by the parties is presumed to be marital property.
Nonmarital property can be converted to marital property by placing a spouse's name on an account or title. Also, a marital interest can be acquired in nonmarital property by the contribution of marital assets to the increase in value of the nonmarital property.
Finally, income from nonmarital property during the marriage of the parties is marital property.
Marital property to be awarded to Wife should be listed in Table 1 and marital property to be awarded to Husband should be listed in Table 2.
What is nonmarital property?
Nonmarital property is property that was acquired prior to the marriage or property that was acquired during the marriage by gift, inheritance, or in exchange for nonmarital property. Nonmarital property is sometimes also called “separate property.”
Additionally, some state teacher retirement benefits are considered nonmarital. RSMo. § 169.572.
Nonmarital property to be awarded to Wife should be listed in Table 3 and nonmarital property to be awarded to Husband should be listed in Table 4.
Statement of Property and Debt and Proposed Separation Agreement--Page 2 of _____
Form CAFC040-10/2/ This form is available for free at www.selfrepresent.mo.gov
2008
Can property be marital and nonmarital?
Yes. If an item of property is partly marital and partly nonmarital, then it should be listed under both the marital and nonmarital sections. For example, if one party had earned pension benefits for five years prior to the marriage and continued to earn the same pension benefits for five years during the marriage, one-half or 50% of the pension and retirement benefits are marital and one-half or 50% are nonmarital. In that situation, the pension and retirement benefits would be listed both under marital and nonmarital property.
What is “fair market value”?
This is the amount someone would pay for this item of property today. It is not what the property cost when you purchased it. A ten year old automobile has a value far less than the amount you paid for the automobile.
What does “security” mean?
The mortgage on a home is traditionally secured by the home. When you finance the purchase of an automobile, the company that loans you the money is listed on the title to the automobile. They too have a security interest in your car. Usually, a debt is secured by an item of property if the person to whom you owe the money can take the item of property if you fail to pay the debt. The schedules of debt ask you to list any security for that debt. You must also list the property that secures the debt under the property listings.
What if I don't agree with this “Proposed Separation Agreement”?
You must take appropriate actions to protect your interests. CONSULT A LAWYER. Do not fail to respond if you have been served with these papers as the court may proceed without any further notice to you.
Do we have to list our property even if we've already divided it?
Yes, it must still be included on one of the tables.
What property should I list on this form?
ALL PROPERTY AND MARITAL DEBT must be divided in a dissolution of marriage proceeding. Your dissolution of marriage may not be final unless this is done.
This includes the following types of property and debt:
• Real estate
• Motor vehicles
• Bank accounts
• Pension and retirement plans and profit sharing plans
• Stocks, bonds or other securities
• Life insurance
• Cash on hand
• Household goods
• Personal goods
• Trust interests
• Businesses or partnerships
• Debts owed to you or your spouse by others
• Any interest in pending litigation or suits to be filed
• Farm equipment, animals or crops
• Interests in contracts made and not performed
• Other assets.
Statement of Property and Debt and Proposed Separation Agreement--Page 3 of _____
Form CAFC040-10/2/ This form is available for free at www.selfrepresent.mo.gov
2008
What debts should I list on this form?
You should list all loans from any individual, bank, credit card company, credit union, savings and loan association or other lending institution. Include all debts owed by either you or your spouse. Make sure to list all credit cards and any amounts owed pursuant to any bankruptcy or other repayment plans.
Debts that the Wife should pay are to be listed in Table 5 and Debts that the Husband should pay are to be listed in Table 6.
Do I have to list property even if my spouse's name is not on it?
Yes, you must list all property owned by you alone, by your spouse alone, and by you and your spouse together. You must list property even if it is not in joint names. Any property in which either you or your spouse claim ANY interest whatsoever, MUST be listed.
In many instances, you will not be able to sell your property or receive your retirement unless you prove that these items were listed in your dissolution of marriage judgment.
Do I have to list property that either of us is buying at the present time?
YES. You must list all property that either you or your spouse is purchasing by making monthly payments. So, even if you owe money on your car or home, it still must be listed. Actually, it must be listed twice: once as an item of property and once as a debt secured by the property.
Do I have to list property I owned before the marriage?
Yes. This is normally nonmarital property, but under some circumstances it may be considered marital property.
Do I have to list property my spouse owned before the marriage?
Yes. Just as you had to list property you owned before the marriage, you should also list property your spouse owned before the marriage. Once again, this is normally nonmarital property, but under some circumstances it may be considered marital property.
I don't know what my spouse owns so how can I list it?
You should hire a lawyer to assist you. A lawyer has the ability to assist you in locating the assets of your spouse.
My mother added my name to her house, but I have not paid any money toward the purchase. Do I still have to list this property?
Yes. This would normally be nonmarital property, but you still have to list it.
Do I have to list property that I acquired after the separation?
You are still married so any property or debt that you have acquired since your marriage has to be included.
What happens if I don't list all the property and marital debt?
It would be a VERY BIG mistake not to list all your property and marital debt. Your dissolution of marriage may not be final, and your spouse will be able to come back in the future and try and get this item of property. In some cases, you may not be able to receive your pension or sell your property without proof that your dissolution of marriage judgment listed the property.
Statement of Property and Debt and Proposed Separation Agreement--Page 4 of _____
Form CAFC040-10/2/ This form is available for free at www.selfrepresent.mo.gov
2008
Should I list my pension information even though I am not entitled to receive any benefits at the present time?
Yes.
Does this mean that I have to list every dish and towel that we own?
No. You do not need to list property if it is of minimal value. If the item of property is worth less than $100.00, you may omit it from your list.
What if I acquire some property or debt after I file my case?
If you acquire any additional property or debt during the time this case is pending, you must notify the court of that fact at the time of your hearing. If you dispose of any property or pay off any debt during the time this case is pending, you must notify the court of that fact at the time of your hearing.
What if I run out of space on one or more of the tables?
You may make copies of any of the six tables if you need additional room for more property or debt. When you have listed all the property and debt, you should number the pages. Make sure you write “Not Applicable” or “N/A” in each box under “Item of Property” or “Item of Debt” that you do not fill. (Someone could fill this in later with some other information)
After you have completed Part One, you should complete Part Two of this document which pertains to spousal support or maintenance.
Important
This document is placed in a court file, which is an open document available to the public. In listing your bank or other accounts, or your credit card or other debt, do not include the entire account number. You should include only enough information to distinguish your account from other accounts owned by you and your spouse. For example, in listing a credit card number, you should include only the last four digits of the account, such as xxxx-xxxx-xxxx-1234.
Statement of Property and Debt and Proposed Separation Agreement--Page 5 of _____
Form CAFC040-10/2/ This form is available for free at www.selfrepresent.mo.gov
2008
TABLE 1. MARITAL PROPERTY TO BE AWARDED TO WIFE--The following marital property is to become the sole and
separate property of WIFE. NONMARITAL PROPERTY OF WIFE SHOULD BE LISTED IN TABLE 3.
Item of Property Present Fair What is the Is there an amount Party with
Market Value monthly income owed on this Possession of this from this property? Property
property?
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
Statement of Property and Debt and Proposed Separation Agreement--Page _____ of _____
Form CAFC040-10/2/2008 This form is available for free at www.selfrepresent.mo.gov
TABLE 2. MARITAL PROPERTY TO BE AWARDED TO HUSBAND--The following marital property is to become the sole
and separate property of HUSBAND. NONMARITAL PROPERTY OF HUSBAND SHOULD BE LISTED IN TABLE 4.
Item of Property Present Fair What is the Is there an amount Party with
Market Value monthly income owed on this Possession of this
from this property? property?
property?
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
Statement of Property and Debt and Proposed Separation Agreement--Page _____ of _____
Form CAFC040-10/2/2008 This form is available for free at www.selfrepresent.mo.gov
TABLE 3. NONMARITAL PROPERTY TO BE AWARDED TO WIFE--The following nonmarital property is to become the sole and separate property of WIFE. MARITAL PROPERTY OF WIFE SHOULD BE LISTED IN TABLE 1.
Item of Property Present Fair What is the Is there an amount Party with
Market Value monthly income owed on this Possession of this
from this property? property?
property?
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
Statement of Property and Debt and Proposed Separation Agreement--Page _____ of _____
Form CAFC040-10/2/2008 This form is available for free at www.selfrepresent.mo.gov
TABLE 4. NONMARITAL PROPERTY TO BE AWARDED TO HUSBAND--The following nonmarital property is to
become the sole and separate property of HUSBAND. MARITAL PROPERTY OF HUSBAND SHOULD BE LISTED IN TABLE 2.
Item of Property Present Fair What is the Is there an amount Party with
Market Value monthly income owed on this Possession of this
from this property? Property
property?
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
[ ] Yes--List debt in [ ] Wife
Tables 5 or 6. [ ] Husband
[ ] No [ ] Other
(Do not deduct
amount owed
from this value)
Statement of Property and Debt and Proposed Separation Agreement--Page _____ of _____
Form CAFC040-10/2/2008 This form is available for free at www.selfrepresent.mo.gov
TABLE 5. DEBTS TO BE PAID BY WIFE--List all loans from any individual, bank, credit card company, credit union, savings and loan association or other lending institution which are to be paid by WIFE. Wife is to indemnify and hold Husband harmless for all debts listed on Table 5.
The creditor's rights to collect these debts from Husband are NOT affected without the consent of the creditor.
Item of Debt Current Monthly What is the security Marital or
Balance payment for this debt, if any? Separate Debt
(This property should be
listed in Tables 1
through 4)
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
Statement of Property and Debt and Proposed Separation Agreement--Page _____ of _____
Form CAFC040-10/2/2008 This form is available for free at www.selfrepresent.mo.gov
TABLE 6. DEBTS TO BE PAID BY HUSBAND--List all loans from any individual, bank, credit card company, credit union, savings and loan association or other lending institution which are to be paid by HUSBAND. Husband is to indemnify and hold Wife harmless for all debts listed on Table 6.
The creditor's rights to collect these debts from Wife are NOT affected without the consent of the creditor.
Item of Debt Current Monthly What is the security Marital or
Balance payment for this debt,if any? Separate Debt
(This property should be
listed in Tables 1
through 4)
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
[ ] Marital
[ ] Nonmarital
[ ] Both
[ ] Unknown
Statement of Property and Debt and Proposed Separation Agreement--Page _____ of _____
Form CAFC040-10/2/2008 This form is available for free at www.selfrepresent.mo.gov
Part Two. Maintenance and Other Provisions
WHAT IS MAINTENANCE?
Maintenance is money paid on a regular schedule by one spouse to the other after the dissolution of marriage. It may be for a set period of time or it may be for an indefinite period of time. It usually terminates upon the death of either party or the remarriage of the party receiving maintenance unless the parties agree otherwise. It may or may not be subject to future modification upon a showing of changed circumstances. Maintenance used to be referred to as “alimony.”
MAINTENANCE TO WIFE(Check one and only one of these boxes.)
[ ] The court lacks jurisdiction to enter any orders with respect to maintenance of the Wife.
[ ] No maintenance is to be paid to Wife by Husband. This agreement is not subject to modification.
[ ] Husband shall pay to Wife the sum of __________ per month as and for maintenance. Said maintenance is __________ subject to modification. Said maintenance shall terminate upon the death of either party, the remarriage of Wife, or at such earlier time as set forth herein.
MAINTENANCE TO HUSBAND(Check one and only one of these boxes.)
[ ] The court lacks jurisdiction to enter any orders with respect to maintenance of the Husband.
[ ] No maintenance is to be paid to Husband by Wife. This agreement is not subject to modification.
[ ] Wife shall pay to Husband the sum of __________ per month as and for maintenance. Said maintenance is __________ subject to modification. Said maintenance shall terminate upon the death of either party, the remarriage of Husband, or at such earlier time as set forth herein.
WAGE WITHHOLDING FOR MAINTENANCE
(Answer only if maintenance is to be paid by either party.)
[ ] Income withholding shall be prepared by the obligee and issued by the Circuit Clerk upon the effective date of this order.
[ ] Income withholding shall not issue for the following reason(s):
______________________________________________________________________________
NON-MAINTENANCE PAYMENT FROM ONE PARTY TO THE OTHER PARTY
[ ] __________ shall pay to __________ the sum of __________ as and for ____________________.
ATTORNEY'S FEES
[ ] Neither party is to receive attorney's fees from the other party.
[ ] Wife shall pay to __________ the sum of __________ as and for Husband's attorney's fees herein.
[ ] Husband shall pay to __________ the sum of __________ as and for Wife's attorney's fees herein.
ADDITIONAL PROVISIONS:
Statement of Property and Debt and Proposed Separation Agreement--Page _____ of _____
Form CAFC040-10/2/2008 This form is available for free at www.selfrepresent.mo.gov
I certify under oath that I have given my spouse a copy of this Statement of Property and Debt pursuant to Missouri Supreme Court Rule 43.01(d) by: (You MUST check at least ONE of the following three boxes)
[ ] Serving a copy with the petition.
[ ] Mailing a copy to my spouse or his or her attorney on __________, 20 ___ at the following address:
___________________________________________________________________________
(Street)
________________________ ________________________ _______________
(City) (State) (Zip)
[ ] Handing a copy to my spouse or his or her attorney on __________, 20 ___.
[ ] Sending a copy to my spouse or his or her attorney by fax to __________(telephone number) on __________, 20 ___ at __________(time).
Instructions: The following information MUST be filled in before a notary public. Your Statement of Property and Debt is required to be verified before a notary public.
COUNTY OF )
_____________________________
)
) ss.
STATE OF
_____________________________
)
Wife, of lawful age, being duly sworn on her oath, states that she is the Wife named herein and that the facts stated in this Statement of Property and Debt are true according her best knowledge and belief, and that she agrees with the terms and conditions set forth herein.
Further, Wife states that she executed this Statement of Property and Debt as her free act and deed.
______________________________________ ______________________________________
WIFE--SIGN HERE WIFE--PRINT YOUR NAME HERE
Subscribed and sworn to this _____ day of ____________________, 20_____.
_______________________________
Notary Public
My Commission Expires:
COUNTY OF
_____________________________
)
) ss.
STATE OF )
_____________________________
Husband, of lawful age, being duly sworn on his oath, states that he is the Husband named herein and that the facts stated in this Statement of Property and Debt are true according his best knowledge and belief, and that he agrees with the terms and conditions set forth herein.
Further, Husband states that he executed this Statement of Property and Debt as his free act and deed.
______________________________________ ______________________________________
HUSBAND--SIGN HERE HUSBAND--PRINT YOUR NAME HERE
Subscribed and sworn to this _____ day of ____________________, 20 _____.
_______________________________
Notary Public
My Commission Expires:
Statement of Property and Debt and Proposed Separation Agreement--Page _____ of _____
Form CAFC040-10/2/2008 This form is available for free at www.selfrepresent.mo.gov