Asset & Debt Form

SPOUSE'S ASSET & DEBT FORM

INSTRUCTIONS

**Eric will use the assets/debts on this form during the mediation to facilitate the discussion and negotiation of the distribution of all assets/debts. Since you will also almost always need to complete the Court's Financial Affidavit - under the penalty of perjury - please ensure that this Asset & Debt form is accurate and reflects the same information you will include on the Court's sworn to-Financial Affidavit**. THIS FORM IS NOT THE COURT'S FINANCIAL AFFIDAVIT WHICH YOU WILL COMPLETE BEFORE FILING FOR THE DIVORCE WITH THE COURT.

**Each Spouse should complete a form. However, you are free to complete and submit only one form jointly (please ensure your spouse agrees to do so and shares his/her relevant information with you so that the singular form is complete and accurate). If you complete one joint form, please indicate it in the Notes section.
1. Please enter your First name, Last name, Email address, and Current date.
2. Please fill in all relevant information for all applicable Assets and debts.
  1. Be sure to list all descriptive information requested for each category item.
  2. Choose the name of which spouse is currently listed on each asset/debt
  3. Enter the most recent market value, applicable policy amount, or account balance. **Approximations or estimates are fine**
Once you click the Submit Button, you (and Eric) will receive an email with a .pdf copy of the completed form attached. Please forward the completed .pdf to your spouse for their review.

If you ever need to make changes, please follow the Edit link in the email you will receive after submitting the form. You can also save your progress and resume the form later by clicking the Save Button and following the instructions.

If you have any questions, please feel free to contact Eric at 954-272-8292 or eric@peacefulsplit.com.

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First Name*
Last Name*
Email*
Please Enter Today's Date*

MonthDayYear
Date
Folder Name*
Date-Time-Folder

MonthDayYear
Date
Hour Minutes
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ASSETS
Real Property

(e.g., houses, condos, land, time-shares, vacation clubs)

	List Complete Address (e.g., 7655 Main Street, Miami, Florida 33467):	Spouse's Name(s) on Title(s) or Joint)	Approx. Current Market Value	Mortgage?
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$1
$2
$3
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$5
$6
$7
$8
$9
$10
Mortgage(s)

	Mortgage(s) Lender's Name: (e.g., Mr. Cooper or Quicken) (match loan number below to property number above):	Which Spouse(s) Signed For The Mortgage Or Joint?	Approx. Current Mortgage Balance	Last 4 digits of Loan #
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Life Insurance:

	Company's Name (e.g., Prudential Ins Co.)	Policy Type	Insured’s Name	Policy Amount	Last 4 digits of Policy #
(1)
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Motor Vehicles

e.g., cars, motorcycles, boats, etc

	Year	Make	Model	Spouse's Name(s) on Title(s) or Joint	Owned or Leased	Car Loan?
Vehicle #1
Vehicle #2
Vehicle #3
Vehicle #4
Vehicle #5
Vehicle #6
Vehicle #7
Vehicle #8
Vehicle #9
Vehicle #10

Car Loan/Lease

Balance

	Lender's Name (e.g., Capital One) (match loan below to vehicle number above):	Which Spouse’s Signed For The Financing Or Joint	Approx. Loan Balance (ignore if lease)	Last 4 digits of Loan/Lease #
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Bank Accounts:

	Bank's Name (e.g., Wells Fargo Bank)	Account Type	Spouse's Name(s) on Account(s) or Joint)	Approx. Current Account Balance	Last 4 Digits of Account#
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Brokerage/Retirement Accounts

	Brokerage's Name (e.g., Fidelity)	Account Type	Spouse's Name(s) on Account(s) or Joint	Approx. Current Account Balance	Last 4 digits of Account#
(1)
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Miscellaneous/Other Assets

	Describe the Asset, but do not list personal property, such as furniture, jewely, etc	Spouse's Name(s) on Account(s) or Joint	Approx. Current Market Value	Last 4 digits of Account#
(1)
(2)
(3)
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(7)

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7
LIABILITIES/DEBTS
Credit Cards

	Issuer's Name (e.g., Citibank Visa, Capital One Mastercard)	Which Spouse Was Credit Card Issued Or Joint Name?	Approx. Current Card Balance	Last 4 digits of Account #
(1)
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Miscellaneous/Other Debts/Loans:

(e.g., student, personal loans or debts)

	List Name of Lender/Person (e.g., John Doe or Wells Fargo Personal Loan)	Which Spouse’s Signed For The Debt/Loan Or Joint	Approx. Current Loan Balance	Last 4 digits of Account #
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NOTES/QUESTIONS
Should be Empty:

SPOUSE'S ASSET & DEBT FORM

INSTRUCTIONS

ASSETS

Real Property

Mortgage(s)

Life Insurance:

Motor Vehicles

Car Loan/Lease

Bank Accounts:

Brokerage/Retirement Accounts

Miscellaneous/Other Assets

LIABILITIES/DEBTS

Credit Cards

Miscellaneous/Other Debts/Loans: