Fillable Case No. Plaintiff/Petitioner 1 Judge vs./and Magistrate Defendant/Petitioner (Fairfield County)

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Case No. Plaintiff/Petitioner 1 Judge vs./and Magistrate Defendant/Petitioner (Fairfield County)

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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
Titled To
Value
A. Vehicles and Other Certificate
of Title Property
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.
DOMESTIC RELATIONS
WOOD
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: ___________
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Case No. PlaintiffPetitioner 1 Judge vs.and Magistrate DefendantPetitioner (Fairfield County)

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Completed 24 November 2021

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