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Uniform Domestic Relations Form – Affidavit 2 (Affidavit of Property and Debt)
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Supreme Court of Ohio Page 1 of 5 Uniform Domestic Relations Form – Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 IN THE COURT OF COMMON PLEAS ______________________________ DIVISION ______________________________ COUNTY, OHIO Plaintiff/Petitioner 1 vs./and Case No. Judge Magistrate Defendant/Petitioner 2 AFFIDAVIT OF PROPERTY AND DEBT Affidavit of ____________ _____________________ (Print Name) I. REAL ESTATE INTERESTS Address Present Fair Market Value Titled To Mortgage Balance Equity 1.__________________________ __________________________ $ _______________ $ $ 2.__________________________ __________________________ $ _______________ $ $ TOTAL SECTION I: REAL ESTATE INTERESTS : $ II. OTHER ASSETS Category Description Titled To Value A. Vehicles and Other Certificate of Title Property (Include model and year of automobiles, trucks, motorcycles, boats, motors, motor homes, trailers, ATVs, snowmobiles, jet skis, etc.) 1. ____________________________ _____________________________ ________________ $ 2. ____________________________ _____________________________ ________________ $ Instructions: Check local court rules to determine when this form must be filed. List ALL OF YOUR PROPERTY AND DEBTS, THE PROPERTY AND DEBTS OF YOUR SPOUSE, AND ANY JOINT PROPERTY OR DEBTS. You must provide the most recent value for each asset and balance owed for each debt. Do not leave any category blank. For each item, if none, put “NONE.” If you do not know exact figures for any item, give your best estimate, and put “EST.” If more space is needed, add additional pages.
Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: XXXX, 2021 Page 2 of 5 Category Description Titled To Value 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ 5. ____________________________ _____________________________ ________________ $ _______________ 6. ____________________________ _____________________________ ________________ $ _______________ B. Financial Accounts (Include checking, savings, CDs, POD accounts, money market accounts, etc.) 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ C. Pensions & Retirement Plans (Include profit-sharing, IRAs, 401(k) plans, etc. Describe each type of plan) 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ D. Publicly Held Stocks, Bonds, Securities & Mutual Funds (Name of company and number of shares) 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________
Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: XXXX, 2021 Page 3 of 5 Category Description Titled To Value E. Closely Held Stocks & Other Business Interests and Name of Company (Type of ownership and number of shares) 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ F. Life Insurance (Company Name and Term or Whole Life) (Insured Life) Cash Value and Loan Balance, if any 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ G. Furniture & Household Goods, Furnishings, and Appliances 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ H. Safe Deposit Box (Give location and contents) 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ I. All Other Assets Not Listed Above (including jewelry, art, tools, firearms, and other collectibles) (If necessary, attach additional pages) 1. ___________________________ _____________________________ ________________ $ _______________ 2. ___________________________ _____________________________ ________________ $ _______________ TOTAL SECTION II: OTHER ASSETS : $ _______________
Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: XXXX, 2021 Page 4 of 5 III. SEPARATE PROPERTY CLAIMS Separate property includes, but is not limited to, property owned before marriage and gifts or inheritances to only one spouse. Description Why do you claim this as separate property? Present Fair Market Value 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ TOTAL SECTION III: SEPARATE PROPERTY CLAIMS: $ _______________ IV. DEBT List ALL OF YOUR DEBTS, your spouse’s debts, and any joint debts. Do not leave any category blank. For each item, if none, put “NONE.” If you don’t know exact figures for any item, give your best estimate, and put “EST.” If more space is needed to explain, please attach an additional page with the explanation and identify which question you are answering. Type Name of Creditor Name on Account Total Debt Due Monthly Payment A. Secured Debt (Mortgages, Car, etc.) 1. __________________________ _________________________ ____________ $___________ $___________ 2. __________________________ _________________________ ____________ $___________ $___________ 3. __________________________ _________________________ ____________ $___________ $___________ 4. __________________________ _________________________ ____________ $___________ $___________ 5. __________________________ _________________________ ____________ $___________ $___________ B. Unsecured Debt (Credit cards, medical bills, other debts) 1. __________________________ _________________________ ____________ $___________ $___________ 2. __________________________ _________________________ ____________ $___________ $___________ 3. __________________________ _________________________ ____________ $___________ $___________
Uniform Domestic Relations Form – Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: XXXX, 2021 Page 5 of 5 Type Name of Creditor Name on Account Total Debt Due Monthly Payment 4. __________________________ _________________________ ____________ $___________ $___________ 5. __________________________ _________________________ ____________ $___________ $___________ TOTAL SECTION IV: DEBT: $ ___________ V. BANKRUPTCY Filed by Date of Filing Date of Discharge or Relief from Stay Type of Case (Ch. 7, 11, 12, 13) Current Monthly Payments 1. __________________________ _________________________ ____________ $___________ $___________ 2. __________________________ _________________________ ____________ $___________ $___________ TOTAL SECTION V: BANKRUPTCY : $ ___________ OATH OR AFFIRMATION (Do not sign until Notary Public is present) I, (print name) , swear or affirm that I have read this Affidavit and, to the best of my knowledge and belief, the facts and information stated in this Affidavit are true, accurate, and complete. I understand that if I do not tell the truth, I may be subject to penalties for perjury. Your Signature STATE OF _____________________ ) ) SS COUNTY OF ___________________ ) Sworn to or affirmed before me by this day of , . ________________ __________________ Signature of Notary Public __________________________________ Printed Name of Notary Public (Affix seal here) Commission Expiration Date: ___________