COURT OF COMMON PLEAS

DIVISION OF DOMESTIC RELATIONS

HAMILTON COUNTY, OHIO

Plaintiff / Petitioner
-vs/and-
Defendant / Petitioner

Date:
Case No.
File No.
CSEA No.
Property Statement

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

If the Court finds that the issues to be decided are limited, and in the event that Defendant fails to answer or appear for the scheduling conference, the Court may make all such final orders including all parenting orders, child support, spousal support, attorney fees and costs, and a division of property as are necessary and appropriate to the resolution of this matter on the above date and time.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

INSTRUCTIONS

Pursuant to O.R.C. §3105.171 (B) every asset and liability, both marital and separate property, is subject to the jurisdiction of the Court. Therefore, every asset and liability of either party must be listed.

Pursuant to O.R.C. §3105.171 (A) (2) “during the marriage” for purposes of identifying marital property is defined as from the date of marriage to the date of final hearing “unless it would be inequitable to use such dates.”

For purpose of this property statement “during the marriage” is defined as the following dates:

(date of marriage)

(other) to (date of separation), (date of filing complaint) (date of final hearing) (other specify) .

Date of Valuation used for purpose of this statement:

1: REAL ESTATE	Appraisal/	Marital/Separate	Source of
Address/Title	Market Value	Mixed	Valuation	Equity

Comment:

2: HOUSEHOLD GOODS (Please attach inventory of property claimed to be separate as well as marital property for which you request an individual award. If all household goods are to be divided equally, please so indicate.)

Comment:

3: AUTOMOBILES

Appraisal
Description/Title	Year & Make	or Current Market Price	Marital/Separate Mixed	Source of Valuation	Equity

Comment:

4: FUNDS ON DEPOSIT

Description/Title	Type of Account	Number	Marital/Separate Mixed

Comment:

5: STOCKS AND BONDS

Appraisal
Location/Title	Description/ Number	or Current Market Price	Source of Valuation	Marital/Separate Mixed

Comment:

6: RETIREMENT SAVINGS PLANS/PENSIONS/PROFIT SHARING

Name of Plan/Employer	Year of Employment	Years in Plan	Vested?	Amount	Marital/Separate Mixed
H:
W:

Comment:

7: TAX REFUNDS

Year	Source	Present Value	Date of Receipt	Marital/Separate Mixed
H:
W:
J:

How many tax exemptions are you presently claiming, including yourself?

8: LIFE INSURANCE

Name of Company	Policy No.	Insured	Owner	Beneficiary	Face Amount	Cash Value	Marital/Separate Mixed

Comment:

9: EXPECTANCIES AND INHERITANCES OF THE PARTIES

Location/Titled	Value of Fund	Date of Valuation	Source of Valuation	Marital/Separate Mixed

Comment:

10: OTHER ASSETS List location, title, valueof item including date and source of valuation, including whether this property is	claimed to bemarital, separate, or mixed.

$
$
$
$

LIABILITIES

Name of Creditor	Encumbrance	Who is Liable: Plaintiff/Defendant	Bal. Due	As of	Marital/Sep/ Mixed
1:
2:
3:
4:
5:
6:
7:
8:

Comment:

Total Asset Value minus Total Liabilities equals Total Equity

STATE OF OHIO	}

} S.S.

COUNTY OF HAMILTON }

___________________________________, being first duly cautioned and sworn, deposes and states that the facts set forth in the foregoing Property Statement are true as they verily believe.

_____________________________________________

Sworn to and subscribed in my presence this _______________ day of _______________________________________ 20 ________ .

_____________________________________________

Notary Public

PROOF OF SERVICE

I hereby certify that a copy of the foregoing property statement has this day of 20 , been served by upon Service has been requested through the Clerk of Courts.

_____________________________________________

Attorney for