COURT OF COMMON PLEAS

DIVISION OF DOMESTIC RELATIONS

HAMILTON COUNTY, OHIO

Case No.
Plaintiff/Petitioner	File No.
v./and
Judge
Defendant/Petitioner	Magistrate
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. 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.

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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 date and time indicated on the Notice of Hearing.

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AFFIDAVIT OF PROPERTY
Affidavit of
(Print Your Name)

I. REAL ESTATE INTERESTS

Address	Present Fair Market Value	Titled To	Mortgage Balance	Equity (as of date)
1.	$	Your Name Spouse's Name Both	$	$
2.	$	Your Name Spouse's Name Both	$	$
TOTAL SECTION I: REAL ESTATE INTERESTS	$

II. OTHER ASSETS

Category	Description (List who has possession)	Titled To	Value/Date of Value
A. Vehicles and Other Certificate of Title Property	(Include model and year of automobiles, trucks, motorcycles, boats, motors, motor homes, etc.)
1.	Your Name Spouse's Name Both	$
2.	Your Name Spouse's Name Both	$
3.	Your Name Spouse's Name Both	$
4.	Your Name Spouse's Name Both	$
5.	Your Name Spouse's Name Both	$
6.	Your Name Spouse's Name Both	$

B. Financial Accounts	(Include checking, savings, CDs, POD accounts, money market accounts, etc.)
1.	Your Name Spouse's Name Both	$
2.	Your Name Spouse's Name Both	$
3.	Your Name Spouse's Name Both	$
4.	Your Name Spouse's Name Both	$

Category	Description (List who has possession)	Titled To	Value/Date of Value
C. Pensions & Retirement plans	(Include profit-sharing, IRAs, 401k plans, etc.; Describe each type of plan)
1.	Your Name Spouse's Name Both	$
2.	Your Name Spouse's Name Both	$
3.	Your Name Spouse's Name Both	$
4.	Your Name Spouse's Name Both	$

D. Publicly Held Stocks, Bonds, Securities & Mutual Funds
1.	Your Name Spouse's Name Both	$
2.	Your Name Spouse's Name Both	$
3.	Your Name Spouse's Name Both	$
4.	Your Name Spouse's Name Both	$

Category	Description (List who has possession)	Titled To	Value/Date of Value
E. Closely Held Stocks & Other Business Interests and Name of Company	(Type of ownership and number)
1.	Your Name Spouse's Name Both	$
2.	Your Name Spouse's Name Both	$

F. Life Insurance Type (Term/Whole Life)	(Any cash value or loans)	(Insured party & value upon death)
1.	Your Name Spouse's Name Both	$
2.	Your Name Spouse's Name Both	$
3.	Your Name Spouse's Name Both	$
4.	Your Name Spouse's Name Both	$

Category	Description	Who Has Possession	Value/Date of Value
G. Furniture & Appliances	(Estimate value of those in your possession, and value of those in your spouse’s possession)
1.	Your Name Spouse's Name Both	$
2.	Your Name Spouse's Name Both	$
3.	Your Name Spouse's Name Both	$
4.	Your Name Spouse's Name Both	$

H. Safe Deposit Box	(Give location and describe contents)	Titled To
1.	Your Name Spouse's Name Both	$
2.	Your Name Spouse's Name Both	$

I. Transfer of Assets	Explanation: List the name and address of any person (other than creditors listed on your Affidavit) who has received money or property from you exceeding $300 in value in the past 12 months and the reason for each transfer.
1.	Your Name Spouse's Name Both	$
2.	Your Name Spouse's Name Both	$
3.	Your Name Spouse's Name Both	$
4.	Your Name Spouse's Name Both	$
Category	Description (Also list who has possession)	Titled To	Value/Date of Value
J. All Other Assets Not Listed Above	Explanation: List any item you have not listed above that is considered an asset.
1.	Your Name Spouse's Name Both	$
2.	Your Name Spouse's Name Both	$
TOTAL SECTION II: OTHER ASSETS	$

III. SEPARATE PROPERTY CLAIMS: Pre-marital assets, gifts to one spouse only, inheritances

If you are making any claims in any of the categories below, explain the nature and amount of your claim. This includes, but is not limited to, inheritances, property owned before marriage, and any pre-marital agreements.

Category (Pre-marital Gift, Inheritance, etc., acquired after separation)	Description	Why do you claim this as a separate property?	Present Fair Market Value
1.	$
2.	$
3.	$
4.	$
5.	$
TOTAL SECTION III: SEPARATE PROPERTY CLAIMS	$

IV. DEBT

List ALL OF YOUR DEBTS, the debts of your spouse, 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/Purpose of Debt	Account Name	Name(s) on Account	Total Debt Due	Monthly Payment
A. Secured Debt (Mortgages, Car, etc.)
1.	Your Name Spouse's Name Joint	$	$
2.	Your Name Spouse's Name Joint	$	$
3.	Your Name Spouse's Name Joint	$	$
4.	Your Name Spouse's Name Joint	$	$
5.	Your Name Spouse's Name Joint	$	$
B. Unsecured Debt, including credit cards
1.	Your Name Spouse's Name Joint	$	$
2.	Your Name Spouse's Name Joint	$	$
3.	Your Name Spouse's Name Joint	$	$
4.	Your Name Spouse's Name Joint	$	$
5.	Your Name Spouse's Name Joint	$	$
TOTAL SECTION IV: DEBT	$

V. BANKRUPTCY

Filed by: Your Name Spouse's Name Both	Date of Filing: Case Number	Date of Discharge or Relief from Stay	Type of Case (Ch. 7, 11, 12, 13)	Current Monthly Payments
1.	Your Name Spouse's Name Both	$
2.	Your Name Spouse's Name Both	$
TOTAL SECTION V: BANKRUPTCY	$

OATH

(Do Not Sign Until Notary is Present)

I, (print name)	swear or affirm that I have read
this document and, to the best of my knowledge and belief, the facts and information stated in this document 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
Sworn before me and signed in my presence this	day of	,	.
Notary Public
My Commission Expires: